New Ontario Naloxone Rules Don't Go Far Enough

[Z]

http://www.vice.com/en_ca/read/addiction-experts-are-concerned-new-rules-for-overdose-antidote-dont-go-far-enough-amid-current-crisis


[size=3rem]Addiction Experts Are Concerned New Rules For Overdose Antidote Don’t Go Far Enough Amid Crisis
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A harm reduction worker in Hamilton, Ontario opens a naloxone kit. Photo by Allison Elkin
With the introduction of bootleg fentanyl and an increase in the number of opioids being prescribed, the rate at which overdose deaths in Canada have multiplied, leaving many advocates dumbfoundead. Now, Health Canada is proposing to change the restriction around an overdose antidote that has the ability to save thousands of lives.
In Ontario alone, [/color]nearly 5,000 people died from opioid-related overdose between 2000 and 2013[/size][size=3rem]—with a 464 percent increase since 2000—and it's estimated that hundreds more have died between then and 2015. Across the country, there have been similar epidemics, such as the fentanyl crisis in Alberta—an ordeal that left 213 people dead from overdose in the province between January and September last year.
According to a press release put out by the Government of Canada yesterday, Health Canada is aware of the growing number of opioid deaths across the country and is now opening a consultation program to reassess the possibility of naloxone—a lifesaving drug that has been used widely by doctors to reverse opiate overdose—being available as an over-the-counter (OTC) medication.
The consultation invites Canadians—both civilians and medical professionals—to input comments and ideas before the close date of March 19, after which the drug will either be allowed for non-prescription use or will remain restricted. The release notes that the current proposal is to proceed with derestriction of the drug.
Currently, access to naloxone is on a prescription-only basis, and many programs that offer it via "take-home" initiatives dispense it in controlled quantities. Most hospitals, while being readily equipped the drug, don't send patients home with it after experiencing an overdose.
Naloxone, an opioid antagonist, essentially works by binding to opioid receptors to reverse and stop an overdose from being fatal. Last month, the Municipal Drug Strategy Coordinators Network of Ontario (MDSCNO) put out a press release calling on the government to take the opiate epidemic more seriously by introducing new harm reduction initiatives and expanding upon existing programs such as naloxone programs.
Michael Parkinson, a spokesperson for MDSCNO, compared the lack of access to naloxone for some going into overdose to not having access to an EpiPen when going into anaphylactic shock, and advocacy groups have widely cited it as one of the critical flaws in addressing the growing number of overdose deaths.
"This is a simple solution that can be implemented easily. There is really no good explanation for not allowing this [medication] to be more widespread," Parkinson told VICE in December.
Parkinson told VICE today that, while he and other advocates are happy about the new perspective on the antidote, he worries that the lack of mention of it being included in a provincial or federal drug plan overlooks the fact that opiates will still be much cheaper for drug users to obtain than the naloxone itself.
"Re-scheduling naloxone is but one step in expanding access. Unlike our American neighbours, no provincial, federal, or veteran's drug benefit plan in Canada covers the cost—approximately $50 retail currently—of naloxone. By comparison, more than 150 opioids are on the Ontario Drug Benefit plan. Until naloxone is supported on drug benefit plans, opioids will continue to be cheaper and easier to obtain," he said.
Wiplove Alexander, an addiction physician at St. Michael's Hospital in Toronto, told VICE that the cost for the drugs are largely an issue due to fact that the formulas created by pharmaceutical companies tend to be extremely pricey. He also adds that the consultation process, which could change Health Canada's decision on derestriction of the medication, should rely largely on existing evidence, rather than on the personal opinions of people.
"I think you have to listen to what everybody says, and even in the long run, in addiction treatment, some of the people who work in the field are pro medication or anti-medication, pro-harm reduction or anti-harm reduction. But I hope there's somebody who is critically appraising the evidence and it's not just based upon personal input of people."
Follow Jake Kivanc on Twitter.[/size][/font]

[dizzle]

Fucking nuts the pharm companies make naloxone SO FUCKING expensive, if you look at the costs of Naloxone over the last 20 years, it went from basically nothing to INSANE numbers.


Big Pharma gives ZERO fucks about saving lives, they've proven that time and time again. I hate them, I hate the politicians that try to block access to stuff like this, I hate that there are people out there that actually believe addicts SHOULDN"T have access to stuff like this, clean needles, etc. It sickens me, like, quite literally, if I think about it too much I actually get a physical response and start to get nauseous.

[Z]

I am always amazed that people think naloxone shouldn't be available.  You don't get high from it, and it saves lives.  I don't see any downsides unless you think addicts should all kill themselves.  I say that half jokingly, but I have actually heard that argument from people.


In an ideal world Naloxone should be readily available and subsidized by the government.  As an alternative you could pay for the first one, but replacements could be available for minimal cost.  Since using it means someone's life has been saved I think a low cost replacement option is justifiable.  Doctors prescribing opiates should prescribe naloxone as a matter of course.  I believe they don't because if you follow directions you shouldn't need it.  This ignores the realities of pain and pain medication.  It isn't like an antibiotic that you take once a day. It also ignores the possibility that the medication gets into the wrong hands.  If a child accidentally wears a fentanyl patch from the garbage having naloxone on hand could be the difference between life and death.


It is a sad reflection on our society that everyone doesn't rally behind naloxone as an essential medication.  It is even on the UN's 10 essential medications list.

[Griffin]

I'd assume that all of the costs associated with overdose and death that would be saved by everyone having access to naloxone would off-set the expense of giving it out for free to everyone in bulk. The reduced paramedic and hospital trips alone would probably save enough money that with the same budget they could pass it out like candy all day for free.

The government more than likely incurs most of the expenses for e.r. and ambulance rides anyway because a lot of users don't have health insurance. I am not sure how the Canadian health care system works to be honest with you but I'd assume sure that the cost of care is not cheap, doctors, paramedics, ambulances, tests, and everything in between is hella expensive. I assume that when someone doesn't have insurance that the hospitals or government are left with the bill.

I know that the amount of debt that hospitals in the US take on each year is pretty astronomical. I am like you dizzle I am physically repulsed by people who think that killing and incarcerating is what we need to do. Some people are so dumb and ignorant it hurts my brain, how can you just blow off all research and studies that show that harm reduction, treatment, and legalization all work much much better than throwing people in a cage, and making them use dirty needles, and everything else that comes from it being illegal.

How do they not understand that the current policy of throwing everyone in a cage, giving them a criminal record so that they can't get a job or house, and only doing abstinence based treatment programs increases the addiction, infectious disease, and over dose rates which in turn make make everything way more expensive. That treating these people, and using harm reduction not only saves tons of money but it also saves lives.

 Just the amount saved from decriminalizing it would be enough to pay for the new regulations. The budget would be reduced so much that they wouldn't know what to do with all of the money after they paid off all of their debt. Just think how much less they would have to spend if we had less law enforcement, less government officials, lower health care costs, lower unemployment & homeless rates, less crime especially theft, less people in prison, less prison staff and facilities, less people on government benefits like welfare, food stamps, and medicaid, less people in the e.r., etc.

If they taxed it and made $100 million each year from taxes alone like colorado did with weed, all taxes and costs would be lower. It would create a new industry creating more jobs with higher pay and more benefits, a bigger more skilled work force, which creates more revenue how much lower everyones taxes would be more people could goto college because they would have more money and the economy would be much better over all.

Just think instead of them taking 45% of all your money after income, sales, and every other tax everyone would have that money. They could spend the money on good shit like schools, teachers, fire fighters, education, disease research, health care, addiction treatment, homeless resources, veterans, national defense, families in need, programs to lower recidivism,  pretty much every single thing would be better. Money doesn't buy happiness but financial security sure lowers stress which lowers health care costs.

You add lowering the pay for all elected officials to the average median income and change their pension/retirement/healthcare/tax system to be exactly like every other job in america we would probably save another $100 million a year. Maybe if people were educated we would stop trying to bully the entire world and tell them what to do we wouldn't be spending half as much on an offensive military.

If we stopped lobbying we would be able to stop using most all fossil fuels and be 100% energy independent on clean fuel sources such as hemp, giving us even less incentive to fight the middle east. We could make all of our cars about 4x more gas efficient and lower the amount of pollution we put off. We could give better incentives for companies, to stay here and not out source jobs and we would be able to afford it with all of our extra money. Break up a few monopolies maybe so that people can have a chance at starting a successful business.

[Poppy]

The only improvement in drug treatment in the UK is that naloxone kits are available on request (including a short lesson on how to use them)

Well they are at my clinic and those of Benz and Citric Burn and we all live in different parts of the country so I assume it's a nationwide thing
 If not it should be.

[Griffin]

That was one of the major improvements my clinic made this year. They now have monthly narcan classes that come with 4 free doses, and they started passing out flyers to the needle exchange to everyone and they do the same narcan class. I know that colorado recently changed their laws a bit to make narcan easier to get, now pharmacists can prescribe it to you. I think most clinics can as well but I am not sure about that every clinic should have that class. Hopefully things change and we see a decrease in OD deaths.

[Z]

Basically in Canada we have what is called a single payer system.  The government pays for hospital stays, doctor visits, and various other health expenses like tests.  In general prescriptions and ambulances aren't covered, although that can vary from province to province.  It is called single payer because the government is the only party paying for service, and because of this they can set the prices they pay.  In the US it runs opposite to that with medicare: The hospitals set their (very high) prices, and medicare pays for it. 


Because it is single payer the cost is significantly lower on a whole.  The statistics I've seen suggest that the cost in Canada of universal health care is LESS then what the US pays for medicare and veterans affairs.  I'm not sure exactly how this statistic was arrived at, but you can look on wikipedia for an explanation: https://en.wikipedia.org/wiki/Comparison_of_the_healthcare_systems_in_Canada_and_the_United_States  I honestly haven't dug through it so I might be explaining it wrong, and the statistics might have changed from when I read it.

[Griffin]

Thank you for the info, I have always been curious but to lazy to research. How do you think the standard of care is? Is it hard to make appointments or find doctors? The reason I ask is because if the people in the medical field are making as much fewer people would get into it. I think that would improve the quality of care because only people get in it because they are interested and want to help people.

I will look up how much docs make compared to the US. I can't even imagine how much cheaper health care would be if it was the government setting the price, even if they are owned by big pharma it would be significantly cheaper I'd assume. Do you guys allow lobbying in the way that the US does? Here lobbying means companies giving large sums of money, and putting the person on their payroll so the companies make their own regulations by buying off all politicians.

I would think that is a much better system do most European countries run a similar platform? What are the cons of having that system compared to a corporate money driven system? I think everyone should be allowed to get healthcare. The system we have now is flawed in a lot of aspects. I am very glad that I am poor enough for medicaid, its the best insurance I have ever had.

I lost my insurance through work after being fired when it switched to obamacare here and the price for continuing my policy without the job with the switch was $500 a month. What I hear from people that is not uncommon. From what I hear the prices for insurance and health care if your uninsured are insanely high, and its more limited compared to what it was like before it switched over. Everyone is required to have insurance or they are fined now. What my brother pays for his family is stupid because him and his wife both have pre-existing conditions.

[Z]

I think the main problem is waiting.  Because there is a finite amount of available service we end up with waiting lists for specialists, and for higher end treatments.  They distribute resources based of urgence really, so priority is given to some and everyone else fills in the empty spots.


There used to be enough doctors here, but there have been quite a few who have moved to the us for higher salaries.  It is a real problem with people taking spots in university programs and then immediately leaving.  University is subsidized to an extent here too, and I assume that the expectation is that they will pay it back through the contribution to society.  This talks about university subsidies, and is intersting if you want a better understanding: http://www.macleans.ca/education/uniandcollege/think-your-tuition-bill-is-too-high-check-out-the-governments/  This talks about the "brain drain" as they like to call it: http://www.macleans.ca/authors/julia-belluz/are-we-in-for-another-doctor-exodus-to-the-u-s/


The other problem is hospitals and emergency care.  Since there can be a lack of doctors in some areas the hospitals end up clogged with people who could be served somewhere else.  I know people who bring their kids to the hospital for a cold/flu.  Because of people like that there can be 12 hour or more waits in hospitals for non-urgent care.  Urgent care is prioritized obviously.


There are pluses and minuses I guess.  My example is my youngest son.  When he was one month old my wife was holding him in our bathroom with marble floors.  She was wearing socks and fell on the ground.  He flew out of her arms and bounced off the floor and then slammed into the border on the wall which was marble as well for the first 8" or so.  He ended up with a fractured skull in 3 places.  It was basically all around his head like a ring except for in the front.


He was in the childrens hospital for three weeks of intensive care.  He had several MRI, ultrasound, and many many other tests and treatments. He ended up seeing a specialist afterwards to have a prosthetic helmet made to protect his head while it healed, and to ensure his head healed in a proper shape.  He was on a multitude of medications in the hospital as well, and since it was in a hospital they are all covered.


Clearly a major major hospital occurence that came about from a split second accident.  He was too young to have his provincial health insurance yet, so we recieved a bill until he got processed and then it was paid by the government.  The bill was in excess of $100k.  If I was american and didn't have insurance it would have been crippling.  I would still be paying it now 5 years later.


I think when you are healthy it seems like an excess burden, but we all get sick at some point.  We are all born, and we all die.  If nothing else we begin and end our lives with medical procedures.  When you need it then the government health plan is a life saver.  Literally.


The situation with a lack of doctors is slowly resolving.  I think it is just the nature of he system.  I can't get instant service, but I also don't get stuck with a $100k bill that I can't pay.  There are definitely benefits and drawbacks, and I can see how cmobining the systems with the best of both might be an interesting way to handle it.