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It's High Noon and Alberta Won't Draw its Pistol

In recent news, an article was published in the Edmonton Journal that discussed Ontario’s recent ruling to delist higher-strength opioid medication prescriptions from the Ontario Drug Benefit (ODB) program and Alberta Health Minister Sarah Hoffman’s response to the delisting. Health Minister Hoffman said that the NDP government isn’t ready to follow suit quite yet.

“We’re certainly interested in seeing what’s happening in other jurisdictions. We know we’re not alone in facing challenges with opiates.”

“There is some merit in watching how it plays out and how that public plan coverage might be playing a role in some of what’s happening there. I don’t want to rule it out as something we might consider here.”

WHAT ARE PROVINCIAL DRUG BENEFIT PROGRAMS?

Provincial drug benefit programs are implemented to allow patients to know what is and what is not covered under supplemental health plans. Each province has its own specific drug benefit list, which can be accessed through their respective government websites. Currently in Alberta, over 4,000 drugs are listed as benefits for supplemental health plans.

HESITANT TO PULL THE TRIGGER

Health Minister Hoffman’s lack of commitment to delisting is another example of Alberta’s historical hesitancy to delist opioid medications from its Drug Benefit Program. In the early 2000s, Oxycontin became the centre of attention due to reports of addiction and overdoses reaching levels never seen previously. In 2012, the entire country followed the lead of Ontario in delisting Oxycontin (otherwise known as Oxycodone) from benefit programs and replaced it with OxyNeo, a tamper-proof version of Oxycontin—with the exception of Alberta. As of August 1st, the most recent update of the Alberta Drug Benefit List, Oxycontin is still listed as receiving regular benefit. So why is Alberta so hesitant to delist?

DOES DELISTING HELP?

Since 2012 and the delisting of Oxycontin, prescription opioid rates have increased 18.6% in Canada to 21.7 million prescriptions in 2014. In the following two years after Oxycontin was delisted in Ontario, the prescription rates dropped to almost zero, but it was replaced by increases in prescription rates of Hydromorph Contin. Opioid-related deaths in Ontario actually increased from 2012 to 2013 by 8%. Prof. Benedikt Fischer, senior scientist at Toronto’s Centre for Addiction and Mental Health, stated the following in a Globe and Mail article in April 2016:
“We need to rein in excessive prescribing. When we do that, then we will likely make a dent into this problem. Right now, we’re not.”

GETTING TO THE CORE OF THE PROBLEM

Although delisting certain “problem” medications may seem like a knee-jerk reaction, Alberta’s hesitation seems to acknowledge that a more gradual solution that addresses over-prescription might be necessary. Prof. Fischer’s statement hits on the root of the problem in Canada and our medical practitioner’s relative willingness to dole out opioid medications, leading Canada to become the second highest prescriber of opioids in the world. Until our provincial health associations, colleges, and governments can come together and realize that singling out specific medications at specific doses – although a good first step – won’t solve our problem, we will likely continue to see a rise in opioid-related adverse reactions and deaths.

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