Cliff # 980489 MINISTRY OF HEALTH INFORMATION BRIEFING NOTE. PREPARED FOR: Graham Whitmarsh, Deputy Minister, Ministry f Health Heather Davidsn, ADM, Planning and Innvatin Divisin FOR INFORMATION TITLE: PURPOSE: Prescriptin Drug Abuse Agenda Item n Federal/Prvincial/Territrial Cnference f Deputy Ministers f Health Meeting n May 14, 2013 T brief senir Ministry f Health (the Ministry) executives in advance f the May 14, 2013 meeting. BACKGROUND: At the Federal/Prvincial/Territrial (F/P/T) Cnference f Deputy Ministers Meeting n December 12, 2012, Deputy Ministers agreed t establish an F/P/T wrking grup f senir fficials t review existing prescriptin drug harm-related activities acrss jurisdictins and t prpse cllabrative actins that address key gaps. That grup is reprting ut at the upcming meeting (see Appendices 1, 2, and 3 fr mre details). Certain prescriptin drugs, like piids, stimulants, sedatives and tranquilizers are assciated with serius harms such as addictin, verdse and death. These drugs, while helpful fr treating sme cnditins, can have a serius impact n peple s lives and their families, as well as place a significant burden n health care, scial services and public safety systems. In ne regin f British Clumbia, the rate f prescriptin piid verdse deaths (2.7 per 100,000 persns) has been nted similar t that f the number f residents killed in any given year in mtr vehicle accidents invlving alchl (2-3 per 100,000 persns). In many f these deaths the presence f ther psychactive drugs was nted 1. A c-relatin between prescribed strng piid cnsumptin rates in bth BC and Ontari, with increases in death rates frm 2005-09, has recently been published 2. The Ministry has made sme recent changes t the PharmaCare frmulary. On March 8, 2012, the Ministry discntinued PharmaCare cverage fr OxyCntin and began prviding nly exceptinal case-by-case cverage fr OxyNEO. OxyNEO als remained n the Palliative Care Drug Plan. Utilizatin f xycdne (as xycdne shrt-acting, OxyCntin r OxyNEO ) in BC is declining. PharmaCare recrds nte a decreasing trend fr this drug starting in mid-2011 and cntinuing with nly a subset f patients mving t alternate piid prducts. 1 Crneil, T., Elefante, J., May Hadfrd, J., Gdisn, K., & Harris, B. Nn illicit, nn methadne, prescriptin piate verdse deaths in BC s Interir Regin: Findings frm a Retrspective Case Series, 2006 2011. British Clumbia Interir Health Alert. September 2012. 2 Fischer, B, Jnes, W, Rehm, J. High crrelatins between levels f cnsumptin and mrtality related t strng prescriptin piid analgesics in British Clumbia and Ontari, 2005 2009. Pharmacepidemilgy and Drug Safety; 22: 438 442. 2013. Page 1 1 f 2
Subsequent t the establishment f the F/P/T wrking grup, the Canadian Centre n Substance Abuse, in partnership with many agencies frm acrss Canada, released a natinal strategy, First D N Harm: Respnding t Canada s Prescriptin Drug Crisis 3, t address the harms assciated with prescriptin drugs that define the scpe f the crisis Canada faces and prvides a ten-year radmap t reduce the harms assciated with prescriptin drugs (Appendix 4). DISCUSSION: BC has a number f initiatives that deal with prescriptin drug issues including the Restricted Claimant Review Prgram; the Duplicate Prescriptin Prgram; the Prescriptin Review Prgram; Healthy Minds, Healthy Peple: A Ten-Year Plan t Address Mental Health and Substance Use in British Clumbia; A Path Frward: The First Natins and Abriginal Peple s Mental Wellness and Substance Use Ten Year Plan; the BC Methadne Maintenance Prgram; a range f treatment ptins including withdrawal, utpatient and residential treatment services; PharmaCare cverage f drugs t assist with addictins, including methadne and buprenrphine/nalxne (Subxne ); and the Pharmaceutical Services Divisin is develping a Prvincial Academic Detailing service tpic, Opiids in Chrnic Nn-Cancer Pain, fcusing n the safe and cautius prescribing f piids in chrnic nn-cancer pain (Appendix 5). ADVICE: BC agrees that there are serius harms caused by addictins r verdse f certain prescriptin drugs, such as piids r sedatives. A BC crss-ministry wrking grup is being frmed t review recent publicatins and activities in BC t ensure a crdinated apprach. BC lks frward t wrking with clleagues acrss the cuntry t cntinue t address this imprtant issue. Prgram ADM/Divisin: Arlene Patn, ADM, PPH Barbara Walman, ADM, PSD Barbara Krabek, ADM, HAD Telephne: 250 952-1731 Prgram Cntact (fr cntent): Warren O Brian (PPH), Eric Lun (PSD), Ann Marr (HAD) Drafter: Brian Emersn Date: May 3, 2013 3 http://www.ccsa.ca/eng/pririties/prescriptin Drug Misuse/Pages/default.aspx Page 2 2 f 2
Pages 3 thrugh 20 redacted fr the fllwing reasns: S16
Appendix 4 - First D N Harm: Respnding t Canada s Prescriptin Drug Crisis 1 On March 27, 2013 the Canadian Centre n Substance Abuse in partnership with many agencies frm acrss Canada, released the abve named natinal strategy t prvide a 10-year radmap t reduce the harms assciated with prescriptin drugs. Key findings in the strategy include: While there are currently n estimates n the csts related t the harms assciated with prescriptin drugs in Canada, recent research frm the United States estimates the annual cst f the nn-medical use f prescriptin piids t be mre than $50 billin, with lst prductivity and crime accunting fr 94 per cent f this amunt. Canada is the wrld s secnd largest per capita cnsumer f prescriptin piids, with the U.S. ranked as number ne. Accrding t the Internatinal Narctics Cntrl Bard, Canada s rate f prescriptin drug use increased by 203 per cent between 2000 and 2010, an increase steeper than in the United States. These high rates f use appear t be related t substantial prblems, althugh mst f the studies riginate frm Ontari. Sme First Natins in Canada have declared a cmmunity crisis due t the prevalence f the harms assciated with prescriptin drugs. The Strategy was develped arund five streams f actin: Preventin, Educatin, Treatment, Mnitring and Surveillance, and Enfrcement. These streams aim t: Prevent prescriptin drug-related harms Educate and empwer the public and prmte healthy and safe cmmunities Prmte apprpriate prescribing and dispensing practices; Increase timely, equitable access t a range f effective treatment ptins; Identify effective, evidence-infrmed practices and plicies; Develp a standardized pan-canadian surveillance system t imprve understanding f the nature and extent f the harms; Establish prescriptin mnitring prgrams in each prvince and territry; Ensure that law enfrcement has adequate tls and resurces t address the diversin f prescriptin drugs; Engage industry, gvernments, regulatry bdies and thers with a stake in this issue t jin frces, cmmit t specific recmmendatins, leverage existing resurces and cllectively be part f its slutin by strengthening system capacity t address this issue; Develp r clarify legislatin and regulatins t reduce barriers t effective treatment and prmte preventative effrts; and Cnduct research t address knwledge gaps and prmte effective strategies. The Strategy includes 64 recmmendatins. Of thse, the fllwing recmmendatins are applicable t prvincial/territrial gvernments: Develp and prmte risk-reductin prgrams fr individuals that use 1 http://www.ccsa.ca/eng/pririties/prescriptin-drug-misuse/pages/default.aspx Page 21
prescriptin drugs in a manner that places them at increased risk. Identify, develp, prmte and evaluate evidence-infrmed, culturally-safe practices, resurces and plicies t build cmmunity and individual capacity t address cnditins that increase r prtect against harms assciated with prescriptin drugs fr individuals, families, municipalities and cmmunities, particularly rural, islated and remte cmmunities; Develp and prmte guidelines fr individuals and families related t the use, safe strage and dispsal f prescriptin medicatins. Develp and evaluate accessible evidence-infrmed resurces fr practitiners and educatrs wrking with yuth t help incrprate prescriptin drug-related harm preventin int prgrams and plicies while ensuring that unintended cnsequences are avided. Imprve access and prvide budgetary allcatin t services and supprts in all (including rural and remte) cmmunities and settings alng the full cntinuum f addictin, mental health, and pain management services Ensure healthcare prviders have timely access t expertise t supprt evidenceinfrmed clinical decisin making. Align current investments in the treatment sectr that are wrking twards cmmn aims. Ensure that there is apprpriate prvincial and territrial PMP legislatin t: Assess when infrmatin-sharing is apprpriate, Prvide a framewrk fr gvernance and peratins f PMPs, where apprpriate, and Facilitate infrmatin-sharing within and acrss jurisdictins. Ensure that death investigatins acrss Canada are cnducted in an evidenceinfrmed and cnsistent manner. Identify and address barriers t immediate access t and sharing f relevant infrmatin f arrests and cnvictins f pssible diverters between law enfrcement and regulatry clleges, prescribers and dispensers Review the federal and prvincial/territrial regulatry requirements fr medicatin-assisted treatment (e.g., methadne and/r buprenrphine/nalxne) t determine the extent t which they act as barriers r facilitatrs f access t treatment and cnsider the safety features that are addressed by these regulatins and recmmend revisins as indicated. Cnsider implementatin f cmplete lifecycle surveillance as a cnditin f apprval f new and existing branded r unbranded piids, sedatives and hypntics, and stimulants t enhance understanding f their ptential risks and therapeutic effectiveness Review, and if necessary, recmmend amendments t existing privacy legislatin t help facilitate infrmatin sharing related t prescriptin mnitring prgrams amng prescribers, dispensers, and ther health practitiners as well as with law enfrcement and industry where apprpriate. The next phase invlves the implementatin f the recmmendatins and evaluatin f the strategy s prcess, and its impact. Page 22
Appendix 5 BC Initiatives n Prescriptin Psychactive Drugs B.C. has ne f the best systems in the cuntry fr mnitring prescriptins and dispensing patterns fr prescriptin drugs including: The Restricted Claimant Review prgram, which registers patients t stp them frm visiting multiple dctrs, The Duplicate Prescriptin Prgram which ensures drugs like Oxycntin must be prescribed in writing using a special security prescriptin pad. The Prescriptin Review Prgram, which reviews physician prescribing patterns t identify ptential cncerns and educate physicians n prescribing patterns. Pharmanet, a wrld class system that keeps track f prescriptin patterns fr mnitring prescriptins and dispensing patterns fr prescriptin drugs. Healthy Minds, Healthy Peple - A Ten-Year Plan t Address Mental Health and Substance Use in British Clumbia 1 has a number f actin items related t pharmaceuticals i.e. Cntinue t develp guidelines fr physicians fr assessment and treatment f peple with mental health and/r substance use prblems. Increase the capacity f clinicians t deliver evidence-based treatment services using varius levels f intensity and in a variety f settings. Imprve rutine screening prtcls fr mental health and substance use prblems during primary care interventins with senirs. A Path Frward - The First Natins and Abriginal Peple s Mental Wellness and Substance Use Ten Year Plan 2 that was just released prvides a fundatin fr dealing with substance use and mental health issues fr abriginal peple. Actin F3 specifically states Develp and supprt appraches, including public educatin campaigns, fr health service prviders and First Natins and Abriginal peple t reduce the nn-medical use f prescriptin drugs and increase awareness abut the imprtance f taking medicatins and ver-the-cunter drugs as directed by reliable health prfessinals. The Ministry wrks with the Cllege and ther stakehlders, t administer the BC Methadne Maintenance Prgram. Peple in BC wh develp prblems related t prescriptin drug use, and thse n the Methadne Maintenance Treatment prgram, have equitable access t the range f treatment ptins, including withdrawal, utpatient and residential treatment services. PharmaCare cvers drugs t assist with addictins, including methadne and buprenrphine/nalxne (Subxne ). The Pharmaceutical Divisin is wrking n a Prvincial Academic Detailing (PAD) service tpic, Opiids in Chrnic Nn-Cancer Pain fcusing n the safe and cautius prescribing f piids in chrnic nn-cancer pain. This is a an evidence-infrmed cntinuing educatinal mdule in which a pharmacist meets with physicians, nurse practitiners, pharmacists, and ther health care prfessinals ne-n-ne t discuss selected drug therapy tpics. 1 http://www.health.gv.bc.ca/library/publicatins/year/2010/healthy_minds_healthy_peple.pdf 2 http://www.health.gv.bc.ca/library/publicatins/year/2013/first_natins_abriginal_mwsu_plan_final.pdf Page 523