Without Safe Supply in Ontario, Physical Distancing is Almost Impossible.

Does it take a pandemic to move the provincial government to action on the overdose crisis?

In Ontario, one thousand three hundred and thirty seven dead of overdose by the most recent statistics from 2018. More people are dying in the province than at the epicentre of the overdose crisis, British Columbia. It’s 2020 and we’re still dying. It’s just that the provincial government has stopped noticing. Ontario’s illicit drug supply is unpredictable, the contributing factor to most of these deaths. The public health advice to prevent overdose death is “never use alone”. Meanwhile, COVID-19’s recent emergence has put Ontario under lockdown, with strict physical distancing regulations, while much of the province is shut down.

If ‘never’ using alone was  impractical for people at risk of overdose before, it’s downright impossible in the midst of the COVID-19 pandemic. This is a pandemic that requires distancing ourselves from others in order to avoid contracting the virus. So “never using alone” is no longer an option for people at risk of overdose. Instead of connection, today’s reality is life in physical isolation from one another. 

In order to flatten the curve and  increase uptake of physical distancing practices, Health Canada has taken the unprecedented step of issuing a class exemption to Canada’s Controlled Drugs and Substances Act (CDSA) for all practitioners and pharmacists in the country. This class exemption gives practitioners the ability to issue prescriptions verbally, and not just in writing. It gives pharmacists the ability to extend or refill a prescription without a prescriber’s approval, and allows them to transfer prescriptions to other pharmacies.

The most telling part of Health Canada’s class exemption is the following, “We strongly urge Ministries and regulators to conduct a thorough assessment of any barriers to access to medications that could contravene public health advice for social distancing...including temporarily lifting temporary restrictions on take-home doses, or ‘carries’ of opioid agonist treatments (OATs)… and allowing those with chronic conditions to have enough medications to last through self isolation.” Consider this a nudge to provincial governments, like Ontario’s, where draconian regulations mean someone receiving OAT is expected to travel to a clinic every day to take their medications while “observed” by a healthcare professional. These practices are restrictive and make effective physical distancing near impossible.

British Columbia, moving on Health Canada’s class exemption, has recently released prescriber guidelines in the context of two public health emergencies- the overdose crisis and COVID-19. Despite the overdose crisis being a public health emergency for five years in British Columbia, it took COVID-19 to push the province to release “safe supply” guidelines, that provide legal prescription alternatives to the unpredictable illicit drug supply, including opioids, stimulants, and benzodiazepines. 

Safe supply is a lifeline for people who use illicit drugs. Regulated, pharmaceutical substances of predictable dosage greatly reduce the risk of fatal overdose. Take home doses of safe supply drugs promote effective self isolation practices, and reduce the risk of passing COVID-19 to others. As Ontario’s caseload grows with each passing day, and passes two thousand, safe supply has never been more urgently needed. Doctors take note.

Ontario’s Ministry of Health and Long-Term Care and the province’s regulatory Colleges should work together to ensure that ensure people get two weeks of take home doses to promote effective physical distancing.

It’s been said human beings can get used to anything, even wars, pandemics or an overdose crisis. We’ve gotten horrifically familiar with death, but Ontario won’t see a better future, if we stay complacent in the present day. There’s never been a more crucial time to push the government to act. For physicians, now is the time to prescribe safe supply.

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