01/10/2017 12:24 EST | Updated 01/10/2017 12:24 EST

Vulnerable Patients Will Suffer Under 'Two-Tier' Pain Med System

Close up of an african seniors hand placing tablets into a tube. Langebaan, Western Cape, South Africa
AfricaImages via Getty Images
Close up of an african seniors hand placing tablets into a tube. Langebaan, Western Cape, South Africa

Welcome to the new Ontario. A province that, on February 1, will introduce two-tier health care for those who suffer from chronic pain. In their response to the overdose deaths from illegal fentanyl found in cocaine, heroin and fake Oxycontin pills, Ontario has decided to stop covering the cost of higher doses of pain medication for the elderly and those on disability.

The higher doses will still be prescribed, but only those on private health plans or who have enough money can realistically obtain them. The elderly who can't afford the prescription or the disabled whose disability payments can't cover it, on the other hand, will simply suffer. Ontario will no longer pay. Our modern-day form of "Let them eat cake."

If you are not dead within 12 months, you must reapply.

Ontario has made one concession and one concession only: if you are in palliative care and expected to die, and if your doctor is registered as a palliative care provider or if they consult with such a person, then you can have your pain relief. If you are not dead within 12 months, you must reapply.

I did write about these proposed changes back in August and pointed out the absurdity of this strategy fully expecting that the government might have some second thoughts. I was not the only one who recognized the futility of banning medication from sick people to prevent overdose deaths. All the experts agree that the source of the illicit fentanyl is mainly from smuggling and not from diverted prescriptions.


(Photo: Joe Amon via Getty Images)

The government has instituted some sensible controls to ensure that those who have legitimate prescriptions for high doses are using them and not diverting them to street trafficking. Patients are required to give urine specimens to ensure there are opioids in their system. Those who get fentanyl patches must return the used patches to the pharmacy to get their next prescription. And it was suggested when this program was first announced that those already on high doses for legitimate reasons would be able to continue. They cannot!

As for exceptions? Ontario Public Drug Programs told me that "while the ministry understands that prescription narcotics are important treatment options for pain management when prescribed and used appropriately under the careful supervision of a physician, the ministry also recognizes that there is a serious opioid abuse issue facing many Ontarians and their families throughout the province."

My interpretation is that while they recognize this treatment is important when properly prescribed, we feel that those who benefit should be made to suffer if they can't pay for it because some other people are facing challenges that are totally unrelated.

It is not hard to see why Premier Kathleen Wynn has an approval rating of 14 per cent.

Dan Malleck, an associate professor in health sciences at Brock University, wrote an excellent op-ed in the Globe and Mail where he points out that all the talk is about painkillers rather than pain itself. Most people take pain medications because they have pain. What is wrong with that?

According to the Pain Resource Centre, one in five Canadians suffers from chronic pain and that "chronic pain is associated with the worst quality of life as compared with other chronic diseases such as chronic lung or heart disease." It also "costs more than cancer, heart disease and HIV combined. Estimates place direct health care costs for Canada to be more than $6 billion per year and productivity costs related to job loss and sick days at $37 billion per year."

And while Ontario frets about opioid overdose deaths (as we should), they ignore the fact that there is another group of people who take opioids but commit suicide because of the pain they suffer and their inability to get proper relief. The Pain Resource Centre also points out that:

"Pain medication related deaths in Ontario are increasing and that most of the people who died had been seen by a physician within nine to 11 days prior to death (emergency room visits and office visits respectively) and the final encounter with the physician involved a mental health or pain related diagnosis. In almost a quarter of the cases the coroner had determined that the manner of death was suicide."

In a positive move, Ontario has made the overdose antidote Naloxone available for free. In the event of a life-threatening overdose, the quick administration of this drug will reverse the effect of the opioid and prevent death.

I don't recall who said this, but if you are going to provide Naloxone free then EpiPens should also be distributed free of charge. For a child with a life-threatening anaphylactic reaction to peanuts or some other allergy, the pen is essential. Why should the parents have to pay if addicts don't?

It is not hard to see why Premier Kathleen Wynn has an approval rating of 14 per cent.

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