Ontario medical regulator proposes eight-week limit on safer supply prescriptions

TORONTO · The College of Physicians and Surgeons of Ontario is proposing sweeping new restrictions on prescribing safer supply drugs, including an eight-week time limit and a requirement that patients consume the medication in front of a health-care professional. The regulator's board of directors is set to meet on Oct. 13 to vote on the proposed changes, which would also mandate that safer supply only be prescribed alongside opioid agonist therapy. The college said the amendments are a response to ongoing concerns about the diversion of prescription pills to the black market. "The proposed amendments build on targeted changes introduced in May and respond to ongoing concerns about the diversion of safer supply medication and the resulting risks to patients and communities," said Mickey Cirak, a spokesperson for the college, in an email. Cirak said the college has consulted with physicians, municipalities, health-care partners and the office of Ontario's chief medical officer of health, Dr. Kieran Moore. Moore's office did not respond to a request for comment.

The college said the initiative to change the rules is its own and did not come from the provincial government. The proposal has the support of Health Minister Sylvia Jones. "Our government does not and will never support the distribution of illegal drugs, including the illicit use of hydromorphone masked as 'safer supply,'" said Satnam Grewal, a spokesperson for Jones. "We welcome any action from Ontario’s 27 regulatory colleges who set standards and obligations for health-care professionals, including the College of Physicians and Surgeons of Ontario, to crack down on the predatory prescribing of addictive drugs." Safer supply involves prescribing medications, most commonly hydromorphone, as an alternative to street opioids for people at high risk of overdose. The proposed rule states that "physicians must only prescribe safer supply medications in conjunction with opioid agonist therapy," which uses medications like methadone to treat addiction. These changes follow amendments made in May that required in-person assessments before prescribing and mandatory offers of opioid agonist therapy.

Word of the proposed changes has reached people who depend on safer supply, according to Lorraine Lam, an organizer with the Shelter and Housing Justice Network and a longtime harm reduction worker. "The changes are really dangerous and very destabilizing," Lam said. "People are really, really scared and people are really, really anxious and very angry." She said some people using safer supply have been able to get jobs or return to school and she worries about what will happen if they are cut off.

"The reality is people who are on safe supply are going to be de-prescribed really, really quickly, which will increase the chances of people turning to the street unregulated supply, which will then therefore increase the risk of overdoses and deaths," Lam said. The provincial government has moved to an abstinence-based model in its approach to the opioid crisis, closing provincially funded supervised consumption sites and banning them near schools and daycares. Ontario has since opened 29 homelessness and addiction recovery treatment hubs, known as HART hubs, at a cost of more than $500 million. The hubs offer primary and mental health care, addiction services and peer supports. The college's board will consider the proposed prescribing changes at its meeting next week.

With files from The Canadian Press, Global News and CBC News