Health Minister Jane Philpott has asked her staff to work on a range of options to address Canada’s epidemic of opioid abuse, including setting up a national surveillance system to monitor drug overdoses.

“There’s an exponential growth in the number of opioid overdose deaths,” Dr. Philpott told The Globe and Mail. “It’s one of the most stark examples of why we have got to find a new way forward and we have got to address this.”

Dr. Philpott spoke to The Globe ahead of this week’s special session of the United Nations General Assembly on the world drug problem. She will lead the Canadian delegation on Wednesday, when she plans to signal to the international community that drug policies under the federal Liberals will be built on a foundation of public health rather than law enforcement.

Dr. Philpott said she has asked bureaucrats at Health Canada to address gaps in the system that make it difficult for front-line workers to respond to the opioid crisis. This involves asking them to take into consideration “all possible options,” including looking at updating guidelines for prescribing the drugs. The guidelines have not been updated since 2010, which puts Canada out of step with the United States.

A Globe investigation found that neither Ottawa nor the provinces are taking adequate steps to stop doctors from indiscriminately prescribing highly addictive opioids to treat chronic pain. And addiction-treatment programs are few and far between – a legacy of the former Conservative government’s tough-on-crime policies.

The minister has not yet given Health Canada bureaucrats a timeline. She has asked them to examine whether British Columbia’s response to a surge of overdoses from fentanyl and other drugs in that province can be adopted elsewhere.

B.C. declared a public health emergency last week – a move that allows officials to collect real-time data on overdoses.

Illicit fentanyl is rapidly moving east from B.C. and Alberta, where overdoses linked to the drug claimed 418 lives in 2015. The illegal form is largely a product of organized crime. The crisis has its roots in Canada’s epidemic of prescription painkiller abuse.

Policy makers are scrambling to find a replacement for opioids to reduce the problem. At a conference in New York on Monday before the UN summit, doctors and researchers debated the merits of substituting other drugs that could be used as painkillers, such as medical marijuana.

Rosalie Pacula, vice-president of the International Society for the Study of Drug Policy, told the gathering that in U.S. jurisdictions where cannabis has been legalized for medical use, hospitals have seen a significant reduction in patients showing up in emergency rooms after overdosing on opioids.

“It’s about a 40-per-cent decline in treatment admissions, which is really, really large, and something that we were confused by,” said Ms. Pacula, who presented the new research. “Why such a big effect? We have to assume … that people are substituting marijuana for opioids, and in doing that they are becoming less addicted to opioids, so there are fewer treatment admissions.”

Cannabis use does not result in the respiratory deaths that opioid overdoses are causing because the section of the brain that controls respiratory function does not have cannabinoid receptors, said Susan Weiss, associate director of scientific affairs at the U.S. government’s National Institute on Drug Abuse.

However, that does not mean marijuana is without its own risks and problems. Better data are needed to study the issue, researchers say, since switching one drug for another could lead to a different addiction, along with other unforeseen health problems, since marijuana is often used recreationally in conjunction with alcohol and tobacco.

Brian Emerson, a medical consultant for the British Columbia Ministry of Health, praised Ms. Pacula’s research as “tantalizing evidence” that marijuana could be a safer option than opioids to treat pain. However, he said more work must be done from a public-health perspective to determine what risks are associated with increased cannabis use.

The problem with medical marijuana, the meeting heard, is the lack of research on the drug to indicate how it can be used. Cannabis has for decades been treated as an illicit substance, so the type of clinical trials common for pharma drugs have not been performed on it.

“We need to understand a lot more about the utility and efficacy of marijuana for pain. It works for some kinds of pain, but not for others, it works or some people, not for others,” said Benedikt Fischer, senior scientist at Toronto’s Centre for Addiction and Mental Health.

Dr. Fischer said the U.S. research is promising, but Canada needs more data on its own situation.

Understanding Fentanyl, Canada’s newest public health crisis (The Globe and Mail)

TORONTO and NEW YORK — The Globe and Mail
Published Monday, Apr. 18, 2016 9:50PM EDT
Last updated Monday, Apr. 18, 2016 10:20PM EDT