Changes to prescribing safer supply drugs approved by Ontario medical regulator

Ontario’s medical regulator approved major changes to safer supply prescribing. Physicians will have to prescribe these medications alongside opioid agonist therapy, such as methadone or Suboxone. Patients will also have to take the safer supply medication in front of health-care professionals instead of bringing pills home. The changes aim to reduce diversion, meaning prescribed drugs reaching the illegal market.

Hydromorphone is the most common safer supply medication. Under the new approach, a patient may receive it only while also receiving opioid agonist therapy. Dosing will be supervised, often through a pharmacy or another health-care setting. The regulator decided not to impose an eight-week limit on prescribing, despite considering that option earlier.

The policy may create access problems. Board member Peter Wiesner highlighted rural patients far from pharmacies and employed patients who may struggle with daily visits. The College of Physicians and Surgeons of Ontario will monitor the changes and may adjust them later.

A safer supply is medication given to people at high risk of overdose as an alternative to illicit opioids. The goal is to provide a prescribed option rather than leave patients dependent on an unpredictable illicit drug supply. Ontario’s regulator is changing how these medications are prescribed because officials are concerned that some prescribed drugs are being diverted to the streets.

Hydromorphone is the most common safer supply medication mentioned in the article. It is a powerful opioid often prescribed for pain. However, the article describes it as significantly less potent than fentanyl and its derivatives, which dominate the illicit drug supply chain. Patients receiving it will now need to take doses in front of health-care professionals.

The regulator is not ending safer supply. Instead, it is adding conditions around treatment and supervision. Doctors must combine it with opioid agonist therapy. The College will monitor the changes and could revise them if they do not work for everyone.

The board heard that more than 87 per cent of patients receiving safer supply are also receiving opioid agonist therapy. That means a minority are not receiving the therapy. The information came from the Ontario Drug Policy Research Network and was cited during the policy discussion.

Board member Peter Wiesner focused on that minority. He described the policy as potentially failing the 12 per cent for whom opioid agonist therapy does not work. He argued that the regulator should consider exemptions. The figures show why the new requirement could affect some patients differently, even though most already receive the therapy.

The article does not provide a total number of patients, so it cannot show how many people the percentages represent. The College of Physicians and Surgeons of Ontario approved the requirement anyway. Its chair, Dr. Patrick Safieh, said the changes will be monitored and adjusted later if necessary.

In this context, diversion means safer supply medication prescribed to a patient ending up with someone else or in the illegal drug market. The article does not give a detailed definition, but officials use the term for hydromorphone moving from the intended treatment system to the streets. That concern is driving tighter prescribing and supervised dosing.

Police forces in Ontario have reported that patients’ prescribed hydromorphone is being diverted to the black market. The regulator also received information from governments, Addiction Medicine Canada, the Ontario Medical Association’s addictions section and public health officers. These sources agreed that hydromorphone is reaching the streets from at least some safer supply prescriptions.

Officials also acknowledged an important limitation. They do not have data that properly quantifies where all street hydromorphone comes from. Still, they believe safer supply prescriptions account for at least part of it. The new rules are intended to prevent diversion while keeping treatment available to people at high overdose risk.

Patients will no longer be allowed to take safer supply pills home under the approved changes. They must take the medication in front of health-care professionals. This approach is meant to reduce diversion, but it makes receiving treatment more dependent on regular access to a pharmacy or another supervised setting.

Peter Wiesner warned that rural Ontario residents may be especially affected because they are not always close to a pharmacy. A person who previously carried medication home could instead need to travel for each supervised dose. The article also identifies employed patients as a concern. Daily pharmacy visits may conflict with work schedules and create practical barriers to treatment.

The regulator did not approve the previously considered eight-week prescribing limit. It will monitor the new rules and may make adjustments later. That leaves open the possibility of future exemptions or other changes, especially if the policy does not work for patients who cannot attend daily dosing.

Ontario’s regulator is requiring safer supply to be combined with opioid agonist therapy because it wants treatment and overdose prevention to work together. Opioid agonist therapy uses medicines such as methadone and Suboxone to treat opioid addiction. The policy is also intended to reduce the chance that safer supply medication will be diverted to the streets.

Dr. Patrick Safieh said the regulator wants people who require safer supply to take opioid agonist therapy as well. He described the longer-term purpose as helping people eventually reach a point where they no longer need safer supply. The new rule therefore links access to hydromorphone with another form of addiction treatment.

The approach may not work for everyone. The board heard that more than 87 per cent of safer supply patients already receive opioid agonist therapy, leaving about 12 per cent outside that group. Peter Wiesner called for possible exemptions. The College will monitor the policy and adjust it if necessary.

The article identifies methadone and Suboxone as opioid agonist therapies but does not explain their biological mechanism. Established medical knowledge shows that these medicines act on the brain’s opioid receptors in a controlled way. They can prevent or reduce withdrawal symptoms and lessen cravings, helping people stay engaged in treatment rather than urgently seeking illicit opioids.

Methadone activates opioid receptors steadily. Suboxone contains buprenorphine, which partially activates those receptors and can reduce the effects of other opioids. Because treatment is controlled and stable, it can reduce the need to use an unpredictable illicit supply. It does not make overdose impossible, and safe prescribing and monitoring remain important.

This matters in the article’s setting because fentanyl and its derivatives dominate the illicit drug supply chain. Reducing exposure to that supply may lower overdose risk. The regulator’s stated goal is to ensure safer supply patients also receive opioid agonist therapy, while monitoring whether the combined requirement works for everyone.