432-00305 (Health)

The Government of Canada is deeply concerned about problematic substance use in Canada, including the ongoing opioid overdose crisis and the devastating impact it is having on the well-being of individuals, families, and communities. Tragically, there were more than 16,364 apparent opioid-related deaths in Canada between January 2016 and March 2020.

The Government recognizes that the complexity of this crisis has only increased due to the ongoing COVID-19 pandemic. Public health guidance around physical distancing and self-isolation presents a unique challenge for people with substance use disorder. Health Canada and the Public Health Agency of Canada have been working with provinces and territories and other partners, including researchers, advocates and people with lived and living experience, to help make sure that people who use(d) substances can continue to access treatment, harm reduction services and other necessary medications during the pandemic.

For example, the Minister of Health has asked provinces and territories and regulatory colleges to improve access to prescribed medications and to allow for flexibility during the pandemic response that reduce or remove requirements that may not align with public health direction during the pandemic. This could include take-home dosing, and the removal of the requirement for witnessed ingestion, doctors’ visits and urine screening.

Health Canada also issued a temporary class exemption to allow pharmacists to extend and renew prescriptions, to transfer prescriptions to other pharmacists, and to allow other individuals to deliver controlled substances to patients, and ensure continuity in access to pharmacotherapy for addiction treatment and management of other health conditions such as chronic pain. To allow patients with chronic medical needs to adhere to physical distancing and self-isolation guidance, Health Canada has allowed prescribers to issue verbal prescriptions for narcotics. This exemption was extended to September 30, 2021, given the ongoing nature of the COVID-19 pandemic.

Additionally, Health Canada has developed and disseminated a toolkit to service providers to better support people who use drugs, in order for them to physically distance and self-isolate and stay safe. The toolkit provides a summary of the exemptions now in place for health care professionals to facilitate flexible models of care during the pandemic. It includes prescribing and practice guidelines for health care professionals to increase the appropriate prescription of medications to address symptoms of withdrawal, including methadone, Suboxone, and to provide access to pharmaceutical-grade medications like hydromorphone, as a safer alternative to the toxic street supply. It will also assist people who use drugs, harm reduction advocacy groups and families who support people who use drugs to understand the changes and exemptions in order to secure medications and treatment supports, as well as educate on harm reduction measures.

Health Canada’s Substance Use and Addictions Program (SUAP) is providing $21.9 million in funding over four years to support 11 projects that provide a supply of pharmaceutical grade medications for people with opioid use disorder in British Columbia, Ontario and New Brunswick. This includes $16.1M for five multi–year pilot projects and $5.8M for six shorter-term initiatives funded in response to the risk posed by the worsening toxic illegal drug supply as a result of the COVID-19 outbreak. Health Canada is also working with community organizations funded through SUAP to re-direct resources from funded activities to support the COVID-19 response. For example, the British Columbia Ministry of Health will use a portion of its SUAP funding to provide personal protective equipment to pharmacists providing injectable opioid agonist treatment and the University of Victoria will use a portion of its funding to purchase basic needs and supplies (such as food) for clients at select front-line harm reduction sites.

The Government of Canada is committed to a holistic, public health approach to addressing problematic substance use that is focused on reducing harms and saving lives, through the Canadian Drugs and Substances Strategy. The Strategy includes four pillars – prevention, treatment, harm reduction and enforcement – and is designed to be comprehensive, collaborative, compassionate and evidence-based.  The Government is placing particular focus on:

• ensuring that life-saving harm reduction measures are available to Canadians who need it;
• working with stakeholders to reduce stigma directed at people who use drugs, which acts as a barrier to accessing critical health and social services and often leads to social isolation;
• working with provinces and territories to improve access to evidence-based treatment options; and
• implementing additional surveillance and research activities that will further build the evidence base and allow us to pursue innovative solutions to this public health crisis. 

While our government is not considering the decriminalization or legalization of illegal drugs at this time, we will continue to work with civil society organizations to assess options that could better support the needs of people who use drugs, during this difficult time.

The Government of Canada also recognizes that the overwhelming majority of deaths caused by the opioid overdose crisis are due to a street drug supply that is contaminated with highly toxic substances, such as fentanyl. The Government is taking a series of actions to address this issue, including:

• funding the development of national guidelines for injectable opioid agonist treatment;
• removing federal regulatory barriers to effective, evidence-based treatment options, including making it easier for health practitioners to prescribe diacetylmorphine and methadone to patients with opioid use disorder, and facilitating community delivery models for opioid agonist treatment;
• allowing the importation of drugs approved in other countries (but not yet in Canada) to address urgent public health needs, including diacetylmorphine for the treatment of opioid use disorder;
• approving the use of injectable hydromorphone by qualified healthcare professionals as a treatment for adults with severe opioid use disorder – the first approval of injectable hydromorphone for this purpose in the world;
• supporting pilot projects to provide pharmaceutical-grade alternatives to the contaminated illegal supply to eligible clients at risk of overdose; and,
• working with provinces, territories, and stakeholder groups to address this issue and identify what additional steps can be taken.

The Government of Canada has made substantial investments to address the overdose crisis. Recent examples of key federal investments in this area include:

• investing $76.2 million to take action to protect Canadians and prevent overdose deaths. This investment will be used to scale-up key lifesaving measures and increase access to a safer drug supply as an alternative to the contaminated supply. These measures build on the Budget 2019 investment of $30.5 million over five years, with $1 million ongoing, to expand access to safer alternatives to the illegal drug supply and support better access to opioid overdose response training and naloxone in underserved communities;
• providing $1.7 million to the University of Saskatchewan to increase access to chronic pain services, and providing $1.2 million to implement and evaluate pathways to care for people living with pain and opioid use disorder, both funded through the Substance Use and Addictions Program.

• providing $231.4 million over five years through Budget 2018 for additional measures to help address the opioid overdose crisis, including a one-time $150 million emergency treatment fund for provinces and territories to improve access to evidence-based treatment services;
• providing emergency funding to British Columbia ($10 million) and Alberta ($6 million) to address the ongoing crisis in these two jurisdictions, plus $5 million in targeted health care funding for Manitoba to assist with priority needs, including their opioid response;
• providing an additional $200 million, with $40 million per year ongoing, to enhance the delivery of culturally appropriate addictions treatment and prevention services in First Nations communities; and,
• allocating $13 million over five years to launch a new national, multi-year public education campaign to help reshape Canadians’ attitudes and perceptions about people who use drugs.

The Government of Canada is further supporting those who are most vulnerable during the COVID-19 pandemic by investing $500 million towards health care, including support for Canadians experiencing challenges with substance use, mental health, or homelessness. This investment is part of the more than $19 billion invested through the Safe Restart Agreement to help provinces and territories safely restart their economies and ensure Canadians have the support they need in these challenging times.

In order to prevent and reduce the harms of problematic substance use, including to enable access to evidence-based treatment and support recovery, the Government has undertaken a broad range of policy, legislative and regulatory actions, including:

• Approving supervised consumption sites (with 37 currently in operation across Canada), and providing class exemptions to facilitate the establishment of overdose prevention sites;
• supporting the passage of the Good Samaritan Drug Overdose Act, which encourages people to call for emergency help at the scene of an overdose by providing protection against simple drug possession charges;
• establishing effective Federal, Provincial and Territorial public health emergency governance, including the Special Advisory Committee on the Epidemic of Opioid Overdoses and the Federal/Provincial/Territorial Assistant Deputy Minister Committee on Problematic Substance Use & Harms;
• collaborating with provinces and territories to better understand the evolving crisis, and undertaking timely monitoring and reporting of opioid-related deaths and harms in Canada;
• deploying public health officers from the Public Health Agency of Canada to support public health surveillance systems in provinces and territories; and,
• supporting the development and dissemination of national clinical practice guidelines to treat opioid use disorder, which include a recommendation for medication-assisted treatment as a front-line option for patients, through the Canadian Research Initiative in Substance Misuse.

We are focusing on supporting a range of care models for people at risk of overdose and building the evidence base for innovative public health interventions. The use of pharmaceutical-grade opioids to treat opioid use disorder is an established medical practice, supported by research and peer-reviewed clinical guidance. To protect the health and safety of all Canadians, any prescription-grade medications, including those that may be used in safer supply programs, may only be provided with the appropriate oversight of a qualified health care provider (e.g., a physician or a nurse practitioner), as per the parameters of the Controlled Drugs and Substances Act and its regulations, as well as applicable provincial, territorial, and professional regulatory requirements.

Some provinces, including British Columbia and Alberta, have declared a formal public health emergency or crisis to address the overdose crisis. Under their respective provincial legislation, these declarations can provide access to additional powers and authorities, such as new funding, and streamlined decision-making. At the federal level, legislation is not required to access similar additional powers. The comprehensive federal response has included reductions of legislative and regulatory barriers, new prescription guidelines, marketing restrictions, new tools for law enforcement, improvements to the knowledge base, and emergency funding to provinces and territories – all of which were put in place without a formal declaration of a public health emergency.

In Canada, our circumstances require that we undertake a comprehensive and collaborative approach across all provinces and territories.  No single organization or level of government alone can solve the opioid overdose crisis.  All levels of government, a wide range of stakeholders and all Canadians who are impacted by opioid use must work together to reduce opioid-related overdoses and deaths, and improve the health and well-being of Canadians who use drugs.

Through the Canadian Drugs and Substances Strategy, the Government of Canada remains firmly committed to addressing all forms of problematic substance use with a public health approach that is comprehensive, collaborative, compassionate, and evidence based.