One Year Later — CADTH’s Commitment to the Opioid Crisis

A Statement from Dr. Brian O’Rourke, President and CEO

In November 2016 I represented CADTH at the two-day Opioid Summit, joining many others to discuss Canada’s response to the escalating opioid crisis and make a formal commitment to the Joint Statement of Action to Address the Opioid Crisis.

I won’t soon forget the people I met and the stories I heard — stories of staggering loss, but also stories that demonstrated the incredible resolve of clinicians and others working in harm reduction to take action and save lives.

Following the conference, we made the effort to fulfil our commitment to the Joint Statement of Action one of CADTH’s highest priorities. Specifically, we pledged to deliver evidence-based recommendations, advice, and decision support tools in two distinct areas — treating opioid use disorder and managing pain with the help of drug and non-drug interventions.

Last month the Canadian Centre on Substance Use and Addiction released the Joint Statement of Action to Address the Opioid Crisis: A Collective Response (Annual Report 2016-2017). The report includes CADTH’s contribution and highlights the critical role that robust evidence must play in informing our collective response to this national crisis.

As I reflect on our progress over the last year and consider the breadth of evidence we’ve provided through our opioid and pain web portals, some examples of impact stand out:

Informing Wider Access to Medication-Assisted Therapy

The evidence shows that medication-assisted treatment with drugs like methadone and buprenorphine is one of the most effective methods of treating opioid addiction. Since last December, several jurisdictions have made formulary changes to provide people who qualify with easier access to buprenorphine/naloxone (Suboxone). The Joint Statement of Action explicitly called for increased access to this drug as a first-line treatment option, citing our appraisal of buprenorphine/naloxone versus methadone as key evidence.

Building on this, we have also explored the evidence for treatment options beyond methadone and buprenorphine — including reviews on sustained-release oral morphine, injectable hydromorphone, and prescription diacetyl morphine as well as different formulations of naltrexone. Our evidence will play a key role as jurisdictions consider the role of these drugs in treating opioid use disorder.

Meeting the Unmet Need for Evidence on Non-Drug Treatments for Pain

Over the past year there has been a growing realization that we need to determine what effective, drug-free pain management looks like. In fact, the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain recommends optimizing non-opioid drug treatment and non-drug therapy, before trialing opioids. But without evidence on the effectiveness of non-opioid alternatives, those attempting to put the guidance into practice face a considerable knowledge gap.

To fill the gap, we addressed key policy and practice questions in this area, delivering more than 20 Rapid Response reports that synthesize and appraise the evidence on non-opioid drug treatments such as topical NSAIDs, magnesium, and anti-seizure medications as well as non-drug treatments like exercise, physiotherapy, occupational therapy, manual therapy, and psychological and behavioural interventions. Links to our work are included in Canada’s new opioid guidelines as practical resources that can help inform treatment decisions.

Serving as a Trusted Advisor on Emerging Technologies

Earlier this summer, when Health Canada loosened regulations and made it possible to import drugs used to treat opioid use disorder not yet approved in Canada, CADTH had already been monitoring developments in this therapeutic area for some time.

Our “Issues in Emerging Health Technologies” bulletins on injectable extended-release naltrexone (Vivitrol) and a buprenorphine implant (Probuphine) are key resources available to all public health officials who may want access to these therapies for their jurisdictions. Our reports offer a snapshot of what we know so far — indications, costs, and current practice, plus a discussion on the quality of the available evidence and implementation issues.

Beyond on our early horizon scanning, we’ve also delivered a rapid assessment of the comparative evidence for various buprenorphine and buprenorphine-naloxone formulations, plus an appraisal of the evidence for existing and emerging forms of naltrexone.

Partnering to Move Evidence into Action

Acting as the evidence partner with our existing customers and in new collaborations with different pan-Canadian organizations, we are getting our evidence into the hands of those who can put it into action. Whether partnering with key associations such as the Canadian Pain Society, clinician groups like the Canadian Pharmacists Association, or groups that have formed in response to the opioid crisis like the Coalition for Safe and Effective Pain Management, we are providing the evidence and tools they need to make a difference. Hardly a week goes by without new requests coming to us, as the need for rigorous, balanced, and timely evidence during this public health crisis continues to grow.

The Path Forward

It’s hard to fathom the scale of this public health crisis and when I look at the data I’m reminded that the end is not in sight — already this year more than 3,000 Canadians have lost their lives from apparent opioid overdoses.

This knowledge instills in me, and everyone at CADTH, the desire to do more. I firmly believe that evidence will play a crucial role in bringing effective, comprehensive, and compassionate treatment to the people who need it most and CADTH remains committed to doing our part.

In the weeks and months to come, watch for new work from us including an Environmental Scan on access and availability across Canada to non-drug options for the treatment of pain, and another report on emerging non-opioid drugs for pain yet unavailable in Canada. We’re also summarizing the gaps in evidence we’ve identified so that researchers and funding agencies will have a sense of where more research is urgently needed. And our eagerly anticipated tool highlighting the evidence on a long list of non-drug treatment options for different types of pain is under way.

To access all work in this area, visit www.cadth.ca/opioids and www.cadth.ca/pain.