As jurisdictions across Canada and the United States struggle to curb the use of opioids, physicians and policy-makers are offering both administrative and legislative solutions. It’s too soon to know which of their approaches will carry the day.

UNITED STATES

In March 2016, the U.S. Centers for Disease Control and Prevention (CDC) released new guidelines for prescribing opioids, recommending that physicians prescribe as low a dosage as possible — and for shorter periods. In August, U.S. Surgeon General Vivek Murthy sent a letter to every doctor in the United States acknowledging that over-prescription was a root cause of the country’s opioid problem and asking for their help in solving it. The U.S. Food and Drug Administration announced that it will require labels warning about the risks of prescribing opioids.

CANADA

Addressing the huge gaps in Canada’s ability to monitor the number of people who abuse and die from opioids each year, federal Health Minister Jane Philpott and Ontario Health Minister Eric Hoskins announced in November that the Canadian Association of Poison Control Centres plans to set up a central database that will keep track of overdoses leading to either hospitalization or death. A more complete portrait of opioid overdoses and deaths — whether deliberate or accidental — will help policy-makers address the problem.

BRITISH COLUMBIA

Canada’s maximum dosage recommendation, which hasn’t been amended since 2010, is four times higher than the CDC’s in the United States. But last spring, as the number of opioid-related deaths in British Columbia rocketed upward, the College of Physicians and Surgeons of British Columbia endorsed the CDC’s guidelines and then revised its own prescribing standards. The B.C. college required that the province’s physicians check their patients’ prescription history before providing any more opioids to them. In February of this year, the province announced that an updated set of guidelines will come into effect in June.

ONTARIO

To combat what it calls the “growing problem of opioid addiction in Ontario,” the province’s Ministry of Health and Long-Term Care announced last July that it would no longer pay for long-acting, higher-strength opioids through the Ontario Drug Benefit program. As of January, those who receive the ODB — such as seniors and people with disabilities — have to pay for higher-dose prescriptions themselves or ask their doctors for lower-dose prescriptions.

Meanwhile, more than 80 Ontario doctors are under investigation after the Ministry of Health’s narcotics monitoring system revealed that they had prescribed exceptionally high amounts of opioids, like oxycodone and fentanyl. “The ministry detected some patterns which I would describe as unusual,” Health Minister Eric Hoskins told the CBC in November. “We’re talking about daily doses of opioids that are equivalent to roughly 150 Tylenol 3s being consumed in a single day. That’s a pretty high level of prescribing.”