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Looking for Solutions in Health Care for 2006 and Beyond

Our health care system needs to change to accommodate new demographics, new technologies and new pharmacologic advancement.

The roots of compassion and caring in health care should not change however, and it is with this in mind that the dialogue of change should be had surrounding health care.

How can we adapt to different needs that emerge as our population ages?

How can we  find sustainability in the midst of so many new advancements?

How can individuals become more empowered in serving their own health care needs?

What role does the individual have in enabling the  health care of others  beyond paying taxes?

Many questions like these need to be answered and if we are willing to look with open minds at the problems within our health care system, and beyond political posturing, then we can find new  solutions to take us further into this century. 

 

 

 

 

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Thursday
May252017

Facing our Opioid Crisis and What Comes Next

 

May 25, 2017 - The latest news reports confirm our greatest fears: the opioid crisis has been escalating for years and the provincial government and health care officials are caught flatfooted dealing with this issue.

Fentanyl is Ottawa’s deadliest drug, a dangerous drug which is 30 – 50 times more powerful than heroin. It has been available on Ottawa streets for years and there is a growing bootleg market for the tablets. In 2015, 17 of 45 (38%) opioid-related drug overdoses had fentanyl in the victims’ bloodstream. The latest figures show there has been 319 emergency department visits to Ottawa hospitals in the first three months of 2017!

So, it is good news that Ottawa's fifteen hundred firefighters will begin carrying Naloxone kits by the end of June. They will carry the easily administered nasal spray version of the opioid antidote naloxone saving time to first response and possibly saving lives. But our leadership in this community – and at Queen’s Park and the Ministry of Health – cannot be complacent with this band aid approach.

Addressing opioid use and abuse will require new resolve as naloxone-resistant fentanyl compounds emerge and move across boarders often in tiny but deadly amounts. Here are some important things to consider.

New types of fentanyl compounds resistant to the antidote are being manufactured off shore. One such compound is Acrylfentanyl. It has surfaced in the U.S. and there are concerns that it may be making its way to Canada as experts in B.C. are warning. Acrylfentanyl requires more naloxone to reverse and it lingers longer in the body. This means that not only may multiple doses of naloxone be needed but that they may also be ineffective.

Naloxone kits are not the end solution. They are simply a tool to be used for now. Our health officials must ask themselves why Canadians are the second highest consumers of prescription opioids on a per capita basis in the world. Our government must to do a better job of anticipating “what next?”.

 

On physicians, prescriptions and our health care realities

It has been easy to blame Canada’s physicians for over-prescribing. Efforts to reduce and control opioid prescribing have been ongoing in Ontario for over twenty years. Despite this, according to a recent Health Quality Ontario report, 1 in 7 people filled a prescription for opioids in 2015/16 and more than 9 million opioid prescriptions were filled—the highest rate ever in Ontario. Why is this?

It is simplistic to blame physicians for over-treating pain although in some cases this may contribute. This is not to absolve physicians from responsible and safe prescribing of opioids but to suggest that there are many other factors involved in opioid use in Ontario.

Conditions in Ontario’s health care system are contributing to this increase through long wait times for care. Patients waiting for definitive treatment for months or years with painful conditions seek relief. Physicians can attempt to provide it through a variety of means starting with non-opioid interventions including physio, acupuncture, exercise therapy as well as psychological support to name just a few. However, severe pain for degenerative conditions requires more robust pain relief efforts. The risks of addiction and dependence must always be weighed with benefit in the judicious use of opioid prescribing.

Of note, the rate of opioid prescriptions filled is higher in rural parts of Ontario and there is a shift toward more potent opioids such as hydromorphone. Prescriptions for hydromorphone increased by 29 per cent in Ontario while codeine prescriptions dropped by 7 per cent.

Lack of timely access to care in rural areas can result in unintended negative consequences and solutions should address this aspect of our health care system.

The drop in prescriptions of codeine, a traditionally acceptable pain reliever, may be in part explained by increased awareness over the past several years that standard doses of codeine may be toxic for people with the CYP2D6 genotype. With more point of care testing it may be possible to more safely prescribe codeine when it is a better option based on a patient’s unique genetic profile.

Difficulties with timely access to care in Ontario also have an impact on prescribing patterns. The overcrowding in emergency rooms across Ontario can result in more opioid pills being prescribed per prescription to prevent patients from having to return to the ER for additional pain relief. Difficulties accessing primary care may result in patients seeking stronger pain relief and more of it “just in case” they need it. While it is easy to comment on these prescribing practices as having negative consequences, the reality is that the environment in which we live has an impact on behaviour.

Prescribing by dentists and dental surgeons should also be considered in efforts to address excessive opioid availability in our communities especially for our youth. Wisdom teeth extractions should not result in every young patient receiving 25 opioid pills when smaller quantities would be sufficient in many cases and when even a less potent medication may suffice.

Health officials must consider the human behaviour contributing to opioid prescribing patterns but also reflect on systemic and social factors that may be contributing to the high rates. Even if opioid prescribing patterns by physicians were ideal all the time, the reality is that illicit fentanyl has changed the landscape of opioid abuse across Canada. As non-prescription fentanyl and its analogues from thousands of illegal drug labs that operate without government oversight or regulation in foreign countries seep into Ontario, efforts to curb inappropriate opioid use must take a more comprehensive approach beyond physician prescribing patterns.

 

Seniors and prescription drugs

The aging of the population with associated rise in cancer cases and other diseases requiring palliation results in more need for severe pain control especially for pain related to tumour metastases. As more patients seek palliative care for comfort from diseases at the end of life, effective pain control is a necessity. It is not unusual to see cancer patients taking large doses of opioids since their tolerance to the drug increases over time and more of it is required to alleviate their suffering.

Robust palliative care includes use of potent opioid drugs but how “left-over” prescription opioid medications are handled will make a difference to the circulation of opioids in our communities. Ottawa Public Health’s “Secure Your Meds” campaign is an effort to encourage patients and their families to lock up medications and to return expired and unused drugs. It is reported that 13 per cent of Ottawa high school students used prescription drugs non-medically and two-thirds of students got them from a family member or from someone they lived with.

 

We must do better

There are no easy answers to this opioid crisis.  However, the government and public health officials need to redouble their efforts to address the issues surrounding the deadly trends of opioid abuse and drug overdoses. These trends cannot be tolerated. They are unacceptable. We must do better. There needs to be new urgency and a comprehensive approach to address this crisis.

 

Reader Comments (60)

R:

I'm copying this from your previous post:

"mfO,
Having equal rights is important. In that sense we are all "equal". Some people require more support and services than others. This ought to be recognized as the reality that we are not the same.

So, mfO...although we may be "equal", we are not the "same".

Each of us is unique, living in circumstances and with experiences unique to each one of us. There ought to be recognition of this."

The "rights" issue is societal desire to assure, if issues,arises we have entrenched legal solutions. A reasonable approach to complex issues. Not entrenched are societal responsibility by each of us. We've had that discussion here many times.

It is a complex relationship between crude and blunt biology, and the "niceness" of all us trying to function in civil society.

In healthcare, in Ontario, we now know each MAiD incident,saves about $25,000 of resources per client that can be better applied. Central will be instructing providers to "promote" MAiD. The MDs accepted this role.

Binding arbitration binds into responsibilities to do as instructed.

The opiods issue is yet another example. Pain control for "legitimate" pain should be optimized as best we know how to. Opiod "abuse" is primarily a reflection of social support system collapse,not medical abuse. To restrict reasonable medical use is not a wise idea.

Like many, it is discouraging to recognize how poorly our social support systems are run.
May 25, 2017 | Unregistered CommenterMovingforwardOntario
excerpt:

""We've been talking about this wait list issue for years and nothing has changed, in fact it's worse in my opinion," Dr. Michael Dunbar​ said.

"We're getting burned out because not only are we looking after sick patients who are becoming sicker, we're dealing with really profound conversations on a daily basis where patients are crying in front of us because they cannot cope anymore," he told CBC's Maritime Noon.

"They can't look after their families and they're losing their jobs and they're losing their mortgages and it's putting us all under duress."​"
May 25, 2017 | Unregistered CommenterMerrilee Fullerton
Would hospitals routinely at overcapacity, beleaguered MDs and staff, lack of available beds, long waits for care have anything to do with this?

http://cmajnews.com/2017/05/23/cmpa-refocuses-on-preventing-complaints-cmaj-109-5435/
May 25, 2017 | Unregistered CommenterMerrilee Fullerton
More Integration ?

What about more basic care such as toiletting and feeding for dementia patients?

http://www.ijic.org/articles/10.5334/ijic.2416/
May 25, 2017 | Unregistered CommenterMerrilee Fullerton
"Results: The CCIC Framework consists of eighteen organizational factors in three categories: Basic Structures, People and Values, and Key Processes. The three most important capabilities shaping the capacity of organizations to implement integrated care interventions include Leadership Approach, Clinician Engagement and Leadership, and Readiness for Change. The majority of hypothesized relationships among organizational capabilities involved Readiness for Change and Partnering, emphasizing the complexity, interrelatedness and importance of these two factors to integrated care efforts.
Conclusions: Organizational leaders can use the framework to determine readiness to integrate care, develop targeted change management strategies, and select appropriate partners with overlapping or complementary profiles on key capabilities. Researchers may use the results to test and refine the proposed framework, with a focus on the hypothesized relationships among organizational capabilities and between organizational capabilities and performance outcomes."
May 25, 2017 | Unregistered CommenterMerrilee Fullerton
That last quote of a 'conclusion' was beyond brilliant....I didnt bother to find out where it came from or in what context it was written. I only needed to do this to judge it: reread it all, outloud, with a dramatic John Cleese voice and see it for what it really is....it could have been a Python scene of some kind...so funny...
May 26, 2017 | Unregistered CommenterKsy11
Ksy11,
Glad you enjoyed it. Perhaps it should be made into a plaque to remind us how resources are diverted from basic patient care.... and we wonder where the $ goes!
May 26, 2017 | Unregistered CommenterMerrilee Fullerton
Ksy11,
If you liked the "conclusion" you may also like "background".

"Background: Interventions aimed at integrating care have become widespread in healthcare; however, there is significant variability in their success. Differences in organizational contexts and associated capabilities may be responsible for some of this variability."


Integrated Care...it's the new eHealth.
May 26, 2017 | Unregistered CommenterMerrilee Fullerton
Higher up there was a post suggesting more access to surgery might decrease opioid dependence. Well, not to be unkind, that may be wishful thinking. It may be true in select disorders.

It appears in many series, particularly those arising in the injured workers arena (WCB) back surgery leads to higher medical costs, chronic opioid dependence, and higher rates of failed back syndrome, total disability, and additional surgery. Psychiatric comorbidity also increased after fusion but was much higher in those who did not return to work.

I think one should be careful to avoid blaming lack of access to intervention for opioid addiction. It seems other factors are significant.
May 26, 2017 | Unregistered Commentereklimek
Not sure if this is on topic. desperate people in pain.


"In November 2011, Passmore was hooked on prescription opiates. They numbed the pain radiating from his lower back, down each of his legs. He thought surgery might give him some relief, eliminate the need for drugs, solve both problems at once. His pain management specialist advised against an operation. "

https://www.dmagazine.com/publications/d-magazine/2016/november/christopher-duntsch-dr-death/


"To the best of my knowledge, the College has never prosecuted surgeons who performed non-indicated operations on desperate patients seeking relief of pain."

Ellen Nergård Thompson, retired Ottawa anesthesiologist (specializing in pain management), Ennismore

http://ottawacitizen.com/opinion/letters/todays-letters-investigating-opioid-use-and-misuse
May 26, 2017 | Unregistered Commentereklimek
When are we ever on topic? That's never stopped us before!
May 26, 2017 | Unregistered CommenterStephen Skyvington
eklimek,
Many factors are at play.
"I think one should be careful to avoid blaming lack of access to intervention for opioid addiction."-eklimek

True...particularly when there are significant confounders.

Delays in treatment have many unintended consequences. Just off the phone with a wife whose spouse declined while waiting for surgery. Now the outcome has been, shall we say, "less than optimal". Patients being treated like widgets is being normalized while hospital staff and administration are under huge pressures...can't go on like this.
May 26, 2017 | Unregistered CommenterMerrilee Fullerton
" Conclusion"& " Background"....Humphrey Appleby of Yes Minister and Yes Prime Miniser came to mind.
May 26, 2017 | Unregistered CommenterAndris
If the free availability of opiods to treat pain is now being policed, how is one going to police the use of cannabis?

Remember it is primarily the use of tainted street drugs, for recreational use that is driving this public health horror.
May 26, 2017 | Unregistered CommenterMovingforwardOntario
So, you are walking along , like this postie, and you see an OD with "white powder" on the mouth. Do you give mouth to mouth?

http://www.ctvnews.ca/canada/mail-carrier-didn-t-feel-comfortable-performing-cpr-on-unresponsive-woman-1.3430247#

Brent Fowler, the president and CEO of St. John Ambulance, says fentanyl is posing new challenges for people trained to provide first aid and CPR. He says for bystanders, deciding how much to help is a personal decision.

"The issues at the end of the day are you need to protect yourself and keep yourself safe, first and foremost as the rescuer and then keep your casualty safe,” he said.

“If the scene isn't safe and you can't make it safe, then there's nothing you can really perhaps other than call 911."

Fyi

carfentanil - due to its extreme potency, it only takes 20 micrograms of the substance to kill a human being. 20 micrograms as a size equivalent would be the same as a grain of salt.
May 26, 2017 | Unregistered Commentereklimek
To rate their comparative strengths, opioids (synthetic opiates) and heroin are compared to morphine which is rated a 1 of strength. Methadone is 3 to 4 times as strong, and heroin is typically 4 to 5 times as strong. Fentanyl is 50 to 100 times as strong and Carfentanil is 10,000 to 100,000 times as strong.

Do Canadian federal or provincial governments keep an eye on what happens around the world? My point being we should have seen this one coming well enough in advance to develop a pan-national plan?

Or have our governments turned their collective backs on all drug users?
Did they see it coming?

https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

Yes. Absolutely. The data is clear.

Up to about 2011 death from prescription drugs began to dip, while overall deaths accelerated. These were synthetic and heroin deaths. Since 2012 this was happening. Five years folks of more and more methadone recovery clinics and a sharp increase in death. Effective use of public health resources? What happened? Doctors are not prescribing carfentanil.
May 26, 2017 | Unregistered Commentereklimek
It is relatively simple. The use of drugs, outside the prescription route, is too politically complicated, thus inaction, and picking up the pieces later avoids conflict.
May 26, 2017 | Unregistered CommenterMovingforwardOntario
"Didn't see it coming?"

The number of carfentanil USA OD cases submitted to CDC for analysis to forensic laboratories increased substantially, rising from 463 in 2014 to 1,870 in 2015. A report from the Office of the Chief Coroner in Ontario cites fentanyl as a factor in more than 150 deaths in that province in 2014. Opioid overdose deaths in Massachusetts increased 150% from 2012 to 2015.

Gee, where were you looking? Respectfully, everyone saw this coming.

https://www.fastcompany.com/3063518/carfentanil-synthetic-opioids-heroin
May 26, 2017 | Unregistered Commentereklimek
So June 17, a general meeting regraing binding arbitration.

Recognize with the binding. MDs are agreeing, in exchange for enough money,they will control abortions and euthanasia of humans in Ontario, based on centrals dictates. You become the conveyors of "qualified "life. Based on centrals economic needs of the day. What a great medical tourism business!

Good luck with that decision.
May 26, 2017 | Unregistered CommenterMovingforwardOntario
So you get "binding arbitration", and have learned the central does not allow conscientious objection in the provision of any medical listed OHIP code.

There is growing pressure for more abortions of "damaged" pregnancies, and the "end of life" chronic disease folks (each MAiD economically saves about $25,000 of care).

You guys are screwed as a professions.

What will happen, over years, the marginal MDs will accept the job offers available from central for MDs to "qualify" meaning full life, thus turning that into a"medical" role in Ontario.
May 27, 2017 | Unregistered CommenterMovingforwardOntario

We have to very attentive and concerned, when governments and the ivory towered medical academics ( who lean towards Kant) start to fiddle with the ethics of the medical profession....Hippocrates made a brave effort some 2400 years ago with variations since...German Nationalist Germany had its ethical code for medical doctors, the USSR had its ethical code that placed the interests of the Party first , it concealed information about scientific and clinical advances generated outside the Soviet block and as we all know it used psychiatrists and asylums in dealing with dissidents

The sulphurous whiff of National Socialistic ethics is certainly in the Ontario air.
May 27, 2017 | Unregistered CommenterAndris
Andris,
I understand those concerns.
Your post was very informative. Unfortunately, I have had to edit. Please consider my edit as friendly and know that I appreciate the context you provide.
May 27, 2017 | Registered CommenterMerrilee Fullerton
R/DrL:

"triggering"i s not a concern.

So it remains clear, MDs, in Ontario are agreeing to "qualify" life,as their job description as part of "binding arbitration".

Each time you see you an MD , in Ontario, they are evaluating "your value of life", under a binding contract.

Do not say, you were not warned.

The BA contract will pass by an overwhelming majority.
May 27, 2017 | Unregistered CommenterMovingforwardOntario
I thought that " triggering" is a phenomenon that overeasily offended snowflakes experience when faced by the facts of reality that challenge their preconceived notions...surely we have none on this blog?
May 27, 2017 | Unregistered CommenterAndris
if "lifism" is encouraged (the ability to determine who lives or dies), why are other "isms" not allowable. Wouldn't "lifism" which is now legislated in Ontario, be setting a precedence that "isms" are acceptable, since now legislated?
May 28, 2017 | Unregistered CommenterMovingforwardOntario
" Those who fail to learn from the mistakes of their predecessors are destined to repeat them". ( Santayana).

" History doesn't repeat itself, but it often rhymes ".( Mark Twain).

The ethic of " killing to heal",

The politicization of the medical profession with the rejection to the " right to one's own body " and the embracing of the " duty to be healthy" ethic.

The physician's duty to be to the political class and " the people" as opposed to individual clients ...all have roots in Kantian philosophy which was embraced by Herr whatshisname and is being embraced by the present administration in Ontario as we can see from its recent Bills.
May 28, 2017 | Unregistered CommenterAndris
The complexity of opioid use and misuse are prone to oversimplification. The demands in daily practice challenge what is reasonably expected of a competent practitioner. Many doctors do not manage these cases. Some may consider that more doctors should, but let's first acknowledge they are not, in fact, trained to do undertake this scope of practice.

Safety precautions may fail with consequences. Patient do unilaterally accelerate their pain killers and become habituated. Some become addicted.

But the tip of the iceberg that is drawing maximal attention, carfentanil and synthetic drug use should not be used to tar the entire profession. We don't prescribe elephant analgesia.

That is a public health problem that is not being resolved by current methods. To give this problem a perspective, overdoses in prison inmates throughout Ontario occur.
May 29, 2017 | Unregistered Commentereklimek
Not to mention that most FPs are so fearful of prescribing opioids now and have been for a couple of years that the pendulum has clearly swung the other way and patients are being undertreated for pain. I see many of the orthopods now cutting back on the potency of opioids they prescribe post-op and the length of treatment. The patients are now told to follow-up with their family doctors for further scripts.

Given this environment over the last two to three years most of these overdoses have nothing to do with physician-prescribed or initiated opioids rather they are patients who have escalated to opioid use on their own accord or sometimes inadvertently (fentanyl dusted non-opiods or fentanyl substituted for less potent opioids).

The real elephant in the room is where is the fentanyl/carfentanil coming from and what are we doing about minimizing this supply? The technology is there to screen the packages from China and it is high time we start talking about the labs shipping the drugs to this country.
Cicm

Thank you for the article.

The crisis of synthetic opioid deaths has propelled this into the public eye. As usual the public demands answers and immediate action but government lacks a coherent plan. Apparently it just happened when no one was looking.

It is proposing wider distribution of naloxone to first care providers. This drug is so toxic 6 times the usually effective dose is needed to"wake up" the comatose.

How about asking the deeper question. What drives addiction?

Is it related to the pervasive mental health issues in young adults?

https://www.thestar.com/news/canada/2017/05/29/youth-mental-health-demand-is-exploding-how-universities-and-business-are-scrambling-to-react.html
May 29, 2017 | Unregistered Commentereklimek
Something doesn't quite add up with this article. At Walmart 200 tablets of name-brand Immodium costs $100 plus tax. One can purchase an Oxycontin 80 mg tab on the street for $80 and have $20 to spend.

If they are using that much loperamide in their smoothies it must be stolen product and sold cheap on the street.


http://www.cbc.ca/news/health/imodium-opoids-sunnybrook-hospital-epidemic-health-1.4108445
Ms. Andrea Horwath: It is now the second most overcrowded hospital in the entire province. Experts tell us that occupancy rates over 85% put patients at risk, but the Sault Area Hospital has been forced to run at an average occupancy of 106% for the past five years.

...

Hon. Eric Hoskins: ...

Mr. Speaker, the reality is, with the Sault hospital, that both the leader of the third party and the official opposition went specifically to the Sault area to criticize the fact that the government is providing a 5% increase to the operating costs of that hospital this fiscal year.

http://www.ontla.on.ca/web/house-proceedings/house_detail.do?Date=2017-5-30&Parl=41&Sess=2&locale=en#P659_109673
May 31, 2017 | Unregistered Commentereklimek
back to the current topic

Posted: May 31, 2017

"In March 2016, the American Center for Disease Control introduced new guidelines for prescribing opioids.

Those guidelines included lower doses for patients — a maximum of 90 milligrams per day, Hollett said.

Four Canadian provinces, including Newfoundland and Labrador, immediately followed suit and endorsed the guidelines.

While the number of prescriptions plummeted, Hollett said, the death rates increased.

Pain patients had developed addictions and turned to other methods to get their fix."

http://www.cbc.ca/news/canada/newfoundland-labrador/fentanyl-newfoundland-haggie-bruce-hollett-1.4138801
May 31, 2017 | Unregistered Commentereklimek
"Ms. Andrea Horwath: There have been nine years of cuts and frozen budgets by this Liberal government. That’s something that this health minister and the ones prior to him need to fess up to.

The people in Sault Ste. Marie know exactly what’s happening to health care: Folks are waiting longer than ever. Admitted patients are waiting up to 53 hours in the emergency room to get a proper bed. People who need a CT scan are waiting three times longer than the provincial target. The Sault Area Hospital is so overcrowded that they’ve actually stopped using their code for gridlock; it’s now meaningless, because they were using their gridlock code every single day.

When will this government stop making excuses and actually repair the damage they’ve done to hospitals in Sault Ste. Marie and right across the whole province, Minister?"
May 31, 2017 | Unregistered CommenterMerrilee Fullerton
Another 500 Ontario jobs lost thanks to the Liberal's assault on businesses which generate wealth for the province At some point we are going to wake up and there wil be no manufacturing sector and very few small businesses left in Ontario.

High energy costs and now increased labour costs will only accelerate the drive to automate and minimize $15/hour workers.

Brockville can ill afford to lose those jobs and tax base.

http://business.financialpost.com/fp-comment/another-multinational-employer-is-fleeing-ontario-and-the-wynne-government-doesnt-seem-to-care
Dr. David Jurliink is our own from Sunnybrook.

"Every day, 91 Americans die from an opioid overdose. Drug overdoses overall -- most of them from opioid painkillers and heroin -- are the leading cause of accidental death in the US, killing more people than guns or car accidents. In fact, while Americans represent only about 5% of the global population, they consume about 80% of the world's opioid painkillers. But how did we get to this point?"

http://www.cnn.com/2017/06/01/health/opioid-epidemic-1980-letter-origins-study/index.html

http://www.nejm.org/doi/full/10.1056/NEJMc1700150?query=featured_home&
Speaking to a businessman struggling to survive....the $15 minimum wage is going to cost him $75,000 per year...when those earning the minimum wage get $15 per hour, those employees already at $15 expect a raise to $18....those at $18 expect +++...and on it goes.

He also has to give employees 48 hours advance notice if they are not required...imagine a restaurant which is fully booked for an event that is suddenly cancelled by the customer without warning.....
June 2, 2017 | Unregistered CommenterAndris
"He also has to give employees 48 hours advance notice if they are not required.." - A

If only this would apply to patients failing to show at the doctor's office.
June 2, 2017 | Unregistered Commentereklimek
So true Dr. Klimek.
"Prime Minister Justin Trudeau says governments won't rest until they turn the tide on a rising opioid epidemic.

Health officials and political leaders have been sounding the alarm about a dramatic spike in opioid deaths across Canada — the focus of a national summit in Ottawa last fall that pulled together experts from across the country."

http://www.cbc.ca/news/politics/trudeau-opioids-epidemic-fcm-1.4143247
TENTATIVE BINDING INTEREST ARBITRATION FRAMEWORK (tBIAF) AGREEMENT
Concerned Ontario Doctors (COD) has significant concerns about this tBIAF agreement and what it means for the physicians and patients of Ontario.


COD’s Position is a firm NO Vote against this tBIAF


To READ THE FULL COD LEGAL ANALYSIS, please visit:

www.CareNotCuts.ca/tBIAF


Some of the most basic flaws and omissions:


NO Recovery of Unilateral Clawbacks: the tBIAF provides no mechanism for the recovery of the illegal government clawbacks from 2014 to 2017. This is an ENTIRE PSA period and represents almost $3Billion. OMA has seen fit to agree to have this EXCLUDED from arbitration. Meanwhile other provinces have had clawbacks returned retroactively with interest.


Strike Definition EXPANDED: while it is common to agree not to strike in return for Binding Arbitration, OMA has consented to EXPAND the definition of No Strike such that you will not be able to engage in ANY Job Action including a work to rule campaign if it involves patients at all. This is NOT the norm. Most collective bargaining agreements are not this restrictive and even other provincial medical associations have not given up the right to engage in job action for items not being arbitrated on (ex. government health policy, legislation and regulatory changes).


Government to have TOTAL Control over Health Policy, Legislation and CPSO Regulatory Changes: this tBAIF explicitly gives total control over health policy to the government. Consider Bills 41, 84 and 87. These bills alone include provisions to control when and where you work, how many patients you see, your reporting responsibilities; they take away your rights to object to participating in certain medical acts; they remove our profession’s self-regulation; they disclose your personal medical information to the CPSO and your right to a fair due process may be lost in the case of a complaint. As written, the tBAIF does not allow for Arbitration OR Strike on ANY of these issues. This will render all physicians forever powerless against ALL present and future health care policies and legislation.


Establishment of the Concept of a Physician Services Budget (PSB): despite the denials of the OMA, the tBAIF indisputably establishes that there IS in fact a PSB and that the OMA shares JOINT responsibility for this. This was why the 2016 tPSA was defeated in the summer. Once again we are being asked to be responsible for increased healthcare utilization.


Risk of Reduction or Elimination of CMPA Reimbursements: it is troublesome that starting in 2024, the door would be opened to potentially detrimental changes to CMPA reimbursements, including a potential reduction or complete elimination of CMPA reimbursements.



Arbitration Criteria: the Arbitrator is to both take into account a “high quality, patient centred sustainable publicly funded health care system” AND the “economic situation in Ontario”. These will virtually guarantee that it will be impossible for the arbitrator to provide a fair decision and risks the imposition of a cap on the PSB.


Perpetual Agreement: if you vote this tBAIF in, ALL of these disadvantageous criteria will be in effect “in perpetuity.”


Ontario physicians have been mistreated and denied fair compensation for at least the last 4 years. We are all desperate for a resolution and for Binding Arbitration BUT this binding arbitration agreement is clearly a bad deal for Ontario’s doctors and patients. Rejecting this tBIAF means both the OMA and the MOHLTC must return to the table to negotiate a new tBIAF. If it precipitates unilateral actions, then this tBIAF was not the result of genuine labour negotiations.


Get Informed. Vote Between June 7-17, 2017. Learn More: www.CareNotCuts.ca/tBIAF
June 2, 2017 | Unregistered CommenterMerrilee Fullerton
As a member of Council in 2012 , the flaws of the proposed agreement were raised, we were assured and reassured that they would not come to pass...the Board members went on their tour reassuring the membership that all was well and that there was nothing to fear...the agreement was agreed to and was signed following which we were clobbered....what we were reassured would never happen, happened.

This latest proposal has obvious flaws, we are being reassured yet again...the President is absolutely sincere in his reassurance....but the well has been poisoned , we simply cannot trust the government in any shape and form, it would take the resignation of Hoskins and a mea culpa from the government to sway the membership...I intend to vote NO and hope that the rest of the membership does as well.
June 2, 2017 | Unregistered CommenterAndris
Back to the topic

Caveat - patients might have been mistaken about, exaggerated, or denied use of opioid medications

But


"The use of opioids was associated with unemployment, disability payments, lower education, current unstable psychiatric disorder, previous suicide attempts, and a history of substance abuse"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4019694/#!po=38.6364

So how does government plan on addressing this group? Crossing your fingers after Naloxone is not a solution.
June 4, 2017 | Unregistered Commentereklimek
Ed, perhaps the government's marijuana policies are perceived to be the solution.
June 4, 2017 | Unregistered CommenterAndris
Drug abuse, present across all social statuses, is most difficult to treat in those whom can not find their "value" in their community. The marginalized, that group, expanding under the current structure. Wait until "guaranteed basic income" hits.
June 5, 2017 | Unregistered CommenterMovingforwardOntario
Drug abuse, present across all social statuses, is most difficult to treat in those whom can not find their "value" in their community. The marginalized, that group, expanding under the current structure. Wait until "guaranteed basic income" hits.
June 5, 2017 | Unregistered CommenterMovingforwardOntario
On cbc today

"The Liberal government says it plans to update the Ambulance Act to allow paramedics to provide on-scene treatment and refer patients to primary care or community care, instead of hospitals, if appropriate.
The government says increased flexibility would reduce unnecessary trips to emergency departments, lessening overcrowding and easing wait times. It's estimated that fully implementing the system will take two years."
June 5, 2017 | Unregistered Commentereklimek

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