ODPRN’s integrated model in working directly with decision makers to provide timely and relevant research is innovative and has become an international example of enabling evidence-informed policy. Over 16 years, the ODPRN has published over 200 academic papers in top journals, produced over 200 policy reports, delivered over 300 presentations, and engaged with nearly 100 students in our training program.
ODPRN’s work has informed policies at the regional, provincial, national, and international level focused on system efficiency, quality of care, and health outcomes for the benefit of Canadians. ODPRN has received national recognition of its impact, including the Bruce Squires award for the CMAJ article most likely to influence clinical practice and an Institute of Public Administration of Canada Public Sector Leadership Award for Impact. Some major areas of impact include work in the area of the opioid toxicity crisis, biologics and biosimilars, drug shortages, and blood glucose test strips:
Opioid Toxicity Crisis
Ontario is facing an ongoing opioid-related toxicity crisis. Examples below demonstrate how ODPRN research significantly influences and informs legislation, guideline development, service provision, and reimbursement policies on Canada’s opioid toxicity crisis at the local, provincial, and national levels:
- In 2022, the ODPRN led the first published quantitative evaluation of a safer opioid supply program worldwide, which was shared extensively with policymakers across Canada, including Health Canada and Carolyn Bennett, the Federal Minister of Mental Health and Addiction. Through this work, the ODPRN has guided federal investments into safer opioid supply programs, including the 2023 Government of Canada announcement of a renewed $144 million, 5-year commitment to the Substance Use and Addictions Program. This research was also specifically cited in a recent court decision that upheld the need for continued access to safer supply programs in Alberta.
- To support continuity of care for Canadians during the COVID-19 pandemic, Health Canada approved a temporary exemption under Subsection 56(1) of the Controlled Drugs and Substances Act (CDSA), which authorizes pharmacists to extend, renew, and adapt prescriptions for controlled substances (effective until September 2023). The ODPRN conducted analyses which were used to inform the Regulatory Impact Analysis Statement and resulted in an extension of this exemption to September 30, 2026.
- In 2022, the ODPRN released a report that examined opioid-related harms among individuals in the construction industry. This report provided detailed information for the first time on the specific needs of this high-risk population. It also served as the rationale for the development and implementation of the Ontario Ministry of Labour’s Naloxone in the Workplace Program, which was officially introduced into legislation on June 1, 2023.
- The ODPRN also supports providing publicly available surveillance on the opioid toxicity crisis through its Ontario Opioid Indicator Tool. This is the first online surveillance tool that enables policymakers at all levels of government to understand regional patterns of opioid use, access to treatment, and harm reduction programs, allowing them to tailor their response to their community’s needs. Since then, the online dashboard has been accessed over 69,000 times, and indicators have expanded in response to emerging needs. It is regularly used by Health Canada, the Ontario Ministry of Health, Mental Health and Addictions Centre of Excellence, CAMH, and local Public Health Units to inform investments and evolving policy decisions. It has been cited as the evidence-base for numerous new opioid-related programs and strategies in Sault Ste. Marie, the Muskoka-Simcoe Health Unit, the City of Hamilton, County of Lambton, Peterborough, among others.
Biologics and Biosimilars
Biologics, complex drugs derived from living cells, are used to treat various serious conditions such as cancer and autoimmune diseases. Due to their complexity and the processes involved in their production, biologics are significantly more expensive than traditional drugs. Biosimilars are highly similar versions of biologic drugs that are significantly less expensive and have been shown to have no clinically meaningful differences in terms of safety, purity, and potency. A joint report with the ODPRN and Canada’s Drug Agency (CDA) estimated the Ontario Public Drug Program would be paying over $1.4 billion annually on biologics by 2021. The ODPRN worked with Canadian policymakers to evaluate policies managing biologic-related costs and their implications on patients, suggesting over $300 million in annual savings if policies mandating a switch to lower-cost biosimilars were introduced. In 2021, the ODPRN’s findings were widely shared with the MOH and the pan-Canadian Pharmaceutical Alliance, leading to the adoption of biosimilar switching policies by most provincial and territorial public drug payers. In Ontario, influenced by this research, the Ontario Ministry of Health (MOH) announced that starting March 31, 2023, recipients of public drug plans using originator biologics would transition to Health Canada-approved biosimilars, with early evaluations from the ODPRN suggesting potential annual savings of $140 million or more. The ODPRN has since been working closely with the Drug Programs Policy and Strategy (DPPS) to refine the scope of an evaluation of this new policy, which will be launched in 2024.
Drug Shortages
One of the ODPRN’s priority areas includes informing policies to address rising medication costs in Ontario and the continued challenges with drug shortages. Foundational work to better understand the impact of drug shortages across Canada has been directly integrated into the process for developing a national at-risk medicine list. In 2020, the ODPRN also released the COVID-19 Ontario Prescription Drug Utilization Tool which provides public access to data on drug utilization in Ontario during the COVID-19 pandemic. The tool is regularly updated as data becomes available, with new indicators added as relevant to informing the impact of COVID-19 on potential drug shortages and uptake of drugs for the prevention of COVID-19 in immunocompromised individuals.
Blood Glucose Test Strips
Blood glucose test strips (BGTS) are typically prescribed to patients with diabetes, but have limited clinical benefit among certain groups of individuals, leading to potential overuse and significant costs to the healthcare system. The ODPRN analyzed potential cost avoidance that might be achieved by establishing maximum reimbursement policies for test strips in various groups of patients who may not require frequent monitoring.
Since the publication of these findings, the Canadian Diabetes Association (CDA) has recognized that limits on government-funded testing are reasonable in some patients, and has changed their recommendations on optimal testing frequency. Subsequently, the OPDP widely implemented new quantity limits for BGTS in 2013. In a 2016 evaluation of this policy, the ODPRN reported nearly $25 million in cost reductions in the year following the introduction of the policy. Furthermore, this evaluation indicated no negative impact on patient outcomes, including hypoglycemia, hyperglycemia and HbA1c.
Recently, these analyses were replicated in 7 other provinces across Canada, and found that considerable savings would be achieved annually if a quantity limit policy were introduced in public drug programs across Canada. These results have been shared with policy-makers across Canada, including the pan-Canadian Pharmaceutical Alliance (pCPA), and quantity limits have now been introduced in British Columbia and by Health Canada’s Non-Insured Health Benefits, with other provinces considering similar changes.