Canada
A federated public system where provinces set drug coverage and prescribing standards during an overdose crisis, which tests how to protect palliative opioid access while tightening controls.
9 domains reviewed · 9 high-confidence · 0 dated estimates · 9 material gaps
WHO region: Americas. World Bank income group: Income group not yet retrieved.
- Domains reviewed
- 9 of 9
- Hospice: 4 of 4
- Backed by a primary document
- 0 of 9
- Open questions
- 11
- Sources behind this dossier
- 23
- Newest source 2026
Lessons from Canada
- Opioid controls aimed at noncancer pain cut access for cancer and palliative patients. Controls need explicit palliative exemptions and monitoring for spillover.213,215
- Generalist palliative care reached outcomes similar to specialist models, and home visits were linked to more community deaths. Funding home visits may matter more than adding specialists.218,217
- Giving nurse practitioners controlled-substance authority created a second workforce for end-of-life home care.216,217
- First Nations communities can lead their own home-based palliative programs when external partners support local control and help close funding gaps.489,490
- Families caring for a child who dies at home often keep unused opioids, so a clear take-back process at the time of death can reduce risk without limiting pain relief.696
- Regional specialist pediatric palliative care was associated with fewer ICU days, lower costs and fewer hospital deaths for children near end of life.699
Palliative care
Is morphine available in Canada?
Opioid supply. Is a therapeutic opioid physically available in the wards that need it? Every country on this question
A 2016 British Columbia prescribing standard for chronic noncancer pain also reduced opioid access for people with cancer or in palliative care. In Quebec, new opioid claims fell slightly after 2016 while cancer pain became a larger share of indications.213,214
What are national opioid consumption and palliative access trends, beyond single provinces?
Help answer it:Search PubMedHow does Canada regulate opioids for pain?
Narcotics regulation. What licensing regime governs stocking and dispensing, and when did it last change? Every country on this question
Federal regulations passed in 2012 extended controlled-medication prescribing beyond physicians. Provinces add their own rules: a legally enforceable British Columbia standard in 2016, revised in 2018, and Ontario's 2017 delisting of high-strength formulations with an exemption for palliative patients.216,213,215
Did other provinces adopt standards like British Columbia's, and did they exempt palliative patients?
Help answer it:Search PubMedWho can prescribe morphine in Canada?
Prescriber authority. Who is legally allowed to prescribe, and can that group be widened? Every country on this question
Since 2012, nurse practitioners, midwives and podiatrists may prescribe controlled medications under federal law. Nurse practitioner scope includes end-of-life care, and general practitioners write most palliative opioid prescriptions in provincial data.216,217
How often do nurse practitioners prescribe opioids in palliative care since 2012?
Help answer it:Search PubMedHow does palliative care reach patients in Canada?
Service delivery. Through what structure does care actually reach a patient at home? Every country on this question
In Ontario, physician palliative care is split among generalist, consultation and specialist models with similar outcomes, and home visits may promote community death. Many decedents received no home visit from a physician or nurse practitioner in their last months.218,217
Do Ontario's patterns hold in other provinces and in Indigenous and rural communities?
Help answer it:Search PubMedWho pays for palliative care in Canada?
Financing. Who pays for the drug, the visit and the workforce? Every country on this question
The Canada Health Act funds hospital and physician services publicly, while home care coverage varies by province and most public plans exclude outpatient drugs for people under 65. Ontario's drug benefit covers most drug costs in end-of-life home care. Palliative fee codes differ across jurisdictions.217,219
How does palliative drug and home care coverage differ outside Ontario for people under 65?
Help answer it:Search PubMedHow are palliative care clinicians trained in Canada?
Training and recognition. What credential exists, who awards it, and does anyone recognize it? Every country on this question
Palliative medicine moved from a jointly accredited added-competence year to a two-year Royal College subspecialty with an accrediting examination. A national continuing-education initiative launched in 2021.220,221
How many physicians have completed the subspecialty, relative to need?
Help answer it:Search PubMedHow does Canada prevent opioid misuse without blocking pain relief?
Opioid safeguards. How are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief? Every country on this question
In Alberta, 23% of people with metastatic cancer received long-term opioids, and 3.4% of them had opioid-related hospital or emergency visits, more often with high doses or co-prescribed sedatives. Across Ontario long-term care homes, the mean share of residents prescribed end-of-life medications in their last two weeks ranged from 37.3% in the lowest-prescribing fifth of homes to 82.5% in the highest. After children died at home, 75.6% of surveyed families had unused opioids, pointing to a need for simple disposal processes.694,695,696
Did Canada's 2017 opioid guideline or provincial monitoring programs reduce opioid access for people dying of cancer or other serious illness, and how do palliative services support patients who use drugs or receive opioid agonist treatment?
Help answer it:Search PubMedHow do children get palliative care in Canada?
Children's palliative care. How do children with life-limiting conditions get palliative care and the medicines they need? Every country on this question
From 2008 to 2014, 74.2% of Canadian children and 98.1% of neonates with life-threatening conditions died in hospital, with more hospital deaths among low-income families. In Ontario, children in a region with specialist pediatric palliative care had fewer health care days, fewer ICU days, lower costs and lower odds of dying in hospital.698,699
How many children with life-limiting conditions in each province receive specialist pediatric palliative care, and what supports exist for families far from pediatric centers?
Help answer it:Search PubMedHospice care in Canada
How the hospice model works here, who can use it, who pays and who it reaches. Covered 4 of 4.
What does hospice care look like in Canada?
Hospice model. What does hospice mean here, who runs it, and in what settings? Every country on this question
Canadian sources use the combined term "hospice palliative care"; after palliative care arrived in 1975, "hospice" came to label community-based organizations, and British Columbia now has 68 hospice societies, mostly volunteer-based, with only a few running inpatient hospice facilities. Ontario's regional programs link residential hospices with palliative care units and consultation teams.352,353
Who can get hospice care in Canada?
Hospice eligibility. Who can enter hospice, on what criteria, and how late do patients arrive? Every country on this question
In British Columbia, inpatient hospice facilities serve terminally ill people who are expected to die within a few months. In long-term care, hospice use does not track eligibility well, with some people who do not meet eligibility receiving it and many who might benefit not receiving it.352,355
What prognosis thresholds do residential hospices in other provinces use, and how long do patients stay?
Help answer it:Search PubMedWho pays for hospice care in Canada?
Hospice funding. Who pays for hospice care: a public benefit, insurance, charity or families? Every country on this question
In British Columbia, most hospice society funding comes from individual and corporate donors, with supplemental support from regional health authorities. The 24-hour medical and nursing care in inpatient hospice facilities is typically fully funded by health authorities. This is a provincial finding.352
How are residential hospices funded in Ontario, Quebec and other provinces?
Help answer it:Search PubMedHow many people reach hospice in Canada?
Hospice reach. How many dying people use hospice, and who is left out? Every country on this question
In a national aging cohort, 17.2% of decedents died in a hospice or palliative care unit, and dying in Quebec or of cancer raised the odds. Among long-term care residents, the reported hospice care rate was under 3%, with ageism, rurality and dementia identified as barriers.354,355
What fills the gap in Canada
How people get care outside formal services: families, faith communities, volunteers, health workers, healers, other medicines and charity. Described, not scored.
- Family caregiving
Nunavut patients and families described extensive medical travel for cancer and end-of-life care and a preference for care within the community with family involved. Staff with strong community ties were valued. Scope is 10 interviews.492
Subnational evidenceFor people experiencing homelessness and poverty, the 'family' caregivers were often living in the same conditions, and almost half were street family or friends. Their care included finding food and shelter alongside other tasks.491
- Community health workers and home-based care
Four First Nations communities in Ontario and Manitoba built their own palliative care programs, led by Elders, Knowledge Carriers, community leaders and First Nations health workers, so people could receive care at home. In Naotkamegwanning, the Wiisokotaatiwin pilot served six clients in 10 months and worked around a federal-provincial funding gap. Evaluations were done by the research partners.489,490
Subnational evidenceSelf-reported
Sources cited here
- 213Panagiotoglou D, Peterson S, Lavergne MR, et al.
The effects of a provincial opioid prescribing standard on prescribing for pain in adults: an interrupted time-series analysis. CMAJ 2025;197(18):E497-E505. British Columbia's 2016 standard for chronic noncancer pain, revised 2018, reduced opioid access for people with cancer or in palliative care. Abstract read.
- 214Attisso E, Guenette L, Dionne CE, et al.
New opioid prescription claims and their clinical indications: results from health administrative data in Quebec, Canada, over 14 years. BMJ Open 2024;14(4):e077664. New claims fell slightly after 2016/2017; cancer pain a rising share of indications. Abstract read.
- 216Ambrose MA, Tarlier DS.
Nurse practitioners and controlled substances prescriptive authority: improving access to care. Nursing Leadership 2013;26(1):58-69. New Classes of Practitioners Regulations passed November 2012 give nurse practitioners, midwives and podiatrists controlled-medication prescribing authority. Abstract read.
- 215Martins D, Khuu W, Tadrous M, et al.
Impact of delisting high-strength opioid formulations from a public drug benefit formulary on opioid utilization in Ontario, Canada. Pharmacoepidemiology and Drug Safety 2019;28(5):726-733. High-strength formulations delisted in January 2017 except for palliative patients. Abstract read.
- 217Scott MM, Ramzy A, Isenberg SR, et al.
Nurse practitioner and physician end-of-life home visits and end-of-life outcomes. BMJ Supportive and Palliative Care 2024;14(e3):e2761-e2769. Nurse practitioner scope includes controlled substances and end-of-life care; many Ontario decedents had no home visit; Canada Health Act coverage and gaps; Ontario drug benefit for end-of-life home care. Abstract and full text read.
- 218Brown CRL, Webber C, Seow HY, et al.
Impact of physician-based palliative care delivery models on health care utilization outcomes: A population-based retrospective cohort study. Palliative Medicine 2021;35(6):1170-1180. Generalist, consultation and specialist models in Ontario achieved similar outcomes; home visits may promote community death. Abstract read.
- 219Lapp JM, Mokhtarnia M, Quinn KL.
Exploring the Definitions of Physician-Delivered Palliative Care in Canada: A Narrative Review. Journal of Palliative Medicine 2026;29(3):363-367. Substantial variability in palliative care definitions and fee codes across jurisdictions. Abstract read.
- 220Pilkey J, Downar J, Dudgeon D, et al.
Palliative Medicine: Becoming a Subspecialty of the Royal College of Physicians and Surgeons of Canada. Journal of Palliative Care 2017;32(3-4):113-120. Path from a jointly accredited added-competence year to a two-year Royal College subspecialty with an accrediting examination. Abstract read.
- 221Pereira J, Meadows LM, Rhayel A, et al.
Spread, participant experience, and implementation of Pallium Canada's Palliative Care ECHO project: a mixed methods study. BMC Palliative Care 2025;24(1):176. National continuing-education initiative launched April 2021. Abstract read.
- 694Harsanyi H, Yang L, Lau J, et al.
Long-term opioid prescribing and healthcare encounters in metastatic cancer: observational population study. BMJ Support Palliat Care 2025. Alberta population cohort of 10,927 opioid-naive people with metastatic cancer, 2004-2017. Abstract read.
- 695Tanuseputro P, Roberts RL, Milani C, et al.
Palliative End-of-Life Medication Prescribing Rates in Long-Term Care: A Retrospective Cohort Study. J Am Med Dir Assoc 2024;25(3):532-538.e8. Ontario administrative data on 55,916 long-term care residents who died in 626 homes. Abstract read.
- 696Rapoport A, Navarro L, Bordman W, et al.
Unused Opioids Following Palliative Care for Children at Home: A Missed Opportunity for Opioid Stewardship? J Pain Symptom Manage 2025;71(1):210-218. Online survey of 45 bereaved families from one tertiary pediatric palliative care program in Ontario; single site, 37.2% response. Abstract read.
- 697Wu EX, Collins A, Briggs S, et al.
Prolonged Grief and Bereavement Supports Within a Caregiver Population Who Transition Through a Palliative Care Program in British Columbia, Canada. Am J Hosp Palliat Care 2021;39(3):361-369. Follow-up of bereaved caregivers in one regional palliative care program (Fraser Health); authors include program clinicians. Abstract read.
- 698Widger K, Brennenstuhl S, Tanuseputro P, et al.
Location of death among children with life-threatening conditions: a national population-based observational study using the Canadian Vital Statistics Database (2008-2014). CMAJ Open 2023;11(2):E298-E304. National vital statistics study of 13,115 children and neonates who died with life-threatening conditions. Abstract read.
- 699Lysecki DL, Gupta S, Rapoport A, et al.
Children's Health Care Utilization and Cost in the Last Year of Life: A Cohort Comparison with and without Regional Specialist Pediatric Palliative Care. J Palliat Med 2022;25(7):1031-1040. Ontario administrative cohort of 807 children comparing two regions with and without specialist pediatric palliative care; authors include program clinicians; not causal. Abstract read.
- 352Anderson S, Carter RZ, Roberts D, et al.
Establishing a common definition for care provided by hospice societies in British Columbia, Canada: a Delphi process. Palliat Care Soc Pract 2025;19:26323524251320104. Delphi study defining the role of community hospice societies in British Columbia, with background on history, services and funding; provincial scope; two team members sit on the Hospice Care Alliance steering committee (advocacy interest). Full text read.
- 353Pereira J, Contant J, Barton G, et al.
Implementing the first regional hospice palliative care program in Ontario: the Champlain region as a case study. BMC Palliat Care 2016;15:65. Case study of the regional hospice palliative care program in one Ontario region, involving residential hospices, a palliative care unit and consultation teams; single region; authors were program leaders (self-evaluation). Abstract read.
- 355Xiong B, Freeman S, Banner D, et al.
Hospice use and one-year survivorship of residents in long-term care facilities in Canada: a cohort study. BMC Palliat Care 2019;18(1):100. Linked administrative data on 185,715 long-term care residents with RAI-MDS assessments in 2015 showing hospice care rates under 3% and barriers linked to age, rurality and dementia; long-term care population only. Abstract read.
- 354Aryal K, Downar J, Jones A, et al.
Home, Palliative Care Units or Hospice, and Hospital Deaths: An Analysis of the Canadian Longitudinal Study on Aging. J Palliat Care 2026. Secondary analysis of 1,287 decedent proxy interviews in a national aging cohort (2012-2022) reporting place of death, with hospice and palliative care units combined; older adults only. Abstract read.
- 489Kelley ML, Prince H, Nadin S, et al.
Developing palliative care programs in Indigenous communities using participatory action research: a Canadian application of the public health approach to palliative care. Ann Palliat Med 2018;7(Suppl 2):S52-S72. Six-year participatory action research with 4 First Nations communities in Ontario and Manitoba; the research team facilitated and evaluated the work it describes. Abstract read.
- 490Nadin S, Crow M, Prince H, et al.
Wiisokotaatiwin: development and evaluation of a community-based palliative care program in Naotkamegwanning First Nation. Rural Remote Health 2018;18(2):4317. Process evaluation of a single-community pilot with six clients in 10 months; evaluated by the program's research partners. Abstract read.
- 492Galloway T, Horlick S, Cherba M, et al.
Perspectives of Nunavut patients and families on their cancer and end of life care experiences. Int J Circumpolar Health 2020;79(1):1766319. In-depth interviews with 10 patients and family members in Nunavut communities. Abstract read.
- 491Stajduhar KI, Giesbrecht M, Mollison A, et al.
Caregiving at the margins: An ethnographic exploration of family caregivers experiences providing care for structurally vulnerable populations at the end-of-life. Palliat Med 2020;34(7):946-953. Critical ethnography with 25 family caregivers of people experiencing homelessness and poverty in Canada. Abstract read.