Fentanyl crisis poses challenge
As Alberta’s death toll from fentanyl soars, an addictions doctor warns the drug and others like it pose the greatest public health threat in the province.
Dr. Hakique Virani said any effort to crack down on the illicit trade of fentanyl without dealing with underlying addictions would only shift demand to other drugs.
“The problem will shift back probably to heroin or one of the other prescription opioids,” Virani said. “As long as there’s that demand for opioids from the substance abuse disorder population, we’re going to see something else.”
Fentanyl, a highly addictive and potent opioid, was linked to 145 Alberta deaths in the first six months of the year, a death toll that has already surpassed last year’s total of 120 fatal overdoses.
Virani, who works at a methadone clinic in Edmonton, said he treats patients with varied backgrounds, from soccer moms and new immigrants to First Nations and children of wealthy parents.
“I’ve got patients who don’t have bank accounts, and I’ve got patients who are investment bankers.”
Virani said the province must open up more treatment spaces for patients hooked on opioids. He said research shows the most effective treatments are methadone and suboxone, replacement therapies that satisfy cravings but offer no euphoria, allowing patients to go back to work, take classes and begin restoring strained relationships.
“Having done this for 10 years, I can’t think of a more rewarding sentiment than watching somebody turn from a completely dysfunctional individual to somebody who’s parenting again and back to work, and no longer has seven or eight warrants out for their arrest,” he said.
Fentanyl and other opioids give users a euphoric high, which one reformed user called pure bliss, but they’re also highly addictive. Parents have told the Herald their children have stolen from their families and sold their own prized possessions to pursue that high from fentanyl and avoid the crushing agony of withdrawal.
Alberta Health said Monday that efforts are underway to open up access to treatments. In a statement, the department said a generic and cheaper form of suboxone is now available in the province and that officials have been trying to get the word out to doctors across Alberta.
The department said officials are also studying ways to provide greater access to methadone, though the challenge is complicated and may require changing how physicians are compensated for their work.
“We are looking at all the necessary steps to make this happen.”
According to health officials, the problem can’t be solved simply by throwing money at it. They say the biggest challenge is encouraging more doctors to prescribe opioid replacement drugs.
Fewer than 100 Alberta physicians prescribe these drugs, but most of the work is carried out by 20- 30 who offer the therapies as a large share of their practices, according to Dr. Michael Trew, the province’s chief addiction and mental health officer.
Trew has been consulting doctors across the province in an attempt to create incentives for more physicians to adopt these therapies and to remove barriers that discourage them from doing so.
A key problem is that Alberta doctors can’t charge fees for much of the work involved with treating opioid- addicted patients with methadone and suboxone, given that doctors typically charge when they see patients, Virani said. For instance, when they consult with pharmacies, monitor patient drug tests or talk to family members of patients, doctors can’t charge for their work.
Virani said solving these challenges is a top priority for senior public health doctors, though he acknowledged that progress has been slow.
He said physicians in Alberta began noticing a rise in fentanyl abuse in 2013.
“Here we are, two years after spotting fentanyl and heroin for the first time in a long time in Alberta, and we still haven’t solved this problem.”
Alberta Health said in its statement that government officials have been responding to the sharp rise in fentanyl deaths, pointing to a program that distributes the overdose- reversing drug called naloxone to social agencies.