B.C. drug users question ‘exceptional’ availability of medicine

Drug users who didn’t respond well to a reformulated methadone treatment introduced in British Columbia four years ago now have access to a medication that may work as well as the original version for some people but advocates worry it’s available only on an “exceptional basis.”

Nearly 18,000 people were switched from methadone to Methadose in 2014. However, drug users say they weren’t consulted before the change to a medication that failed to keep painful withdrawal symptoms at bay for 24 hours.

The new option, called Metadol-D, has recently been offered to Methadose patients, though advocates are questioning why the drug that’s been around for years wasn’t made available sooner.

Dr. Christy Sutherland, who treats substance users in Vancouver’s Downtown Eastside, said Methadose caused substance users to become “dope sick” in about 14 hours, instead of 24 hours, leading to withdrawal symptoms that had many people seeking intravenous drugs such as heroin on the streets during a crisis fuelled by the deadly opioid fentanyl.

“Methadone and Methadose are supposed to be the same but the entire population said they felt incredibly different with that change,” Sutherland said.

“Patients would always say to me, ‘It doesn’t have legs.’ And what they meant was that it didn’t last the 24 hours,” she said of Methadose. “They would wake up each morning in withdrawal, with cravings, with sweats, sometimes with diarrhea, with pain. So they would be quite desperate for their dose that day. That led to a lot of instability for people.”

Sutherland said she has now switched many of her patients from Methadose to Metadol-D, adding it seems to work well.

She said Metadol-D is the old formulation of methadone for diabetics because it doesn’t contain sugar.

The B.C. Centre on Substance Use has been providing information about Metadol-D to doctors, but they must apply for the medication on an exceptional basis for each patient.

The province has said the switch to Methadose was believed to be a better option because it has a longer shelf life, and was less prone to dispensing errors because pharmacists don’t have to compound it.