Pharmacare letting down British Columbians
The fentanyl crisis is largely a mental-health crisis, as I pointed out in a recent commentary. One of the reasons for that situation is the lack of access to timely and appropriate mental-health and addiction treatment. This includes the lack of access to skilled mental-health care providers and to safe, effective, tolerable treatments.
Media reports and online forums often perpetuate myths regarding psychiatric medications: They don’t work, they’re all the same, they make everyone worse. By highlighting snippets of negative research without considering the larger body of data or clinical experience that demonstrates the benefits of these treatments, irresponsible reports fuel fear.
Consequently, psychiatric medications are commonly regarded as dangerous, unnecessary, intolerable or ineffective. This has perpetuated the stigma and burden of mental illness, adding to the weight of fear and shame mentally ill patients often carry.
Even my own medical colleagues from other specialties and some allied health professionals, such as pharmacists and nurses, are not immune to these misleading, spurious narratives regarding psychiatric illnesses and treatments. By choosing to remain ignorant of the facts, particularly the importance of early, effective and complete treatment, they too are perpetuating stigma and causing great harm.
The B.C. government has relied on these uninformed health-care professionals to determine whether to fund treatments for mental illness.
We are fortunate in British Columbia to have “Plan G,” a Pharmacare program that pays for many psychiatric medications for those unable to afford them. Some medications require “special authority” and are therefore only available once other medications have been tried and failed. I believe the criteria are developed without any input from prescribers, because they require that trials of inappropriate, unapproved medications be undertaken before the requested treatment is approved.
There are many psychiatric medications and the newest ones are not necessarily better. However, every person I treat is an individual: Their brain, their circumstances and their illness are unique to them, so their treatment must be tailored to their individual needs.
There are two pertinent examples — bipolar disorder and attention deficit hyperactivity disorder (ADHD) — of B.C. Pharmacare’s lack of foresight, demonstrated by blocking access to approved, effective psychiatric treatments.
Bipolar disorder is a challenging illness to live with and to treat. Many patients spend most of their lives both ill and depressed. They have very high rates of hospitalization, 20 times the risk of suicide compared to the general population and they commonly develop impairing, chronic depression and cognitive symptoms.
There are only two treatments approved by Health Canada for bipolar depression. One is quetiapine, which can cause significant sedation and extreme weight gain, while the other, lurasidone, rarely causes weight gain or other serious side effects. Yet B.C. is the only province in Canada that doesn’t have Pharmacare coverage for them. I cannot access lurasidone for my patients unless they’ve been subjected to drugs that are not approved by Health Canada for their illness and are virtually guaranteed to cause weight gain and other miserable side effects.
Then there is ADHD, in which untreated or undertreated adults struggle to maintain relationships, effectively parent and keep a job. They’re far less likely to finish high school and they have much higher rates of deadly car accidents, drug and alcohol addiction plus incarceration than adults without ADHD.
Despite these serious negative consequences, long-acting stimulant medications for the treatment of ADHD are not covered for adults in B.C. Pharmacare is aware that these medications are endorsed and recommended by all professional ADHD organizations and they have been counselled by experts both in B.C. and across Canada regarding their necessity and safety. Despite this, B.C. is the only province in the country without Pharmacare access to any long-acting stimulants for adults with ADHD.
B.C. Pharmacare argues it cannot afford these treatments, especially due to the cost of managing the fentanyl crisis. It fails to acknowledge that providing access to safe, well-tolerated and universally recommended treatments saves money. These treatments would reduce the cost and negative consequences of untreated or undertreated illness for many patients and for society by reducing hospitalizations and lowering rates of addiction, family breakdown, homelessness and disability. Because many of the victims of fentanyl also have bipolar disorder, ADHD or both, providing these treatments will also save lives.
B.C. Pharmacare’s short-sighted approach in spending money on bandages when there is a gaping wound that needs to be attended to is not serving British Columbians and it’s not saving money. An emergency room visit to Vancouver General Hospital costs our Medical Services Plan $335, a one-day admission is $1,500 and a day in the intensive care unit costs over $5,000 a day. One year of Pharmacare coverage of a long-acting stimulant or lurasidone costs less than one day in hospital.
It remains to be seen whether the NPD’s new Ministry of Mental Health and Addictions and its minister, Judy Darcy, will make a meaningful difference in the lives of mentally ill British Columbians. It can start by giving psychiatrists and family doctors better access to the tools they need to help their patients.