Different drugs needed for replacement therapies
Opioid addicts require range of different substances for different needs, critic says
Record numbers of opioid addicts entered drug-substitution programs in B.C. last year, but only one-third stick with treatment for 12 months, according to a report issued by the provincial health officer.
More than 3,900 drug users entered programs that prescribe methadone or suboxone last year, but that amounted to a net increase of only 1,292 participants because of the dropouts.
The increase in use of so-called opioid replacement therapy has been spurred by a rash of overdose deaths that killed 922 people in B.C. last year, said Dr. Perry Kendall, the provincial health officer.
The addition of the powerful synthetic opioid fentanyl to heroin by drug dealers has been implicated in many of those deaths.
“What does this overdose crisis tell us about our quality of care?” asked Michael Krausz, a psychiatrist and UBC-Providence leadership chair for addiction research.
“Why do we have an overdose crisis when countries like Austria, Germany and Switzerland do not?”
Drug-substitution programs in those countries have 12-month retention rates above 60 per cent, he said. B.C.’s retention rate in 201415 was 32 per cent, down from 41 per cent five years earlier, according to the report.
What those figures really mean is muddled by a lack of detail about the users, whether they were on maintenance or tapering doses or moving from other provinces or in and out of jail, said Kendall.
Krausz was more pointed in his analysis.
“The retention rate for people in substitution treatment is extremely low (in B.C.),” he said. “Our current system is not successful. The drugs they are providing and the doses are not sufficient.”
The popularity of suboxone — a combination of buprenorphine and naloxone, which blocks the effects of street drugs — has been particularly strong since the drug was covered under Pharmacare in October 2015, with 3,445 new patients in 2015-16 compared with 341 five years earlier.
More than 19,000 people in total are enrolled in methadone and suboxone programs in B.C.
But while many sign up for suboxone, long-term adherence among drug users has remained elusive.
“We are giving people access to buprenorphine (through suboxone), but it is not a substitution medication that is appreciated by street drug users,” said Krausz. “So they drop out and continue to use street drugs. It’s a vicious circle.”
Suboxone does not produce euphoria and blocks the highs from street drugs, while preventing overdoses.
European programs offer prescription heroin and hydromorphone (Dilaudid) to those addicts who do not succeed when first trying methadone and suboxone.
“We need a range of different substances for a range of different needs,” said Krausz.
About 110 addicts in Vancouver get prescription heroin and 25 get hydromorphone at the Crosstown Clinic through a research program called the North American Opiate Medication Initiative, or NAOMI.
Crosstown’s physician Dr. Scott MacDonald says research has shown that providing heroin as medication is cheaper for society than drug addiction.