Almost 100,000 more opioid prescriptions written in 2016 than the year before

via The Chronicle Herald

The province’s Prescription Monitoring Program saw an increase of nearly 100,000 opioid prescriptions last year — but for the right reasons.

It was mostly due to the high number of methadone treatments for addicts.

According to numbers provided by Medavie Blue Cross — the administrator of the province’s PMP — 971,165 opioid prescriptions were made in the past year — nearly 100,000 more prescriptions than 2015.

This is mostly due to an uptick in the number of methadone prescriptions, which account for 54 per cent of all the prescription drugs administered in 2016.

Prescriptions for opioids such as oxycodone, morphine and fentanyl stayed pretty even in comparison.

For example, physicians wrote 13,558 fentanyl prescriptions in 2016, compared with 13,028 the year before.

When the word “opioid” is seen in the news or talked about by public officials, it’s often linked to other words like “crisis,” “addiction” and “death.”

Last November, federal Health Minister Jane Philpott said Canada has the world’s second-highest per-capita consumption of prescription opioids, noting that in some parts of the country drug overdoses were killing more people than motor vehicle accidents.

But methadone is one opioid that is being used as a treatment for those addicted to other drugs.

In fact, Medavie Blue Cross estimates that 98 per cent of last year’s prescriptions were written for treatment of addictions, while the remaining two per cent were strictly for pain management.

Amy Graves, executive director of Get Prescription Drugs Off the Street, says this can be a good thing — but it depends how you look at it.

“In a sense, it’s good that more people are being able to access treatment,” she said.

“But on the other side . . . more people need it, and that’s not necessarily a good thing.”

Graves started her organization in 2011, after she lost her younger brother to an accidental hydromorphone overdose.

Ever since, she has been lobbying the federal and provincial government to analyze the effect of pharmaceutical marketing on physicians.

The PMP is responsible for collecting the doctor’s name, pharmacist information, patient data and type of drug for every prescription in the province.

But Graves questions how good the data is, if it’s not being used to intervene and prevent over-prescribing. She points to the case of Dr. Sarah Jones as an example. Bridgewater police charged Jones for allegedly prescribing 50,000 oxycodone pills to one patient between January 2014 and August 2015. The patient never received them.

It was a pharmacist who reported the suspicious activity to the Nova Scotia College of Physicians and Surgeons — the profession’s governing body — which reported this to police last August.

It was later revealed that Jones was flagged four times over six years for questionable prescribing practices, and the PMP came under fire for missing it.

“I don’t think it was acted on in the timely manner that it should have been,” Graves said.

“When the Dr. Sarah Jones case came to the public’s attention, I think there was more pressure put on to actually make those changes and take it a little more seriously.”

The auditor general released a report in 2012 finding “significant weaknesses” in the program’s control and monitoring processes that could allow abuse or misuse of prescription drugs.

Last spring, the province said that the PMP was being reviewed. The Nova Scotia government hired Medavie Blue Cross to run the program in 2005 and the contract is up for renewal in 2017.

Since last April, Medavie has flagged nine cases to the College of Physicians and Surgeons, which originated from things like complaints by the public or reviews conducted by the Program’s Practice Review Committee.

In an emailed statement, the College told the Chronicle Herald they investigated five physicians in 2015.

In Canada, and internationally, methadone maintenance remains a widely used form of treatment for those dependent on opioids.

According to Health Canada, methadone is a long-acting synthetic opioid agonist.

There is no universal definition of what methadone maintenance treatment is, although they say it typically includes medical care, counselling, mental health services, outreach and advocacy.

More methadone prescriptions mean more people are being treated, but Graves says it’s also important to have the right resources in place first.

“I would hate to see the supply drastically go down without the proper treatment resources available to those that are using,” Graves said.

“We need accessible treatment if we are going to be minimizing supply.”

She mentioned Direction 180, a community-based methadone clinic located in the north end of Halifax, as one resource doing the work of many.

Direction 180 executive director Cindy MacIsaac remembers when the mobile bus was initially intended as a demonstration that would provide treatment for 30 people.

That was in 2001. Now, she says they have about 470 people in their program with mobile buses in three communities.

“It’s positive that more people are accessing a treatment that is safe,” she told the Chronicle Herald on Wednesday, in referance to the PMP numbers.

“(Methadone treatment) reduces the risk of procuring drugs on the street.”

She says it also reduces the risk of unsafe injection practises, involvement with crime and loss of health or social functioning.

But Graves also wants to see timely access to these treatments, as wait lists for these clinics continue to fluctuate.

She also wants naxolone — a synthetic drug used to block effects of opioids in the nervous system — to become more accessible than it already is.

Nova Scotia may not be at the centre of what is now being called an “opioid crisis” in some parts of the country, but she says the province isn’t far behind.

And unfortunately, she says “there is no silver bullet.” The issue needs to be tackled from multiple angles like justice, health and education, she said.

Original publish date: Feb.9, 2017

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