New report flags fentanyl deaths and highlights importance of improving access to evidence-based opioid addiction care in BC

published on June 2, 2016

Report offers key recommendations to safe and effective treatment

Vancouver, B.C. [June 2, 2016] A new report by the B.C. Node of the Canadian Research Initiative on Substance Misuse (CRISM) recommends novel strategies to improve access to opioid addiction care in British Columbia. The report entitled Moving towards improved access for evidence-based opioid addiction care in British Columbia“ provides recommendations that have the potential to greatly reduce the harms of opioid addiction by maximizing the individual and public health benefits of evidence-based treatments.

One major driver of the current public health emergency is untreated opioid addiction. The report recommends improving access to buprenorphine/naloxone (Suboxoneïë), a treatment proven to decrease overdose deaths, as a key component in the response to the epidemic.

Despite the proven efficacy and safety of buprenorphine/naloxone, traditionally, physicians in B.C. cannot prescribe this medication unless they hold a methadone exemption from Health Canada. This restriction makes it difficult for primary care physicians to routinely prescribe this life-saving medication. The de-linking of methadone and buprenorphine/naloxone is recommended in this report and is currently under consideration by the College of Physicians and Surgeons of British Columbia. In October 2015, the province helped to improve access to buprenorphine/naloxone, by including it as regularly covered benefit through PharmaCare.

“When we look at other jurisdictions in Canada and around the world that have removed such barriers to allow all primary care physicians the ability to prescribe buprenorphine/naloxone, more patients are engaged in care and opioid-related overdoses and deaths decline dramatically,” said Dr. Keith Ahamad, Clinical Assistant Professor at the University of British Columbia, Research Scientist at the BC Centre for Excellence in HIV/AIDS and an Addiction Medicine physician at Providence Health Care. “In France, for example, the country saw an 80% reduction in overdose deaths following the roll out of buprenorphine.” Buprenorphine/naloxone also has fewer side-effects and leads to far less overdose deaths than methadone. In B.C., for instance, methadone is implicated in approximately one in four prescription opioid-related deaths and, compared to buprenorphine/naloxone, methadone also has other more serious side-effects.

In addition, the College of Physicians and Surgeons of BC guidelines recommend a two-month period of daily witnessed ingestion of buprenorphine/naloxone at a pharmacy despite the Health Canada-approved buprenorphine/naloxone product monograph that permits unsupervised carries (“take-home” doses) immediately at the discretion of the treating physician. These system barriers, not supported by the safety evidence, hamper more widespread access to buprenorphine/naloxone for many patients seeking treatment for opioid addiction, particularly in areas where specialty clinics and pharmacies are not available.

The report recommends:

  1. Offering buprenorphine/naloxone as a first line treatment for opioid addiction and as an alternative to methadone, given its safety profile and lower risk of overdose.
  2. Removing barriers for treating physicians, such as the requirement for a methadone exemption in order to prescribe buprenorphine/naloxone.
  3. Disseminating and implementing evidence-based guidelines, such as the Vancouver Coastal Health/Providence Health Care Guideline for the Clinical Management of Opioid Addiction, to support new physician prescribers of buprenorphine/naloxone.
  4. Improving professional education and public knowledge of buprenorphine/naloxone as a first-line treatment of opioid dependence and the risks and benefits of this medication relative to methadone.
  5. Removing the recommendation for a two-month period of daily witnessing at pharmacies from provincial guidelines, allowing take home dosing (as described in the Health Canada approved product label) at the discretion of the treating physician.
  6. Supporting research and education aimed at reducing the diversion of opioid agonist therapies.

In August 2014, a $3-million investment was announced by the Government of B.C. to support the development of recommendations for evidence-based addiction care including those in the report released today. “Addressing the serious problems of opioid dependence in B.C. requires scaling up the most effective and safest strategies that have been proven to work,” said Terry Lake, B.C. Health Minister. “We will continue to work to improve access to buprenorphine/naloxone and towards the development of a coordinated, provincial approach to networked leadership in research, education and clinical care. These are just a few of the positive changes that will make B.C. a national leader in opioid addiction care.”

Prompting the recent declaration of a public health emergency by the Provincial Health Officer, Dr. Perry Kendall, surveillance data from the BC Coroners Service from 2006-2015 shows a steep increase in the number of overdose deaths in B.C. There were 480 drug overdoses reported in 2015 alone, a 31 per cent increase from the previous year.