Too many addicts, not enough treatment

The ability to deal with an increase in addiction to painkillers such as OxyContin is being held up by the lack of a national opioid strategy in Canada.

Methadone is a synthetic opioid used to help people overcome opioid addictions. Patients are given one dose of methadone maintenance treatment (MMT) per day, which lessens their craving for opioids. It is provided through provincially funded clinics and fee-for-service clinics. Health Canada states on its website that maintaining patients on the drug is key, otherwise "the potential benefits of treatment will not be realized."

"Our attitude is it’s like insulin for diabetics," said Rob Boyd, director of Oasis at Sandy Hill Community Health Centre in Ottawa, which provides MMT. "We see it as long-term."

Yet there is limited access to methadone since not all doctors are allowed to prescribe it.

A striking increase

Demand for methadone has been increasing throughout Canada.

Ottawa increased its number of spaces for MMT patients from 250 to 950 in the last five years, said Boyd. Ontario went from having 700 patients in 1996 to more than 29,000 in 2010, according to a report published by the Canadian Executive Council on Addictions (CECA).

The Centretown Community Health Centre provides opioid users a safe disposal method for needles.

Many areas have long waitlists for methadone.

People in Newfoundland can wait up to one year for the treatment, while some of their physicians have stopped taking on new patients.

Other provinces' wait times are usually several months.

Dealing with the increased demand for methadone may prove difficult, the report said, because Canada’s current system is “incredibly complex, fractured and under resourced.”

To give it to patients, physicians must obtain an exemption from Health Canada because it's classified as a Schedule 1 drug under the Controlled Drugs and Substances Act. Prospective prescribers must also have support from their licensing body, training in administering the drug, and, in some cases, a mentor to guide them through their first year prescribing it.

A lack of doctors

Dr. Anthony Levinson, a medical professor at McMaster University, said medical students don’t receive a lot of training on opioid addictions.

"It’s a little bit underrepresented [in the curriculum] considering what an important and common issue it is," said Levinson. "It’s kind of an extra add-on training that is usually done by interested people after they’ve got their specialty training in family medicine, internal medicine or psychiatry."

"We are treating a drug addiction with another drug, which is difficult for many to comprehend, especially if their philosophy is one of abstinence," said Beverley Clarke, president of CECA.

This required training can be a barrier to physicians working in provinces like Nova Scotia, Newfoundland and Prince Edward Island that don't offer it. In this case, they must travel to another province - usually Ontario - to receive training. 

Another difficulty in recruiting doctors to prescribe methadone is the stigma attached to drug addiction. 

"We are treating a drug addiction with another drug, which is difficult for many to comprehend, especially if their philosophy is one of abstinence," said Beverley Clarke, president of CECA in an email.

Finding a doctor with an MMT exemption can be a difficult task, especially for those living in smaller provinces or rural and remote areas. Problems include long waitlists, doctors with large caseloads and travel barriers.

Limited Access

To deal with the high demand for methadone, several provinces have developed strategies to recruit physicians or increase funding. Others have started education campaigns about the dangers of opioid abuse.

Health Canada is "committed to preventing the diversion and abuse of psychoactive pharmaceuticals," Gary Holub, a media relations officer for the organization, wrote in an email.

He says the they have tried several strategies to reduce opioid abuse, including national surveys and releasing educational information on the dangers of opioids. They've also given health workers information on how to detect misuse of opioids.

"Health Canada's Non-Insured Health Benefits Program has implemented a series of client safety initiatives to respond to potential prescription drug misuse, including a national Prescription Monitoring Program,  a system of automated warning and rejection messages to alert pharmacists in real-time of potential misuse, as well as dose limits on certain drugs with abuse potential," his email continued.

Sarah Brown of Centretown Community Health Centre puts together a safe injection kit for opioid users.Still, the CECA report said Health Canada's guidelines from 2002 should be reviewed.

Health Canada should work “in consultation with provinces and providers to see if further changes, revisions, and updates are warranted,” Clarke expanded.

CECA is already taking the next steps to prompt action with Health Canada. 

"We’ve made a presentation with them…they’re aware of it. It’s just a matter of priorities," said Carolyn Franklin, senior policy advisor at CECA.

"There isn’t a commitment yet to proceed on that, but hopefully soon."

Another drug that helps treat opioid addiction, buprenorphine, was described in the CECA report as a lost opportunity.

"Further review and consideration of buprenorphine as another option for patients should be considered," said Clarke. It has been largely dismissed because of its high cost, though the report said volume discounts from frequent prescriptions would reduce the cost.

Opioid and Methadone Use across Canada

An infograph showing the prevalence of illegal and prescribed opioid use and harm reduction practices.