Few physicians prescribing safer opioid treatment despite push from provinces

TORONTO | In an effort to stem the opioid crisis across the country, provincial governments are making it easier for doctors to use a safer, effective drug to treat opioid addiction. But few doctors will prescribe it, or know how to use it.Suboxone is composed of buprenorphine and naloxone. It is safer than methadone because the buprenorphine excites the opioid receptors in the brain and curbs cravings and withdrawal symptoms and naloxone stops and reverses the effects of other narcotics, making it less likely to be abused.British Columbia added Suboxone to its drug formulary as a regular benefit in October 2015, making it a first-line treatment for opioid addiction. Then last July, the province’s college of physicians and surgeons made it easier for family doctors to prescribe Suboxone. Previously, access was limited to doctors allowed to prescribe methadone. In Alberta, Ontario, Quebec, Nova Scotia and Prince Edward Island, family doctors are also allowed to prescribe the drug.But history is a factor in why many aren’t doing so, according to Dr. Bernard Le Foll, medical head of addiction medicine service and medical withdrawal at the Centre for Addiction and Mental Health in Toronto.“With methadone being the only option for a long time, the reimbursement schedule favoured methadone,” he said.Dr. Lloyd Westby, a family doctor in Penticton, B.C., who specializes in addiction treatment, says that Suboxone is also a complicated medication.“You don’t just prescribe it, like you would with amoxicillin or other drugs. It would be like saying, ‘We need help with gallbladder surgery. Why don’t you step up to the plate?’ to a non-surgeon. It is not really fair to expect all doctors to prescribe it without knowing what they are doing,” he said.Dr. Westby, who has treated opioid addiction for decades, travels the province educating doctors on the drug and how to use it. He said there has been great interest in his lectures. He and other doctors treating addiction also provide mentoring for physicians starting out with this treatment.Dr. Westby explains that a physician must prepare a patient to take the drug.“You must get them into an advanced state of opiate withdrawal and then quickly bring the medication up. From the time you start the Suboxone until they are settled is 12 to 24 hours. If they are not assessed properly, you can put them into worse withdrawal within two minutes of taking the medication,” he said, adding that the first time he treated a patient, he did it with phone support from a more experienced colleague.“There are not many people with the knowledge needed. And with addictions treatment, it can mean a difficult doctor-patient interactions if it’s not your cup of tea,” he said. “Plus, doctors are busy and running flat out already. To ask anyone to take this on is asking a lot.“The first step is for them to come to an education session and see if it is something they can do.”“It is important to try to get more doctors prescribing it. It is such a huge lifesaving measure, particularly now during this crisis that is costing so many lives.”

Few physicians prescribing safer opioid treatment despite push from provinces

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