SOURCE: British Columbia Centre for Excellence In HIV/AIDS

British Columbia Centre for Excellence in HIV/AIDS

June 02, 2016 13:34 ET

New Report Flags Fentanyl Deaths and Highlights Importance of Improving Access to Evidence-Based Opioid Addiction Care in B.C.

Report Offers Key Recommendations to Safe and Effective Treatment

VANCOUVER, BC --(Marketwired - June 02, 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 (Suboxone®), 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.

About Canadian Research Initiative on Substance Misuse

The Canadian Research Initiative on Substance Misuse (CRISM), supported by the Canadian Institutes of Health Research (CIHR), is a national interdisciplinary research consortium comprising four regional Nodes (BC, Prairies, Ontario, Quebec/Maritimes), uniquely focused on cross-cutting translational and implementation addiction research in the area of addiction clinical trials. The BC Node of CRISM, led by Principal Investigator Dr. Evan Wood, is an expert network of over 50 contributing members, including knowledge users, service providers, community members, and research scientists, affiliated with the BC Centre for Excellence in HIV/AIDS, the University of British Columbia, and Simon Fraser University, among others. Through our work, we are firmly committed to working with communities to ensure translation of scientific evidence into practice and policy change, promoting evidence-based approaches to addiction treatment, and training the next generation of leaders through our comprehensive education programs. Most recently, CIHR announced a $4.4 million investment in CRISM to support the first national randomized clinical trial to tackle the public health issue of prescription opioid misuse.

About the British Columbia Centre for Excellence in HIV/AIDS

The BC Centre for Excellence in HIV/AIDS (BC-CfE) is Canada's largest HIV/AIDS research, treatment and education facility and is internationally recognized as an innovative world leader in combating HIV/AIDS and related diseases. BC-CfE is based at St. Paul's Hospital, Providence Health Care, a teaching hospital of the University of British Columbia. The BC-CfE works in close collaboration with key provincial stakeholders, including government, health authorities, health care providers, academics from other institutions, and the community to decrease the health burden of HIV and AIDS. By developing, monitoring and disseminating comprehensive research and treatment programs for HIV and related illnesses, the BC-CfE helps improve the health of British Columbians.

Contact Information

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    Diane Pepin
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