Pubdate: Fri, 25 Nov 2011
Source: National Post (Canada)
Copyright: 2011 Canwest Publishing Inc.
Contact: http://drugsense.org/url/wEtbT4yU
Website: http://www.nationalpost.com/
Details: http://www.mapinc.org/media/286
Author: Tom Blackwell
Bookmark: http://www.mapinc.org/find?136 (Methadone)

ADDICTS SUBVERTING METHADONE TREATMENT

Prescriptions for Other Opioids "'Big Hole' In System

Nearly one in five addicts undergoing methadone treatment manage to 
get prescriptions at the same time for other opioid narcotics, 
potentially risking their lives and costing taxpayers millions, a new 
Ontario study suggests.

The review of patients whose medication costs are entirely paid for 
by the provincial government - about 40% of total methadone users - 
is some of the starkest evidence to date of a system rife with doctor 
shopping and other abuse, experts say.

"This, I would assume, has a few people rattled," Benedikt Fischer, 
an addiction expert and professor at Simon Fraser University in 
Vancouver, said in an interview. "We're looking at an 
individual-health, a public-health and a regulatory-policy mess.... 
There are a lot of big holes, clearly on a systemic level."

Methadone itself is a type of opioid - potent opium-related 
substances employed chiefly to lessen pain - but administered legally 
to addicts to help keep them off more dangerous drugs in the same class.

Once prescribed mainly to heroin addicts, methadone is being used 
increasingly and now meted out chiefly to patients hooked on 
OxyContin and other prescription opioids, whose use and abuse has 
soared in recent years.

That thousands of those methadone patients are still convincing 
doctors to pre-scribe them other opioids of the kind they are 
supposed to be kicking is unsettling, say the study's authors, led by 
Dr. Paul Kurdyak, an emergency psychiatrist in Toronto.

It is likely the same phenomenon is happening in other provinces, 
too, the study in the journal Addiction concluded.

In Ontario, just over 36,000 residents are receiving methadone 
treatment for opioid addiction, said Kathryn Clarke, a spokeswoman 
for the Ontario College of Physicians and Surgeons, which oversees 
the methadone program with a detailed set of guidelines.

Canada's consumption of prescription opioids has grown in the last 
decade to become second in per capita volume only to the United 
States, with more than $600-million of the drugs sold in 2010, 
according to the IMS-Brogan marketresearch firm. With the boom has 
come a flood of abuse and addiction. Figures from the coroner's 
offices in just four provinces indicate that more than 250 people 
died in 2009 from overdoses related at least partly to oxycodone - 
the active ingredient in OxyContin.

The Ontario study used records from the province's drug benefit plan 
and other databases to look at 18,759 methadone patients, all on 
social assistance, over a seven-year period ending in March, 2010.

Researchers found that more than 18% of them, or about 3,400 people, 
were being prescribed opioids simultaneously, averaging about 12 
prescriptions a year each for drugs ranging from codeine to oxycodone 
and the even more powerful Fentanyl. It is possible at least some of 
the drugs were sold by the methadone patients on the street, the 
study says. Those who consumed the opioid cocktails themselves would 
face heightened risk of respiratory depression - their breathing 
slowing to a halt, with potentially deadly consequences.

"If the individual [on methadone] is taking these other opioids, 
there is the risk of fatal overdose," said Dr. Kurdyak, with the 
Centre for Addiction and Mental Health. "Easy access to opioids to my 
mind counters the benefits of a methadone program."

There are circumstances where additional opioids could be reasonably 
prescribed to a methadone patient, such as to treat the short term 
pain of a tooth extraction, or cancer-related pain - but those cases 
would be relatively limited, Dr. Kurdyak said.

In fact, mixing methadone with other opioids is "universally 
discouraged," pointing to widespread duplicitous, drugseeking 
behaviour by those studied, either for personal use or to sell on the 
street, the paper concluded. About half the opioids were prescribed 
by doctors overseeing the methadone treatment, the rest by different 
doctors the patients also visited. Ms. Clarke said the regulatory 
college is "concerned" about the study's findings, but said the dual 
prescribing might in some cases have legitimate pain-relief reasons. 
The college does advise methadone doctors to talk to their patients' 
family physicians to co-ordinate care and prevent unsafe drug use, she said.

The researchers say tracking prescriptions electronically in real 
time - so doctors and pharmacists can check on patients instantly - 
is likely the only way to effectively combat the problem. A handful 
of provinces have implemented prescription-monitoring programs in the 
last few years, though Prof. Fischer said it can take as long as a 
month for information to be passed along in some jurisdictions, 
somewhat defeating the programs' purpose.

Ontario just implemented prescription-tracking legislation, but its 
database will not be up and running until next spring, said David 
Jensen, a spokeswoman for the province's Ministry of Health. The law 
does already require doctors and pharmacists to keep detailed records 
on patients using opioids, he said.

"It is this type of inappropriate activity [uncovered by the study] 
that led the Ontario government to take action last year," said Mr. Jensen.
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