Pubdate: Wed, 07 Aug 2013
Source: Vancouver Sun (CN BC)
Copyright: 2013 The Vancouver Sun
Contact: http://www.canada.com/vancouversun/letters.html
Website: http://www.canada.com/vancouversun/
Details: http://www.mapinc.org/media/477
Author: James Keller
Page: A7
Cited: http://mapinc.org/url/6aHRsJPc

NO QUICK FIX FOR OPIOID ADDICTION: RESEARCHERS

Newly published paper warns designing treatment around detoxification
programs is ' dangerous'

This is a chronic disease, something that is going to have to be
fought day by day over a long period - potentially a lifetime.

Addiction to heroin and other opioids is a long-term, chronic disease
that cannot simply be fixed with a few weeks or months on methadone, a
group of B. C.- based researchers argue in a newly released paper.

Designing treatment based on the belief that most addicts can become
drug-free quickly - or even at all - is ineffective and dangerous,
the report warns.

The paper, published in the August edition of the journal Health
Affairs, says research has repeatedly shown detoxification programs
that use short-term bouts of methadone or similar therapies, reducing
dosages over a period of weeks or months, are ineffective, with as
many as 95 per cent of patients who complete such programs failing to
stay clean.

One of the paper's authors, Bohdan Nosyk of the B. C. Centre for
Excellence in HIV/ AIDS, said treatment programs that focus on
abstinence as the end goal represent "the most damaging" aspect of
opioid treatment in North America.

"This is a chronic disease, something that is going to have to be
fought day by day over a long period - potentially a lifetime," Nosyk
said in an interview Tuesday. "That's difficult for people to accept.
I still think there's a demand that they want this problem dealt with
quickly."

Nosyk said public health policies in Canada generally acknowledge that
reality, but, in practice, some physicians and patients still hold on
to the notion that treatment with methadone or its lesser-known
counterpart, buprenorphine, should be a temporary stop on the way to
abstinence.

The situation is worse in the United States, said Nosyk, where
detoxification is an essential part of official drug-treatment policy.

"It's a matter of recognizing this as an issue that's likely not going
to go away and using the tools that we have to combat it in the best
possible way," said Nosyk.

Aside from being ineffective, detoxoriented treatment can also be
dangerous, said Nosyk. The risk of death for someone seeking treatment
for opioid addiction is highest during the first two weeks of
treatment and the two weeks immediately after they stop, he said.

The paper examined the availability of methadone and buprenorphine,
which are themselves opioids, in Canada and the United States.
Methadone and buprenorphine are used as substitutes for addictive
opioids to reduce cravings and eliminate withdrawal symptoms, without
getting patients high.

There are between 75,000 and 125,000 injection drug users in Canada,
with most of them using opioids such as heroin, as well as roughly
200,000 people addicted to prescription opioids, such as oxycodone.

Of those, between 30 to 40 per cent are using substitution therapy,
said Nosyk. In the United States, where an estimated 2.3 million
people are hooked on opioids, treatment levels are less than 10 per
cent.

The paper identifies several barriers to methadone and buprenorphine
treatment across Canada, including waiting lists of up to a year in
places such as Saskatchewan and Montreal, financial costs such as
insurance copayments, and the stigma of having to access the therapies
at community drug clinics or pharmacies.

The researchers make a number of recommendations, including changing
the way patients pay for methadone and buprenorphine.

Nosyk said the therapies are typically handled by provincial health
care systems and insurers in the same way as any other prescription
drug, with patients responsible for deductibles or copayments unless
they qualify for low-income drug coverage.

He said policy-makers could learn from B. C.' s approach to HIV/ AIDS
treatment.

The province provides treatment free of charge to every patient with
HIV or AIDS, based on research that has shown widespread treatment is
the best form of prevention. The result has been a consistent decline
in new HIV cases in B. C. - something that hasn't happened in any
other province.

Nosyk said a similar approach would improve opioid addiction
treatment, which, in turn, would save the health care system money, as
well as reduce crime associated with drug addiction.

"People are dying of overdoses, and we know if we get them on
treatment, there are going to be benefits in other areas of society,"
said Nosyk. "We have reason to believe that offering treatment saves
the economy money."

The paper also calls for provinces to expand treatment into doctors'
offices.

In Canada, methadone and buprenorphine are primarily administered at
community-based pharmacies, where patients must take their therapy
under the watch of a pharmacist. Patients who are stable and who are
considered a low risk for abuse are allowed to take the medication
home.

Doctors who have obtained special certification can administer the
treatment in their offices, but Nosyk said very few doctors outside of
Vancouver and Toronto have such certification.

"On the whole, we're doing much better ( than in the United States),
but getting physicians to get their exemptions to prescribe methadone
and buprenorphine, particularly in rural regions, hasn't been easy,"
said Nosyk, noting the certification can be obtained through a
weekend-long course.
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MAP posted-by: Matt