Pubdate: Wed, 04 Nov 2015
Source: Vancouver Sun (CN BC)
Copyright: 2015 Postmedia Network Inc.
Contact:  http://www.canada.com/vancouversun/
Details: http://www.mapinc.org/media/477
Author: Tiffany Crawford
Page: A9

DOCTORS ASKED TO TAKE NEW TACK IN DEALING WITH OPIOID ADDICTION

Vancouver Coastal Health has established first-of-its-kind guidelines
in the treatment of opioid addiction, including having doctors use a
safer drug than methadone as a first-line treatment.

The health authority says the nine recommendations are aimed at
improving physicians' knowledge of treatment in light of ongoing
challenges with methadone, and opioid overdoses linked to fentanyl and
prescription drugs like oxycodone.

Dr. Evan Wood, the health authority's medical director of community
addiction services, says methadone, while a highly studied form of
treatment, has many safety issues, including side-effects, addiction,
and it can be fatal.

So the guideline directs doctors to use buprenorphine/ naloxone (also
known as Suboxone) as a preferred first-line treatment. Although the
drug has been available for decades, Wood said doctors in Canada have
used it as a last resort, after methadone failed.

"In some ways, B.C. has had it backwards," he said, of prescribing
methadone before buprenorphine. "Essentially, what we're encouraging
physicians to do is generally start with the least-toxic,
most-effective approach first, and proceed from there when necessary."

Wood said buprenorphine is six times safer than methadone in terms of
overdose risk, has fewer side-effects, and unlike methadone, patients
are not required to pick up the medication from the pharmacy on a
daily basis.

He added that because buprenorphine has no street value, using it as a
first-line treatment could lead to fewer overdose deaths.

"We know that in one in four prescription (opioid) overdoses,
methadone is involved," he said.

As part of their study, Wood and his team looked at reports from the
U.S. and the U.K. where there has been a high success rate using
buprenorphine. Wood said the reports showed that it is "exceedingly
rare" that buprenorphine is implicated in an overdose.

The guideline recommends that patients who respond poorly to
buprenorphine be transitioned to methadone.

Also included in the guideline, is a strong recommendation that
patients do not go through a detox program without longer term
treatment. Wood noted that the relapse rate for patients addicted to
prescription painkillers, who go into detox with no followup
treatment, is more than 80 per cent.

The B.C. government in August provided $3 million in funding to
support Wood's team in finding new ways to treat substance dependence.
The health authority says it will now work with the province to figure
out how to expand the guideline to other regions of B.C.

 From Grief to Action, an association of families and friends dealing
with addiction, supports the new guideline. The group's founder
Nichola Hall said, in a statement, that they agree with the health
authority's recommendation that detox is not complete without any
followup treatment.

She said it is also very important for psychosocial support to be
offered in conjunction with pharmacological treatment, especially for
youth.

Laura Shaver, a spokeswoman for the B.C. Association of Persons on
Methadone, also welcomed the guideline, saying having more choices for
treatment is "an excellent place to start."
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MAP posted-by: Matt