Pubdate: Wed, 07 Aug 2013
Source: Globe and Mail (Canada)
Copyright: 2013 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Andrea Woo
Cited: http://mapinc.org/url/6aHRsJPc

REPORT SAYS B.C. A MODEL FOR TREATMENT

British Columbia could serve as a model for effective treatment of
opioid dependency for the United States, where opioid overdose is one
of the leading causes of accidental death, according to a new report
by Canadian and American researchers.

The report calls for both countries to expand "evidence-based
treatment" for dependency on opioids such as heroin and, increasingly,
prescription opioids including Oxycontin, Percocet and Vicodin.

"In the U.S., opioid related overdoses are now the second leading
cause of accidental death behind only motor vehicle accidents," said
Bohdan Nosyk, an associate professor of health economics at Simon
Fraser University's Faculty of Health and lead author of the report.
"It's become a really big problem and policy makers and treatment
providers are scrambling to address it."

One of the report's chief recommendations is to expand opioid
substitution treatment to office-based settings in the U.S., where
methadone, for example, can only be prescribed and dispensed on an
outpatient basis through federally regulated drug treatment centres.
The number of methadone-prescribing facilities in the U.S. constitutes
only about 8 per cent of all substance-abuse treatment facilities. And
it is estimated that less than 10 per cent of Americans addicted to
heroin and prescription opioids are receiving opioid substitution
treatment, according to the report, titled A Call for Evidence-Based
Medical Treatment of Opioid Dependence in the United States and Canada.

In B.C., the number of patients receiving methadone rose to about
13,000 in 2012 from 2,800 in 1996, the year office-based treatment was
implemented in Canada, said the report, citing figures from the
College of Physicians and Surgeons of B.C. In Ontario, the figure rose
to nearly 30,000 from 700.

The model allows not only for increased ease of access to treatment,
but enables further care of comorbidities, such as HIV, hepatitis C
and psychiatric illnesses, according to the report. Treatment in a
doctor's private office would also be less stigmatizing.

While doctors in this province can take weekend courses to become
certified, there remain limited treatment options outside of the Lower
Mainland, Dr. Nosyk said.

The report, which describes opioid dependence as a "chronic, recurrent
condition," also highlighted the apparent risks in using opioid
substitutions such as methadone to "detoxify" patients from opioids,
despite that being discouraged in clinical guidelines.

"That's the scariest part," Dr. Nosyk said. "When people are on
treatment, they're productively maintained, they're three times less
likely to die than they are as a regular user. But that risk of death
is actually highest in the first two weeks of treatment, when they're
just getting used to the medication =C2=85 and [in] the two weeks after
dropping out. That's where detox becomes such a big problem."

He used three-week detox programs, considered a standard in many parts
of the U.S., to illustrate. "Over the span of five weeks, people are
exposed to really high risk of death for four out of five of those
weeks," he said.

In B.C., a long-term, maintenance-oriented approach to treatment is
generally advocated over abstinence. In a study of clients entering
methodone programs from 1996 to 2007, about half had dose decreases
toward the end of treatment, Dr. Nosyk said. Of those clients, only
2.5 per cent were successful in tapering their doses down to zero with
no relapse within 18 months.

"It's unfortunate, but I think people need to be realistic about
opioid dependence and recognize that it is a chronic condition," Dr.
Nosyk said.

Health Minister Terry Lake was unavailable for comment on Tuesday, but
the ministry issued a statement thanking the B.C. Centre for
Excellence in HIV/ AIDS for the report and acknowledging many of its
recommendations are in line with measures the province is taking.

"The B.C. government is committed to continuing to work to improve our
systems for substance dependence treatment, with a particular focus on
opioid addiction, in order to help people with these addictions lead
better lives," the statement read.

In the past few years, the ministry has worked with the College of
Physicians and Surgeons of B.C. on its Methadone Maintenance Handbook,
implemented a 10-year mental-health and substance-abuse plan and added
Suboxone, a combination of buprenorphine and naloxone, to PharmaCare
as an alternative medication for patients who cannot take methodone.
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MAP posted-by: Matt