Pubdate: Sat, 28 Mar 2015
Source: Calgary Herald (CN AB)
Copyright: 2015 Postmedia Network
Contact:  http://www.calgaryherald.com/
Details: http://www.mapinc.org/media/66
Authors: Hakique Virani, Ian Forster and Omar Rahaman
Page: A22

ALBERTA'S DRUG TREATMENT FALLS SHORT OF DEMAND

Opioid dependency needs better access and funding

In early 2012, one of the most abused drugs in modern medicine -
OxyContin - was taken off the market, and replaced by a somewhat
tamper-resistant formulation, OxyNeo.

OxyNeo is designed to be resistant to crushing, so it is difficult to
snort. The tablets become gel when they come in contact with water, so
it is even harder to dissolve and inject.

Naturally, OxyContin's addicted, dependent and recreational users
panicked. This population, which included many high-school-aged youth
from upper-middle-class families, discovered that this popular party
drug was virtually impossible to quit cold turkey. Experts warned that
large numbers of OxyContin users would need to seek out treatment
through opioid dependency programs, but access to treatment in Alberta
remained embarrassingly inadequate.

Meanwhile, as drug users worked to figure out how to hack OxyNeo's new
security, the black market saw opportunity. The street price of
OxyContin climbed from $25 per pill to over $100 (almost 100 times the
actual cost at a pharmacy) in less than a year. Rates of associated
crime - shop and pharmacy break-ins and home invasions - increased as
expected.

Experts predicted that the increased unmet demand would cause heroin,
typically only found in Canada's port cities, to move inland. It did.
Addiction medicine specialist doctors hadn't seen much heroin use in
their practices over the preceding 10 years. And they'd certainly
never seen the illicit fentanyl from clandestine labs that is
currently plaguing Alberta.

Illicitly sourced drugs come with more societal dysfunction, violence
and property crime. Today, most new patients with an opioid problem,
even many whose opioid use started with a prescription from their
physician, report using heroin or illicit fentanyl most recently. It's
as scary as it was predictable.

The disappearance of OxyContin for a short time - before heroin and
illicitly sourced fentanyl became available - provided a small window
of opportunity to ramp up treatment access. The more untreated opioid
dependency in the population, the more new opioid users there will be.
It's a known epidemiologic phenomenon. Treatment access for those in
need would have gone a long way to preventing future opioid addiction
in young people.

Yet, in Alberta, instead of increasing the amount of treatment
provided, access decreased. In Edmonton, the AHS Opioid Dependency
Program (ODP) is providing treatment to almost 150 fewer patients than
it was in June 2013. There is greater demand for treatment, but the
system is actually treating fewer people.

AHS has one other ODP in Calgary, and it has a three-month waiting
time. Death from opioid overdose is on the rise, but even using the
2013 rates, in that three-month wait time, approximately 90 Albertans
will die from opioid overdose. Indeed, overdose deaths now surpass
motor vehicle collisions as the most common cause of preventable
injury death in Alberta.

At the Blood Tribe in southern Alberta, a state of local emergency has
been declared in response to this problem. The RCMP have charged
traffickers of fentanyl with criminal negligence causing death. What
responsibility should our health system bear for its negligence in not
providing treatment?

In his address to Albertans on Tuesday night, Premier Jim Prentice
called for care of the vulnerable, better quality and efficiency, and
creativity to increase service delivery. Will the health system
respond to this call when it comes to opioid dependency treatment? It
must. The financial cost of untreated opioid dependence to the health
system alone - not even considering the human costs and the societal
costs to justice, law enforcement and social services sectors - is
multiple times the cost to treat it effectively.

This should not be a moral issue or even a political one. Everyone
agrees that optimizing conventional treatments that have decades of
solid medical evidence to support them should be the first attempt at
care. Sadly, treatment for opioid dependency just isn't available in
Alberta. Heroin is. And now, so is illicit fentanyl.

Dr. Hakique Virani is a public health and preventive medical specialist 
and addiction medical specialist, and clinical assistant professor at 
the University of Alberta's faculty of medicine. Dr. Ian Forster is an 
addictions medicine specialist and medical director at Lifemark Health 
Institute. Dr. Omar Rahaman is an addictions medicine specialist at 
Lifemark Health Institute and clinical assistant professor at the 
University of Alberta's faculty of medicine.
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MAP posted-by: Matt