Greater care by doctors when prescribing medication would help curb North America’s opioid crisis, say experts who were set to speak at a conference on managing opioid addiction in Whitehorse May 31 and June 1.
Opioids are a class of narcotic drugs which include prescription medications such as morphine, codeine and oxycontin, as well as illicit drugs like heroin. They are commonly prescribed by doctors to manage both chronic and short term pain, which can lead to dependencies and addiction said Dr. Launette Rieb, a family physician, addictions specialist and clinical associate professor with the University of British Columbia who is presenting at the conference.
“People who have prescribing abilities for opioids need to be much more careful about how you prescribe … this will help curtail future problems for addictive disorders,” she said.
“Eighty per cent of people who use heroin started with a prescription from their physician for an opioid.”
Fentanyl, which has been linked to five deaths in the Yukon over the last year, is also an opioid. In clinical settings it is sometimes prescribed in patch form for long-term pain management. It has become a popular street drug in recent years, and has been finding its way into other drugs, such as oxycontin and cocaine.
Dr. Brendan Hanley, Yukon’s Chief Medical Officer of Health, said the conference is “one part of our response to the opioid crisis.”
“The conference is to offer education,” he said. “But we are also deliberately cultivating ideas. Where are the gaps in services and care? Where are people seeing these gaps and how can we fill them? What about integrating care for additicts and mental health, optimiazing pain management … without going down the opioid route.”
Rieb likens opioid addiction to chronic conditions like diabetes, where the focus is not on a cure, but on managing the symptoms to allow people to have normal lives.
“We look at addiction as a brain disease — the target of dysfunction is your brain. It’s not curable, but it’s manageable,” Rieb said.
Rieb said it helps to look at any addiction through a three-tiered model which assesses the type of drug, the person’s history and genetic dispositions alongside the environment the person lives in. “This is a really great way to frame what is happening with addiction,” she said.
“If people do develop an addiction disorder, getting them help as soon as possible is key,” she added.
Tighter controls, education, intervention and faster referrals would all help stem the tide of opioid addiction and its consequences, Rieb said.
Opioids are extremely hard to kick, partly because of their severe withdrawal symptoms said Mae Katt, a nurse practitioner from Thunder Bay, Ont., who will be speaking at the conference.
Katt helped pilot an opioid treatment program in a First Nations high school using the replacement drug buprenorphine/naloxone, which is sold under the brand name Suboxone. Suboxone is a pill meant to help wean people off opioids without the brutal withdrawal symptoms. The drug, which belongs to a class of treatments called opioid agonists, works by binding to the receptors in the body the opioids would normally adhere to, thus blocking the effects that cause a pleasureable opioid high, she said.
Katt works with the Nishnawbe Aski Nation, which encompasses 49 Ojibwe-Cree communities in Ontario with a population of 50,000. This community, she said, experienced a “suicide epidemic,” in which 500 people took their own lives over the last 20 years. This, along with the trauma of residentials schools, has caused deep disturbances for people living in these communities.
“There is a backdrop to every addiction. We had a suicide epidemic … they had no outlet and some people used the drug to mask the pain,” Katt said. “We have people who’ve been harmed.”
Part of the difficulty of opioid addiction in small northern communities, she says is the high cost of the drugs, and what people do to get the money to pay for them. A single pill of oxycontin that would sell for $10 in Toronto is $80 a pill in Thunder Bay. Put it out on a plane to a fly-in community and it’s $800, she said.
Users split the cost, dilute the pill and then shoot it instead of taking it orally, stretching out their supply, she said.
“The cost of any kind of illicit drug (in northern communities) is more expensive,” she said.
Even at such exorbitant prices, the drugs become addictive incredibly fast, she said.
Katt also specializes in a form of land-based addictions therapy. She said this is something which might work well in the Yukon, which bears certain geographical and cultural similarities to Thunder Bay. Like Whitehorse, Thunder Bay is a more remote northern city which services many small, isolated First Nations communities.
Katt said this sort of treatment can be conducted with limited resources within the community.
“It’s not that expensive to do,” she said. “You just take people out onto the land — your treatment centre is basically nature.”
“The Yukon is like northwestern Ontario,” Katt said. “We don’t have an abundance of health care professionals.”
“Addictive disorders are similar wherever you go,” said Rieb. “The biological chemistry is the same and the issues people face are similar.”
The Yukon, said Rieb, has some advantages by being smaller and more isolated than other jurisdictions.
“You can help transform things together,” said Rieb. “If the government is on board together … the advantage of being small is that if you see something you need, you can distribute it to everyone.”
With files from Ashley Joannou
Contact Lori Garrison at email@example.com