'Outdated' restrictions on Suboxone making B.C.'s overdose crisis worse: report

A new report blamesBC's College of Physicians and Surgeonsfor not lifting "barriers" to Suboxone, a prescription drugthatcould dramatically reduce overdose deathsamida public health emergency.

"In the context of a dramatically escalating overdose epidemic, we'd like to see quicker movement," said Dr. Thomas Kerr, who co-authored a report for the Canadian Research Initiative on Substance Misuse.

It urgesthe college to remove"outdated"restrictions on a pill considered sixtimes safer than methadone.

Suboxone reduces cravings for opioids, prevents withdrawal symptoms and includes naloxone, which counters the effects of the drug and precipitates withdrawal if the pill is crushed and misused via intravenous injection.

Suboxone's deregulationin France in 1995 is credited with an 80 percent reduction infatal opioid overdoses, which is why the report's authorswant it made widely available in BC immediately.

Deaths could be reduced

"We have seen, in France, very large reductions in overdose deaths following the widespread rollout of Suboxone" said Kerr.

"Major barriers" keep B.C. addicts from using Suboxone, because only doctors who are allowed to prescribemethadone can prescribe it.

And even if an addict finds a specialist, the college's website specifies "daily witnessed ingestion for the first two months" so addicts must attend a pharmacy daily, even though Health Canada lifted that requirement when the product monograph was updated nearly two years ago.

Recommendations include:

• Allowing all BC doctors to prescribe Suboxone
• Removing thetwo-month, daily-witnessed ingestion guideline
• Suboxoneas the firstline of treatment over methadone

Seventy-threedoctors, includingKerr,signed a reportmaking thesame suggestions six month ago.

Since that report,320 more people have died from overdoses, whilea panel of experts at the Collegecontinues to reviewSuboxonepolicy.

College says revisions coming soon

"We're all workingcollaborativelyand as quickly as we can,"saidDr.AilveMcNestry,deputy registrar of the College of Physicians and Surgeons ofB.C.

She says apanel of experts including ministry of healthofficialsdecided in February to allow all doctors to prescribeSuboxone;but not until theyrewrite theguidelines.

Thatcommitteeonly meets fourtimes a year, and McNestry expectschanges by the end of June.

"It was our jointdecisionthat the way we goforward is that we would revise the guidelines, and they would remove thetechnicalbarrier in PharmaNet" saidMcNestry.

She says any doctor who wants to prescribeSuboxonecanrequest a temporary exemptionand give immediate "carries,"which is a prescription the patient can take at home.

"Idon'tsee this as a huge barrier ... right now today there is nothing topreventaphysicianfrom prescribing carries attheirclinicaldiscretion."

'What in the hell are they waiting for?'

Severalfamilies and addiction doctors have told CBC few doctors are willing to do that.

"Noone wouldgiveJordonaSuboxoneprescription"says Leslie McBain,who lost her son to anan overdose in 2014.

McBainfounded"Moms Stop the Harm" which is lobbying thecollege to allowwidespread access to Suboxone.

"What in the hell are they waiting for? As they hedge on this, people are dying" she said.

2016 death toll could hit 800

"It is a little frustrating. We're seeing so much harm related to untreated opiate addiction ... if you look at the numbers of people who are dying"said Dr. Keith Ahamad, who co-authored the report andpredictsoverdose deaths could rise by 67 per centin 2016, to as many as 800.

"It would literally be like two or three 747 jumbo jets crashing in British Columbia filled with young people ... dying of a preventable illness" he said.

It would literally be like two or three 747 jumbo jets crashing in British Columbia filled with young people ... dying of a preventable illness.- Dr. Keith Ahamad, addictionspecialist, research scientist

"In the context of skyrocketing overdose deaths ...it's unacceptable. We need to move quickly to improve access to life saving treatment," said Ahamad.

"The requirement that doctors have a special licence to prescribe a medication that is very safe ... I don't think is rooted or founded in good scientific evidence" said Ahamad, who suggests any doctor who completes a short online training course should be allowed to prescribe Suboxone.

Suboxonecould have saved daughter

Debra Bailey says her daughter might still be alive ifher doctor had been willing to let her "carry" her pills, rather than make daily, humiliating trips to the pharmacy.

"I don't think she would have been looking for heroin that day if she'd been on Suboxone" said Bailey of the dayIzzy Bailey, 21, died of a fentanyl overdose on December 23, 2015.

Bailey recently wrote the college to demand improved access to Suboxone.

"I'm frustrated that it's taking so long ... I think people's lives could be saved."

"I would have preferred everything to have been sooner," said Terry Lake, B.C.'s minister of health.

He says he has told the College the report's recommendations should be implemented by July.

"We're pushing as hard as we can, but we have to respect the autonomy of the regulatory body."

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