Quebec looking at ways to curb prescription drug abuse

Rather than following Ontario's lead and discontinuing public coverage to curb prescription opioid addiction, Quebec's health minister said he favours educating doctors about the risks of overprescribing the drugs.

Quebec Health Minister Gatan Barrette told CBC Montreal's Daybreak some doctors are too quick to prescribe opioids instead of less-addictive medications.

"Many patients will go to the doctor for a simple procedure and get opioids afterwards for 10 days. Already at that point they will begin being dependent," he said.

Earlier this week, Ontario announced that its public drug planwillno longer payfor higher doses of morphine, hydromorphone and fentanylin an attemptto address the growing problem of addiction to prescription painkillers.

• Ontario to stop paying for higher-strength opioid painkillers

Opioidsare a family of drugs that are typically used to treat pain, but are also known for giving users a feeling of euphoria, making them addictive.

Right now in Quebec, anydose ofprescriptionnarcoticsoropioidslikecodeine, methadone, andoxycodonewill be paid for by the province.

• The painkiller puzzle: How to solve a growingopioidcrisis

A report released in 2013 by Quebec's publichealth research institutestated that, in the five-year periodfrom 2000 to 2004, there were 82 fataloverdoses from medical opioids. From 2005 to 2009, that number rose to139, a 70 per cent increase.

The report says the uptick ispart of a trend that doesn't appear to be subsiding.

Barrette, who is also a trained health professional,said though opioid addiction is a growing problem in Quebec, it's more problematic in other provinces likeBritish Columbia.

He said he is watching the situation to see how it develops, but pointed outopioids are still useful to treat patients in severe pain andmeasures to regulate their prescription would have to allow exceptions for patients who need the higher doses.

Quebec'scollege of physicians says itwill be consulting its members on the issuethis fall and it may recommend measures similar to Ontario's to the health ministerin the coming months.

A growing problem

Dr. Yoram Shir,director of the McGill University Health Centre'sAlan Edwards Pain Management Unit, said he believes Quebecshould have a limitwith exceptions built in.

He said the measure would likely help curtail mortality rates more than addiction rates.

"I think it will not reduce addiction, because addiction is not determinedjust by dose. Addiction is the attitude of the patient towards the medication," he said.

Daybreak Montreal8:30Painkillers: Should the RAMQ only pay for limited doses of narcotics?

Ontario health care will cap its coverage for doses of narcotics equivalent to 200mg of morphine. Should Quebec follow suit? Daybreak speaks to Dr. Yoram Shir from the MUHC's Alan Edwards Pain Management Unit.

Jeremy Wexler, a social worker at the Herzl Family Practice Centre in Cte-des-Neiges, said 15 to 20 years ago their clients were mostly addicted to heroin.

This year, 30 to 40 per cent of the people who have contacted them or been admitted to the centre were abusing prescription opioids.

• Naloxone, safe injection sites could curb overdoses in Quebec

Wexler said he believes imposing alimit on prescribed narcotics eligible for the public health planwould be a worthwhile tool, but fears the measure singles out those without private insurance.

"If I have the money to pay out of pocket, or if I have an insurance plan that will cover my opiates, it sort of says 'go to town,'" he said.

Both Shir andWexleragreed with Barrette,sayingeducating doctors about opioids must be central to any plan to curb addictions and deaths.

• CBCSPECIAL SERIES |Dope Sick: Stories of Prescription Drug Abuse