Anti-addiction pill a you-pay

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Addictions expert Dr. Lindy Lee says Suboxone works faster, has fewer side effects. (RUTH.BONNEVILLE@FREEPRESS.MB.CA)

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   • Should the Manitoba government pay for Suboxone as a treatment for narcotics addiction?

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Addiction experts say the province should pay for a medication that could potentially save lives and help young Manitobans hooked on powerful narcotics such as OxyContin curb their drug abuse.

Dr. Lindy Lee, director of Health Sciences Centre's addiction unit, said Suboxone is a far better option than methadone to treat opiate addiction in teens and young adults, as it comes with fewer side-effects, it's easier to wean them off and there's a lower risk of overdose and accidental death if doses are diverted.

Like methadone, Suboxone is a synthetic opiate that is taken daily to reduce cravings and curb symptoms of withdrawal.

Methadone comes in a liquid form, and addicts start on a very low dose that is closely monitored and increased over several months until their cravings subside. Some methadone patients sell doses illegally; a small amount can be lethal to someone who has never taken it before.

By comparison, Suboxone is a pill taken orally, and the average addict reaches his or her optimal dose within two to three weeks.

Lee said she would like to use Suboxone as the first drug of choice for some of her patients, but she can only use the drug for certain patients who must try methadone treatment first, as Suboxone is not covered by provincial pharmacare. Suboxone costs twice as much as methadone, and Lee said the province will only pay for it on a case-by-case basis because of the price.

Provincial statistics show a three-day supply of Suboxone costs about $41.37, compared to $19.64 for a three-day supply of methadone.

"I think it's a far better option," Lee said of Suboxone. "They don't run the same risk of death, and if they divert it (for sale), it's not risky for the public."

Methadone treatment used to be the last resort for hard-core morphine or heroin addicts, but the number of Manitoba patients in methadone programs tripled in the last year due to the surge in young opiate addicts. The majority of new methadone patients are between 18 and 30 years old, including many suburban teens from Winnipeg and rural communities who experimented with OxyContin at parties and found they couldn't stop taking it.

Lee said many hard-core addicts will probably do better on methadone than Suboxone because the dose is more intense. However, she said young people who have been hooked for only a brief time and have family supports are better suited to Suboxone. Lee currently has about six patients on Suboxone. They are reportedly more stable and have experienced fewer side-effects such as weight gain, fogginess and sweating.

Healthy Living Minister Jim Rondeau said Suboxone is available for patients through exception-drug status and is part of the arsenal doctors can use to treat opiate addiction.

Rondeau said the province has made big strides in reducing the amount of illicit opiates available by restricting the use of OxyContin, and will continue to listen to doctors and experts if they recommend new treatments and drugs.

A cabinet spokesman confirmed it would cost an extra $1 million to $2 million annually to use Suboxone in place of methadone.

"The docs, who are the people we listen to, have said that basically, methadone is the treatment of choice and that Suboxone is only used when methadone isn't appropriate," Rondeau said.

Ian Rabb, a former drug addict who operates three addiction-recovery facilities, said he knows opiate addicts who have been put on methadone treatment after they've abused drugs for just a few months. Rabb said methadone is harder to come off than Suboxone and he can't understand why the province won't make it more available.

"It baffles me that we have such a methadone madness going on," Rabb said.

jen.skerritt@freepress.mb.ca

What is the difference between methadone and Suboxone?

Both are synthetic opiates that help curb cravings and reduce symptoms of withdrawal, but methadone comes in a liquid form and Suboxone as a pill. Addicts on methadone treatment start on a very low dose that is closely monitored and increased over several months until their cravings subside. Addicts on Suboxone reach their optimal dose in two to three weeks and typically have fewer side-effects.

Does the province pay for Suboxone?

Currently, Suboxone is only paid for on a case-by-case basis for patients who tried, and did not respond well to methadone. A three-day supply of Suboxone costs about $41.37, compared to $19.64 for a three-day supply of methadone. Between 2009 and 2010, Manitoba paid $667,000 for methadone prescriptions and another $582,000 in fees to dispense it. Dispensing fees vary by pharmacy, but some Winnipeg pharmacies charge between $10 and $17 to dispense methadone.

Republished from the Winnipeg Free Press print edition December 27, 2010 A3