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MDs look west on OxyContin

Saskatchewan system backed

By: Jen Skerritt

Posted: 06/25/2010 1:00 AM | Comments: 0 (including replies)

JOE.BRYKSA@FREEPRESS.MB.CA Enlarge Image

Manitoba doctors want program to flag ‘doctor shoppers’ to stop drug flow.

Manitoba doctors want the province to follow Saskatchewan's lead and adopt a narcotic review program that allows them to flag "doctor shoppers" and curb inappropriate prescriptions of drugs such as OxyContin.

Dr. Bill Pope, registrar of Manitoba's College of Physicians and Surgeons, confirmed he's asked the province to adopt Saskatchewan's monitoring program that watches out for double-doctoring and educates physicians about drug-seeking behaviours and how to treat pain appropriately. Currently, Pope said the college has no authority to review whether some physicians are doling out inappropriate quantities of narcotics such as OxyContin, and can only ask the Manitoba government to provide prescription data if they receive a complaint.

What is OxyContin?

It's a powerful opiate that's also a commonly prescribed painkiller. In the last two years, front-line addiction workers have seen an alarming rise in the number of Manitobans addicted to painkillers such as OxyContin.

How is Manitoba tackling the problem?

Manitoba recently imposed restrictions on OxyContin meant to reduce the supply of opiates on city streets and the ballooning demand for methadone treatment. So far, it hasn't stifled the demand and experts say there are still not enough treatment spaces to deal with the backlog of addicts who need help.

There are close to 700 Manitobans on methadone and 183 patients are waiting between six and 12 months to get in for help.

How does that compare with Saskatchewan?

OxyContin abuse has not exploded in Saskatchewan and health officials say the opiate drugs of choice in Saskatchewan are morphine and dilaudid, though there hasn't been any recent surge in addiction.

There are 1,800 Saskatchewan patients currently on methadone and the wait to get into treatment ranges from a just a few days to a month. The health ministry said it has built up the province's capacity to deal with opiate addictions and recently added more counselling and case management supports.

Pope said that limits their ability to identify doctors who are over-prescribing potentially addictive painkillers, and prevent some addictions before they start.

Saskatchewan developed a program to tackle inappropriate prescriptions and teach doctors about warning signs their patients are "playing them" for narcotics. Since it started in 2006, prescriptions for benzodiazepines -- which include powerful sedatives such as Valium and Xanax -- have dropped by more than 60 per cent.

"I have raised this with government," Pope said. "We would love to move forward with this."

Pope hasn't received a response, but said college staff will visit Saskatoon next month to learn more.

Doug Spitzig, manager and developer of Saskatchewan's prescription review program, said he thinks the province has seen dramatic results because he reviews one file at a time, and reaches out directly to doctors with problematic patients. Spitzig estimates he's reviewed about 107,000 prescription files and routinely sends notices to doctors to alert them their patients get medications from other doctors. He contacts doctors who may be prescribing inappropriate doses, and helps educate them about drug alternatives and ways to determine if a patient is at risk for addiction.

"I deal with one doctor, one pharmacist, one drug at a time, and you knock it off one at a time," Spitzig said. "That's how you get things done and make a difference."

While Spitzig can't say whether the proactive program is part of the reason Saskatchewan hasn't been hit with a major surge in OxyContin abuse, he said it has been "exceptionally successful" at preventing doctors from prescribing narcotics inappropriately in the first place.

He said Manitoba's move to limit access to opiates won't curb drug abuse since addicts who don't receive proper treatment will continue to seek out other drugs. He said it could also scare doctors and create a "narcotic phobia" that makes it difficult for chronic pain patients to get proper treatment.

"You can't create a narcotic phobia because then you're going to have a whole segment of the population who is not getting proper treatment for their pain," Spitzig said. "If they're restricting one narcotic the appetite doesn't go away. They're just going to go after another (drug)."

There are close to 700 Manitobans on methadone and people on the waiting list can't get in for treatment until someone drops out or has stabilized enough to get the drug from a community pharmacy -- a wait between six and 12 months.

By comparison, Saskatchewan has more than twice Manitoba's capacity to treat opiate addicts. There are 1,800 Saskatchewan patients are currently on methadone and the wait to get into treatment ranges from a few days to a month.

jen.skerritt@freepress.mb.ca

Republished from the Winnipeg Free Press print edition June 25, 2010 A11

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