‘Step in right direction’: doctors college makes it easier to acquire drug to treat opioid addiction

Manitoba’s physician regulator is making it easier for doctors to prescribe a pill used to treat opioid addiction.

At a December meeting of the College of Physicians and Surgeons of Manitoba, council voted to remove a requirement for doctors to complete specific training before being allowed to prescribe Suboxone to patients with opioid dependency. The training, which took place in-person or online, will now be encouraged, but is not mandatory.

College registrar Dr. Anna Ziomek said she hopes the move encourages more physicians to prescribe the stabilizing addictions medication.

“Allowing a broad array of physicians to be able to provide Suboxone to their patients… makes it less difficult for our patients who have difficulties with addiction to access at least the beginning of care, where Suboxone is appropriate,” Ziomek told the Free Press.

“And if you have the skill knowledge and judgement, you can certainly go ahead and give it to your patients.”

Ziomek said the decision came after years of monitoring Suboxone (trade name for the combination containing buprenorphine and naloxone), a pill which prevents opioid withdrawal and reduces cravings.

“When any of these new drugs come along, we’re always worried,” she said. “So Suboxone was monitored initially and over time has proven to be very safe, so some of these restrictions can be lessened.”

The number of opioid agonist therapy (which includes Suboxone) prescribers have grown exponentially in recent years, to more than 170 prescribers in 2022 from nine physicians in 2015, including physicians and nurse practitioners, according to the college.

Additionally, more family physicians and emergency room doctors were looking to prescribe Suboxone, said Ziomek.

Doctors Manitoba welcomed the college’s decision.

“We hope the change will broaden access to Suboxone by allowing more physicians to prescribe it,” said Keir Johnson, spokesperson with Doctors Manitoba.

“It is a step in the right direction, though it’s just one of many steps needed to address the addictions crisis in Manitoba. Making it easier to prescribe Suboxone removes one barrier, but the massive shortage of physicians in Manitoba is a major hurdle to patients accessing all sorts of medical care, including for addictions.”

Others said such a decision is long-overdue.

Dr. Paxton Bach, co-medical director at the British Columbia Centre on Substance Use, said B.C. removed the training requirement around six years ago.

While he praised Manitoba for taking the step now, it remains “low-hanging fruit” in the context of the broader toxic drugs crisis in Canada.

“The reality is that buprenorphine is a lifesaving medication for patients with opioid use disorder, now more so than ever, and it is an incredibly safe medication,” Bach said.

In Manitoba, 377 people died of drug overdoses in the first 11 months of 2022, and 424 people died of drug overdoses in 2021, up from 371 in 2020 and 199 in 2019.

The college acknowledged Manitoba is playing catch-up with other regions.

“When it comes to opioid agonist therapy regulation, CPSM was among the more rigorous provinces requiring approvals, mandating training, and requesting proof,” said Wendy Elias-Gagnon, CPSM spokesperson. “This change aligns Manitoba with other jurisdictions, decreasing barriers to patient access to life-saving treatment.”

Bach said one reason it’s important to remove the training requirement is because it suggests the drug is “specialized,” when it is in fact safe.

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“The key there is we don’t need to put up additional barriers, especially unnecessary ones,” he said, noting how rare it is for doctors to need to do additional training to prescribe medication.

“So forcing a physician to do additional training is not only an unnecessary disincentive… it puts it on this pedestal where physicians feel they’re not trained in it.”

Doctors in Manitoba will continue to need to submit a brief written application with the college before they prescribe Suboxone. Approval is typically issued within 24 to 72 hours.

Physicians will continue to require training before prescribing methadone, a drug which has long been used to treat opioid use disorder but is not considered as safe as Suboxone.

katrina.clarke@freepress.mb.ca

Katrina Clarke
Reporter

Katrina Clarke is an investigative reporter with the Winnipeg Free Press.

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