N.S. doctor urges methadone alternative

A family doctor who treats opiate addicts in Nova Scotia says the province should cover Suboxone, a drug that helps addicts and is safer than methadone.

"We really, really need to have Suboxone as a tool in our clinic," Dr. Bob Mullan told CBC on Tuesday.

Mullan works in the Annapolis Valley, where a 20-year-old woman died last week after taking methadone.

Methadone is safe when it's used as prescribed. But it's a popular street drug, and if people take it when they haven't been exposed to opiates, they can stop breathing. Doctors call it being opiate naïve.

Mullan said Suboxone is a good alternative to methadone. However, he rarely prescribes it because it's not covered by the provincial drug plan.

The province only pays for Suboxone for patients who cannot tolerate methadone.

Suboxone overdose 'very rare'

"If we had access to that drug, I think probably somewhere around 50 per cent of our clients would be ideal Suboxone candidates," Mullan said. "With Suboxone, overdose is very rare."

Mullan said the drug may cost more than methadone, but it's worth it.

"It's a bit of a cost issue," he said. "But if you really look at the dispensing fees and some of the other issues involved, I really think it's probably a zero-sum gain."

Michelle Forsythe, a pharmacist in Kentville, agrees. She said nearly all of the drug addicts who use her pharmacy take methadone simply because it's covered by the provincial plan.

But what if there's another accidental death from it, she said.

"How do you put a cost on a patient's life?" Forsythe said. "How can you say that that patient's life was worth less than the six extra bucks a day to cover the Soboxone or whatever that cost tallies out to be?"

But bureaucrats aren't swayed.

Methadone is 'gold standard'

Judy McPhee, director of pharmaceutical services for the province, said methadone is the "gold standard."

"There's evidence that with Suboxone that patients are not retained as long in therapy and it does not work as well for patients who have been addicted to higher doses of opiates than methadone does," she said.

McPhee said the current policy is based on a review done in 2008. She said if new evidence becomes available, the government could take another look at that policy.

Even if Suboxone was covered by the provincial drug plan, Forsythe and Mullan say it would not solve the Valley's prescription drug problem.