Opioid addictions treatment must go beyond prescriptions: doctors

The cycle of drug addiction can feel endless for people without a variety supports, according to addiction experts in Saskatchewan. 

"The cost, if you're entrenched, is going to be anywhere for $100 to $200 a day," said Dr. Morris Markentin, who is a family doctor at the Saskatoon Community Clinic and manages the opioid agonist therapy program for the College of Physicians and Surgeons of Saskatchewan.

"It takes 24 hours a day to acquire money then to go find the drugs if you can find them and then to use them."

Markentin says someone who is addicted is likely using more than once a day and people will go to great lengths to avoid withdrawal symptoms.

"When you're in opiate withdrawal you feel like you're going to die and so you avoid that at all costs," he said.

Opioid substitution therapies

That's why opioids such as Suboxone and methadone help treat addictions, he said. The daily prescribed dose of either is meant to stabilize people and manage cravings so people can function and focus on recovery.

Suboxone is the first choice of opioid substitution therapy among physicians because it's safer than methadone, which can be dangerous outside of a prescribed setting.

The answer is not writing a prescription for Suboxone and everything is going to go away.-  Dr. Morris Markentin

"If you're opiate naive or have never taken opiates and you drink one dose of methadone it could actually end your life."

Like any drug, there is a chance methadone could end up in the wrong hands, he said. 

The Ministry of Health paid $1,570,828 for methadone and $247,936 for Suboxone in 2017-18. 

There were just over 4, 050 methadone clients and almost 700 Suboxone clients for the same time period. The numbers account for people who received at least one prescription. 

Last week, the province announced new federal funding would go toward training and recruiting health professionals to provide opioid substitution therapies, along with addictions counsellor and social workers. 

There are 71 doctors in Saskatchewan who can prescribe methadone for addictions and 46 who can prescribe Suboxone. Forty physicians can prescribe both.

Markentin says addictions treatment must go beyond a pill. 

"The answer is not writing a prescription for Suboxone and everything is going to go away," he said.

"Eighty percent of our clients on methadone or Suboxone have a diagnosis of a mental health illness, so depression, anxiety or post-traumatic stress and we don't have the supports for that."

Markentin says he's seen people stop using opioids, but "they're still not getting better, so they're self-medicating with crystal meth."

He says there needs to be more resources to treat addictions.

"I think Saskatchewan has been criticized outside of the province for not making Suboxone more readily available in primary care," said Dr. Peter Butt, an addictions expert in Saskatchewan. 

He, too, says opioid substitution therapies need to be one part of a recovery-oriented system and people should consider the social determinants of health. 

Ending addictions cannot solely fall on the prescriber, Butt says.

Full remission is defined as 12 months without use, he says, which means people need to have access to solid support system for at least one year. 

Butt says there are reported gaps in where to refer patients to once they are stabilized. He noted a lack of sober homes available for those in between detox and rehab.   

"We have people reportedly dying on our wait lists. We have problems, so we need to increase capacity, but I don't think this is something that lends itself to a really simple solution."

He says support could be offered with mental health group homes or virtual support groups, and added these could be funded by organizations other than the Ministry of Health. 

Furthermore, he says, cultural activities can be important to recovery as they "improve a greater connection to community and a very healthy and holistic way as well as improving the sense of pride in identity."