British ColumbiaTHE FENTANYL FIX

The pill to manage addiction: why so few doctors are prescribing Suboxone

It's proven to be incredibly effective, but its complex nature makes some doctors hesitant to prescribe it

Farrah Merali - CBC News

January 31, 2017

Suboxone is a form of opioid replacement therapy that helps block opiate withdrawal symptoms and heroin cravings. (Getty Images)

It's a drug that's revolutionized opioid addiction treatment and is credited with saving thousands of lives in British Columbia: Suboxone is a form of opioid replacement therapy that's become more common in recent years alongside methadone.

As the province grapples with the overdose crisis, more and more addictions specialists are turning to it as option to treat those addicted to drugs like fentanyl.

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Despite its effectiveness, a small percentage of doctors in B.C. prescribe the drug or even know how to.

The complex nature of Suboxone and the shortage of those trained to administer it are just some of the barriers to the drug being more widely distributed than it is in B.C.

How it works

There are two active ingredients in Suboxone — buprenorphine and naloxone — that reduce cravings and symptoms of opioid withdrawal.

The drug was developed for the treatment of pain, but in the 90s began being used as a treatment for addiction in France.

Twenty per cent of doctors in the country were allowed to prescribe the drug without special training or a licence, and within the span of four years, there was a nearly 80 per cent reduction in overdose-related deaths.

"Suboxone has been a godsend for us in addiction medicine," said Dr. Lloyd Westby, a family doctor in Pentiction who specializes in addictions treatment.

Westby worked as a doctor in Vancouver's Downtown Eastside before opening his practice in Penticton. He's spent decades treating patients who suffer from opioid addiction.

"Suboxone is saving lives of people that are 20, 30, 40 years old. When you save the life of a 20-year-old, you've saved 60 years of human life."

But it's complicated

Dr. Mark McLean is the medical lead of the Rapid Access Addictions Clinic, which opened four months ago at St. Paul's Hospital in Vancouver.

Buprenorphine and naloxone are the active ingreidents in the drug Suboxone which is adminstered in a pill format.

The clinic provides immediate treatment to those seeking help for various types of addiction.

Anyone can walk in and be treated, and every week between 50 and 70 people arrive in varying states of withdrawal. Part of their treatment is the administration of Suboxone.

"We really are encouraging physicians to take up this practice," said McLean.

But he estimates less than three per cent of doctors are prescribing methadone or Suboxone.

McLean said the complexity of the drug is one reason why some doctors are hesitant to prescribe it: it can only be taken during a specific stage of withdrawal. Otherwise, it can cause severe sudden withdrawal.

"If you do have that occur in your patient it's very unpleasant, often to such an extent they refuse to take it again," said McLean.

Dr. Mark McLean is the medical lead at the Rapid Access Addictions Clinic at St. Paul's Hospital. He says there's a shortage of addictions trained physicians in B.C. (Jacy Schindel)

More generally, McLean said many general practitioners simply don't have the desire to take on patients who suffer from addictions as they sometimes have other health issues and take more time.

"And quite frankly, physicians to a large extent are paid a fee for service and they may have a preference to serve patients that don't take much time."

More doctors keen to get educated

McLean said this month his clinic trained 120 physicians in addictions treatment and the administration of drugs like Suboxone.

"We're thinking at least some of those physicians will turn into longer term subscribers and we hope that'll have an impact out there," said McLean.

Similarly, Westby travels the province teaching other doctors and health practitioners about the drug and said there's been strong attendance at the lectures.

"The interest level is fabulous and these talks are all very well attended," said Westby.

"I think people realize we really have a big problem going on and this drug is available."

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