British Columbia·CBC Investigates

'Outdated' restrictions on Suboxone making B.C.'s overdose crisis worse: report

A new report blames B.C.'s College of Physicians and Surgeons for not lifting "barriers" to Suboxone, a prescription drug that could dramatically reduce overdose deaths amid a public health emergency.

Researchers urge widespread access to drug that cut overdose deaths by 80% in France

A collage of recent fentanyl overdose victims in B.C. (CBC)

A new report blames BC's College of Physicians and Surgeons for not lifting "barriers" to Suboxone, a prescription drug that could dramatically reduce overdose deaths amid a public health emergency.

"In the context of a dramatically escalating overdose epidemic, we'd like to see quicker movement," said Dr. Thomas Kerr, who co-authored a report for the Canadian Research Initiative on Substance Misuse.

It urges the college to remove "outdated" restrictions on a pill considered six times safer than methadone.

Suboxone is considered six times safer than methadone and stops opiate withdrawal symptoms and heroin cravings. (Getty Images)

Suboxone reduces cravings for opioids, prevents withdrawal symptoms and includes naloxone, which counters the effects of the drug and precipitates withdrawal if the pill is crushed and misused via intravenous injection.

Suboxone's deregulation in France in 1995 is credited with an 80 percent reduction in fatal opioid overdoses, which is why the report's authors want it made widely available in BC immediately.

Deaths could be reduced 

"We have seen, in France, very large reductions in overdose deaths following the widespread roll out of Suboxone" said Kerr.

"Major barriers" keep B.C. addicts from using Suboxone, because only doctors who are allowed to prescribe methadone can prescribe it.

BC's restrictions on Suboxone are "not consistent with the safety evidence we reviewed worldwide" says addiction specialist Dr. Thomas Kerr. (BC Centre for Excellence in HIV/AIDS)

And even if an addict finds a specialist, the college's website specifies "daily witnessed ingestion for the first two months" so addicts must attend a pharmacy daily,  even though Health Canada lifted that requirement when the product monograph was updated nearly two years ago.

Recommendations include: 

  • Allowing all BC doctors to prescribe Suboxone
  • Removing the two-month, daily-witnessed ingestion guideline
  • Suboxone as the first line of treatment over methadone

Seventy-three doctors, including Kerr, signed a report making the same suggestions six month ago.

Since that report, 320 more people have died from overdoses, while a panel of experts at the College continues to review Suboxone policy.

College says revisions coming soon

"We're all working collaboratively and as quickly as we can," said Dr. Ailve McNestry, deputy registrar of the College of Physicians and Surgeons of B.C.​

She says a panel of experts — including ministry of health officials decided in February to allow all doctors to prescribe Suboxone; but not until they rewrite the guidelines.

That committee only meets four times a year, and McNestry expects changes by the end of June.

Jordan Miller, 25, died in February 2014 from a prescription drug overdose, soon after detox. (Leslie McBain)

"It was our joint decision that the way we go forward is that we would revise the guidelines, and they would remove the technical barrier in PharmaNet" said McNestry. 

She says any doctor who wants to prescribe Suboxone can request a temporary exemption and give immediate "carries," which is a prescription the patient can take at home.

"I don't see this as a huge barrier ... right now today there is nothing to prevent a physician from prescribing carries at their clinical discretion."

 'What in the hell are they waiting for?'

Several families and addiction doctors have told CBC few doctors are willing to do that.

"No one would give Jordon a Suboxone prescription" says Leslie McBain,  who lost her son to an an overdose in 2014.

Leslie McBain (right) and Carl Miller hold a photo of their son, Jordan, who died of an opioid overdose in 2014. (mumsdu.com)

McBain founded  "Moms Stop the Harm" which is lobbying the college to allow widespread access to Suboxone.

"What in the hell are they waiting for? As they hedge on this, people are dying" she said.

2016 death toll could hit 800

"It is a little frustrating. We're seeing so much harm related to untreated opiate addiction ... if you look at the numbers of people who are dying" said Dr. Keith Ahamad, who co-authored the report and predicts overdose deaths could rise by 67 per cent in 2016, to as many as 800.

Illicit drug overdose deaths in B.C., January 1 2007–April 30 2016. ( Office of the Chief Coroner of BC. Released May 3, 2016.)

"It would literally be like two or three 747 jumbo jets crashing in British Columbia filled with young people ... dying of a preventable illness" he said.

It would literally be like two or three 747 jumbo jets crashing in British Columbia filled with young people ... dying of a preventable illness.- Dr. Keith Ahamad , a ddiction  specialist, research scientist

"In the context of skyrocketing overdose deaths ... it's unacceptable. We need to move quickly to improve access to life saving treatment," said Ahamad.

Data from around the world shows that Suboxone has good scientific evidence that it's life saving" said Dr. Keith Ahamad, research scientist, B.C. Centre for Excellence in HIV/AIDS (B.C. Centre for Excellence in HIV/AIDS)

"The requirement that doctors have a special licence to prescribe a medication that is very safe ... I don't think is rooted or founded in good scientific evidence" said Ahamad, who suggests any doctor who completes a short online training course should be allowed to prescribe Suboxone.

Elyse, "Izzy" Bailey, died Dec 23, 2015, after buying heroin that turned out to be fentanyl. (Rhonda Dent)

Suboxone could have saved daughter

Debra Bailey says her daughter might still be alive if her doctor had been willing to let her "carry" her pills, rather than make daily, humiliating trips to the pharmacy.

Debra and Edward Bailey watch a DVD played at their daughter's funeral in January, 2016. (CBC)

"I don't think she would have been looking for heroin that day if she'd been on Suboxone" said Bailey of the day Izzy Bailey, 21, died of a fentanyl overdose on December 23, 2015.

Bailey recently wrote the college to demand improved access to Suboxone.

"I'm frustrated that it's taking so long ... I think people's lives could be saved."

Terry Lake, B.C.'s Minister of Health, wants faster access to Suboxone for addicts. (CBC)

"I would have preferred everything to have been sooner," said Terry Lake, B.C.'s minister of health.

He says he has told the College the report's recommendations should be implemented by July.

"We're pushing as hard as we can, but we have to respect the autonomy of the regulatory body."  


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