Quebec looking at ways to curb prescription drug abuse

Ontario recently announced its public drug plan would no longer cover certain doses of opioids. It's still up in the air whether Quebec will follow suit.

Will Quebec follow Ontario and cut public coverage of certain painkillers?

High doses of morphine (pictured), hydromorphone and fentanyl will no longer be covered under Ontario's public drug plan, a move Quebec's health minister said may or may not be copied here. (Vahid Salemi/Associated Press)

Rather than following Ontario's lead and discontinuing public coverage to curb prescription opioid addiction, Quebec's health minister said he favours educating doctors about the risks of overprescribing the drugs.

Quebec Health Minister Gaétan Barrette told CBC Montreal's Daybreak some doctors are too quick to prescribe opioids instead of less-addictive medications.

"Many patients will go to the doctor for a simple procedure and get opioids afterwards for 10 days. Already at that point they will begin being dependent," he said.

Earlier this week, Ontario announced that its public drug plan will no longer pay for higher doses of morphine, hydromorphone and fentanyl in an attempt to address the growing problem of addiction to prescription painkillers.

Opioids are a family of drugs that are typically used to treat pain, but are also known for giving users a feeling of euphoria, making them addictive.

Right now in Quebec, any dose of prescription narcotics or opioids like codeine, methadone, and oxycodone will be paid for by the province.

A report released in 2013 by Quebec's public health research institute stated that, in the five-year period from 2000 to 2004, there were 82 fatal overdoses from medical opioids. From 2005 to 2009, that number rose to 139, a 70 per cent increase.

The report says the up tick is part of a trend that doesn't appear to be subsiding.

Just one of the many types of fentanyl patches available in Quebec. Fentanyl is a powerful opioid painkiller that is usually used to treat chronic pain. (Tracey Lindeman/CBC)

Barrette, who is also a trained health professional, said though opioid addiction is a growing problem in Quebec, it's more problematic in other provinces like British Columbia.

He said he is watching the situation to see how it develops, but pointed out opioids are still useful to treat patients in severe pain and measures to regulate their prescription would have to allow exceptions for patients who need the higher doses.

Quebec's college of physicians says it will be consulting its members on the issue this fall and it may recommend measures similar to Ontario's to the health minister in the coming months.

A growing problem

Dr. Yoram Shir, director of the McGill University Health Centre's Alan Edwards Pain Management Unit, said he believes Quebec should have a limit with exceptions built in.

He said the measure would likely help curtail mortality rates more than addiction rates.

"I think it will not reduce addiction, because addiction is not determined just by dose. Addiction is the attitude of the patient towards the medication," he said.

Ontario health care will cap its coverage for doses of narcotics equivalent to 200mg of morphine. Should Quebec follow suit? Daybreak speaks to Dr. Yoram Shir from the MUHC's Alan Edwards Pain Management Unit. 8:30

Jeremy Wexler, a social worker at the Herzl Family Practice Centre in Côte-des-Neiges, said 15 to 20 years ago their clients were mostly addicted to heroin.

This year, 30 to 40 per cent of the people who have contacted them or been admitted to the centre were abusing prescription opioids.

Wexler said he believes imposing a limit on prescribed narcotics eligible for the public health plan would be a worthwhile tool, but fears the measure singles out those without private insurance.

"If I have the money to pay out of pocket, or if I have an insurance plan that will cover my opiates, it sort of says 'go to town,'" he said.

Both Shir and Wexler agreed with Barrette, saying educating doctors about opioids must be central to any plan to curb addictions and deaths.

with files from CBC Montreal's Daybreak