New Brunswick

Drug monitoring won't address causes of addiction, front-line worker says

The provincial government is working on the second phase of its long-awaited New Brunswick prescription monitoring program, aiming to give pharmacists the ability to see who may be misusing prescriptions for addictive drugs in real time.

Real-time drug monitoring coming for pharmacies, but province doesn't have an exact timeline

New Brunswick is working on the ability to monitor prescribing and dispensing of addictive drugs in real time. (CBC)

People who work with drug users are warning a prescription monitoring program the province is preparing to launch won't help fix the root causes of opioid addiction — and could create an even more dangerous drug problem.

The provincial government is working on the second phase of its long-awaited prescription monitoring program, aiming to give pharmacists the ability to see who may be misusing prescriptions for addictive drugs in real time.

"It identifies an issue, but ultimately we have to ask what the root cause of the issue is," said Lisa Frechette, a nurse practitioner who works with drug users at RECAP Saint John.

The clinic focuses on treating patients with Hepatitis C but also offers methadone treatment to about 200 people.

When prescription monitoring starts identifying more people who need help, Frechette isn't sure they'll be able to get it right away.

"I think we could do some more work to be ready for an influx of more people requesting opioid replacement therapy."

Not enough help

Lisa Frechette, a nurse practitioner at RECAP in Saint John, says drug monitoring doesn't fix the root causes of addiction. (CBC)
A CBC News investigation into the province's treatment system last year found a patchwork system that is confusing to navigate.

A person could wait days, weeks or months for treatment, while others may have to travel across the province for help.

Adding to that, Frechette said, is a lack of mental health services and safe housing for that same group of people.

"There's not enough capacity right now in the mental health system to help patients," she said.

Addiction treatment is on the list of the issues for the provincial government's opioid working group says it will tackle.

But the government hasn't said yet what exactly it will do to help treat people found to be misusing their prescription drugs — people who may find themselves suddenly cut off from addictive medication.

"There's no quick solution to any of this," Health Minister Victor Boudreau said earlier this month.

"We're going to have to continue to work with our various partners, whether it be our regional health authorities or the medical community, working with our community pharmacists to make sure we are there to provide that support."

Unintended consequences

Boudreau also said he doesn't have "an exact timeline" for when the prescription monitoring program would start raising red flags to indicate people who may be misusing the system.

This past winter, every pharmacy connected to one drug information system for the first time. But the system still can't flag when a person tries to fill a prescription at multiple pharmacies.

When in place, an electronic display will offer real-time alerts about prescribing and use of several drugs, including opioids like Dilaudid and other addictive prescription drugs, such as Ritalin and Ativan.

In the meantime, other areas have adopted prescription monitoring programs with mixed results.

In the United States, where 142 people die from drug overdoses every day, prescription monitoring may have pushed people to more unpredictable opioids such as heroin and fentanyl, according to the President's Commission on Combating Drug Addiction and the Opioid Crisis.

"As access to prescription opioids tightens, consumers increasingly are turning to dangerous street opioids, heroin, fentanyl alone or combined, and mingled with cocaine or other drugs," the commission wrote in a report this week.

'Like squeezing a balloon'

Alistair Bursey, a pharmacist-owner in Fredericton and chair of the Canadian Pharmacists' Association, believes drug monitoring will be a useful tool in fighting opioid addiction. (CBC)
Nova Scotia has had a prescription monitoring program for more than two decades, but it has been criticized by addiction workers and by Nadine Wentzell, one of its creators.

Wentzell said it went "off the rails" and wasn't doing what it was supposed to do.

She believes New Brunswick's program won't be foolproof but it could avoid the same pitfalls, if the program is reviewed often.

But she, too, acknowledged it won't fix New Brunswick's opioid problem.

"It's like squeezing a balloon," said Wentzell, a consultant now helps develop workplace drug and alcohol programs.

"If people who are using a substance can't get it through the means they normally have been, they'll move to some other. It could be heroin, it could be cocaine."

Doctors, pharmacists support prescription monitoring

Nadine Wentzell, a pharmacist who helped design Nova Scotia's prescription monitoring program about 20 years ago, says it isn't doing what it's supposed to do. (CBC)
Other groups, like doctors and pharmacists, believe prescription monitoring will help.

The New Brunswick Medical Society has said it could help curb opioid over-prescribing by doctors.

The system will give pharmacists more information at their fingertips to better treat patients, according to Alistair Bursey, a New Brunswick pharmacist who chairs the Canadian Pharmacists' Association.

The idea, he said, is pharmacists can intervene if they spot patients abusing the system.

"We need technology to be smart and enable practitioners like pharmacists to be able to make a difference in this opiate crisis that's going on," Bursey said.