Nfld. & Labrador

Opioid prescriptions 'drying up,' doctor concerned where patients will turn

Prescriptions for pain pills in the St. John's have become scarce since a rash of overdoses from the deadly opioid fentanyl, says a top doctor.

Illegal drug users are street savvy; prescription users are often not, warns Dr. Bruce Hollett

Addictions doctor Bruce Hollett says prescriptions for opioids have 'dried up' since fentanyl hit the streets and overdoses began mounting. (CBC)

Prescriptions for pain pills in St. John's have become scarce since a rash of overdoses from the deadly opioid fentanyl, says an addictions doctor.

Bruce Hollett, divisional chief of family medicine, chronic pain and addiction at the Waterford Hospital, is concerned with where patients will turn when their prescription is not renewed.

"Here in the last three weeks in St. John's, a lot of the prescriptions for opioids have started to dry up," he said during a Facebook live special with CBC.

Fentanyl, a synthetic opioid painkiller, is estimated to be around 50 to 100 times more toxic than morphine. (CBC)

"What ends up happening is they find out it's being abused, they stop it immediately, and then the person is left [wondering] where do I go?"

People have augmented their income or supported drug habits by the "rule of thumb," Hollett said — keeping one third of the pills for themselves and selling the rest.

Even though there will be fewer prescription pills on the street, Hollett anticipates overdoses and deaths will continue at the same rate — or higher.

There have been 21 reported overdoses and one death related to fentanyl in the metro St. John's area since April 1, according to Eastern Health.

Prescriptions go down, deaths go up

In March 2016, the American Centers for Disease Control and Prevention introduced new guidelines for prescribing opioids.

Street naive individuals started going into the street.- Dr. Bruce Hollett

Those guidelines included lower doses for patients — a maximum of 90 milligrams per day, Hollett said.

Four Canadian provinces, including Newfoundland and Labrador, immediately followed suit and endorsed the guidelines.

While the number of prescriptions plummeted, Hollett said, the death rates increased.

Pain patients had developed addictions and turned to other methods to get their fix.

Dr. Bruce Hollett says Purdue Pharma led the charge in the opioid epidemic with their drug, OxyContin. (Douglas Healey/Associated Press)

"Street naive individuals started going into the street," Hollett said.

He points to the seizure of fentanyl packed into fake percocet pills found across Canada, and here in this province.

While a street drug user might know the difference between a fake pill and a real one, Hollett said someone who usually gets their fix from a pharmacy might not.

Overprescription a longtime issue

While prescriptions are becoming sparse in St. John's, it hasn't always been that way, Hollett said.

He recalls receiving a fax in 1997 promoting the prescription use of opioids by saying doctors could cure pain without sparking addiction.

He blames drug manufacturer Purdue for leading the charge, with drugs like OxyContin.

Suboxone is considered to be a safer addiction treatment drug than methadone. (Ed Ou/CBC)

The prescriptions not only started a destructive habit for the patients, he said, but also for the doctors prescribing them.

Even though it was widely recognized there was an opioid addiction epidemic, Hollett said doctors continued to prescribe them.

"It's difficult to get physicians to do things," Hollett said. "Once they do, it's difficult to get them to stop."

Government eyeing options

During the live special, Health Minister John Haggie said the provincial government is trying to improve ways to care for people with opioid addictions.

He pointed to St. Paul's Hospital in Vancouver, where patients who do not need emergency attention or a hospital bed can go to a 24/7 detox area with comfortable chairs, a welcoming environment and a dose of suboxone — an anti-addiction drug deemed safer than methadone.

Health Minister John Haggie says the province is considering several options to help with the current opioid crisis. (CBC)

Haggie also said the province is looking at improving the continuing care for a patient who comes to the emergency room for a drug-related matter, but is not ready to face their addiction.

"We're getting there," he said.

"We're not there yet. We're trying to get ahead of the wave. That's sometimes difficult because the wave keeps changing speed."

With files from Ariana Kelland