Sask. 2nd highest province for fentanyl prescriptions

In 2016, Saskatchewan pharmacists dispensed more fentanyl prescriptions than almost every other province in the country, according to new data from the Canadian Institute for Health Information (CIHI).

'Our prescribers are left with very few options,' says Julia Bareham of College of Physicians and Surgeons

Boxes of fentanyl patches are seen at a pharmacy in Laval, Que., on Thursday, January 26, 2017. Saskatchewan pharmacists dispensed more fentanyl prescriptions than all provinces except for Quebec. (THE CANADIAN PRESS/Ryan Remiorz)

Saskatchewan pharmacists dispensed more fentanyl prescriptions than almost every other province in the country last year, according to data from the Canadian Institute for Health Information (CIHI). 

​If residents had "access to better specialized and multidisciplinary services we'd do better for them in their pain care," said Julia Bareham. She's the pharmacist manager with the Prescription Review Program at the College of Physicians and Surgeons of Saskatchewan. 

These should be medications of last resort when everything else has failed.- Julia Bareham

"Everyone says non-drug measures — exercise, physio , massage — should all happen first. How do you deal with that with a patient who is dealing with poverty and can't pay," she said.

"Yet because of their income level, they're insured through the province for their medication." 

Bareham saw a notable shift when therapies like chiropractic services were no longer funded for everyone by the government.

She said the gap between patients and alternative pain management options is growing.

"Our prescribers are left with very few options."

The Canadian Institute for Health Information (CIHI) released a report titled Pan-Canadian Trends in the Prescribing of Opioids, 2012 to 2016. It shows Saskatchewan pharmacists dispensed more fentanyl prescriptions than almost all of the other provinces. (Canadian Institute for Health Information)

Health Minister: statistic 'concerning'

The province came in second in fentanyl prescriptions to Quebec, with 22.4 prescriptions dispensed per 1000 Saskatchewan people in 2016. 

"Anytime we're near the top in a troubling statistic, it's concerning," Health Minister Jim Reiter said.

He said the Ministry of Health provides funding to the College of Physicians and Surgeons of Saskatchewan so it can monitor prescriptions. 

"You never want to have the higher numbers," Bareham said. "I'm happy to see it's a downward trend however, that we're at least moving in the right direction."

The number of dispensed fentanyl prescriptions per 1000 population in Saskatchewan has declined over the last five years. 

Fentanyl is 50-100 times more potent than morphine and the strongest opioid used outside of the hospital. (Graeme Roy/Canadian Press)

Fentanyl is prescribed via patches in the province, a method Bareham said is easier for weak, physically traumatized and elderly patients. A patch is put on the patient once every three days for pain management.

"These should be medications of last resort when everything else has failed."

Patches over pills 

Bareham said she isn't concerned that doctors are over-prescribing fentanyl because the crisis happening in other parts of the country isn't happening here. 

"I find our greatest challenge in Saskatchewan is hydromorphone."

It's the strongest opioid next to fentanyl and is prescribed in a tablet or capsule form. 

She said fentanyl prescriptions are typically ten patches for thirty days, but with hydromorphone people could be getting 60 to more than a hundred pills for the same time period. 

"At least the fentanyl patch limits or lessens rather the amount of drug that can be diverted."

That doesn't mean prescribers aren't mindful there is a risk the drug will end up in the wrong hands, Bareham said. 

Still, she said the goal isn't to cut back because prescribers don't want to limit patients who need it, but new guidelines can help prescribers monitor and assess each circumstance better.

"Our goal is more so to ensure that when we are using any of these opioids, we're using them appropriately and safety."

Bareham noted the current data creates challenges.

"We can't tell who is appropriately on a medication, who's abusing it, who's selling it," she said.

"I don't know if that's a good number or a bad number, because I'm not sure who it's representing."

Julia Bareham said Saskatchewan's population is getting younger, whereas most people prescribed opioids are over the age of 65. She added Saskatchewan did not lead the pack amongst other opioids noted in the report. (CBC)

She added that while the numbers show a trend, they don't tell the whole story. 

Saskatchewan also had the largest number of defined daily doses per 1,000 people. That's the amount a doctor recommends taking in a day and varies depending on patient profile and symptoms.