Sask. lacks doctors willing to prescribe methadone, opioid therapies, experts say

Experts are calling for more family doctors to prescribe methadone and suboxone in order to treat opioid addiction in Saskatchewan.

Nurse practitioners on track to start prescribing methadone

Julia Bareham manages the prescription review program for Saskatchewan's College of Physicians and Surgeons. She wants to see all family physicians become prescribers of methadone or another opioid substitute. (CBC News)

Less than 10 per cent of family doctors in Saskatchewan can prescribe a drug that can help those trying to kick an opioid addiction and are struggling with dependence. 

Two experts are calling for more family doctors to offer opioid substitution therapy, which means they can prescribe methadone to patients or its alternative, buprenoprhone/naxolone — a combination drug that goes by the brand name suboxone — and is touted as safer. Both drugs help patients cope with withdrawal symptoms and cravings for opioids.

In order to become a prescriber, doctors in the province must meet certain requirements set out by the college, such as completing a day or two of training. 

Every family doctor should prescribe methadone

Doctor breakdown in Saskatchewan

As of March 2018, there were 1,371 family physicians and 1,268 specialists for a total of 2,639 doctors in Saskatchewan. 

The College of Physicians and Surgeons says that as of Sept. 12, 2018, 23 physicians were authorized to prescribe methadone for opioid addiction and 47 doctors were authorized to prescribe for both pain and methadone.

The college also lists 55 physicians who are authorized to prescribe buprenoprhone/naxolone, which is sold under the brand name suboxone.

"I would like to see the number of opioid antagonist therapy prescribers to be the equivalent to the number of licensed [family] physicians here in Saskatchewan," said Julia Bareham, who oversees the prescription review program for Saskatchewan's College of Physicians and Surgeons.

She noted there has been a slow uptick of doctors becoming prescribers of either methadone or suboxone over the past few years, but she wants to see a greater increase.  

"Opioid use disorder and substance use disorder is a health condition like any other health condition," Bareham said, adding that those suffering from it deserve to be able to find treatment the same way other patients can be treated for their ailments.  

"I think we've got a bit of work to do in terms of the stigma that we still place on individuals who may use drugs in this manner and we need to work toward improving that," she said. 

More family doctors prescribing could alleviate wait lists

Dr. Peter Butt, an opioid addictions and treatment expert based in Saskatoon, said he's encountered patients and families unable to find a doctor to provide them with methadone or suboxone. 

Dr. Peter Butt, an opioid addictions expert in Saskatchewan, says if more family doctors become prescribers of methadone or suboxone, it could alleviate wait lists. As well, he said rapid care clinics could be established near emergency room hospitals to provide more treatment to those suffering from opioid dependence. (CBC)

He is currently involved in an opioid therapy program in Saskatoon operated by the Saskatchewan Health Authority and believes if more family physicians prescribed opioid antidotes it would alleviate wait lists and build capacity to treat those who come into emergency rooms. 

"People need to have access, and they don't," he said.     

There are several factors for why more doctors don't prescribe opioid substitute, he said. Besides the stigma associated with addiction, Butt cites a lack of education in family medicine as well as the "patchwork" way of dealing with addiction in the provincial healthcare system, from the point of detox to preventing someone in recovery from relapsing.

"There should be no wrong door when people pitch up with a substance use disorder issue. We should be able to refer them, help them get into care and then maintain that care over time until they're doing better," he said.

Butt added that a specialized clinic can first stabilize a user seeking opioid substitute, and then transfer them to a family doctor to continue their care. He says up to 33 per cent of his clients could be transferred to general physicians, making more room for those who have more severe challenges.

In a statement to CBC News, Minister of Health Jim Reiter said he's committed to ensuring all residents have access to their required health services, but pointed out the college is responsible for supporting and recruiting doctors to become prescribers of methadone and suboxone. 

He added doctors must go beyond writing a prescription and include having to refer a patient to other support services and manage other dependencies. 

Nurse practitioners could fill gap

Nurse practitioners in Saskatchewan could soon start prescribing methadone following a vote back in May by the Saskatchewan Registered Nurses Association. 

Jayne Naylen Horbach, interim executive director and registrar, said Thursday that the bylaw will be official as of Friday, but the regulatory scheme is still being developed with the plan being for nurse practitioners to have to undergo some training before becoming a prescribers. 

Currently, there are 256 nurse practitioners are currently on the registrar, she said, adding the plan would be presented to the association's council later this year or in early 2019. 

About the Author

Stephanie Taylor

Reporter, CBC Saskatchewan

Stephanie Taylor is a reporter based in Saskatchewan. Before joining CBC News in Regina, she covered municipal politics in her hometown of Winnipeg and in Halifax. Reach her at stephanie.taylor@cbc.ca

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