More and more patients addicted

Archival Photo Chantal Poirier
To wean patients addicted to opioids, doctors often prescribe a substitution treatment with methadone (photo above). In the table above, the data include prescriptions and the street drug.

Héloïse Archambault

Wednesday, 19 July 2017 06:30

UPDATE
Wednesday, 19 July 2017 06:30

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While prescriptions of opioids, these powerful medications, which treat pain, have increased by 22 % in just three years in Quebec, doctors are concerned to see more and more patients become addicted.

“It’s a little scary, the data, it goes up again,” reacts Dr. Marie-Ève Goyer, a family doctor specializing with patients who have addiction.

“There is a new epidemic of opioid that you didn’t have before,” she said.

From 2013 to 2016, the total number of prescriptions for five opioids (fentanyl, hydromorphone, morphine, methadone, and oxycodone) increased from 2 million to nearly 2.5 million (+22 %). This balance sheet has been compiled by

The Newspaper, thanks to data from the Régie de l’assurance maladie du Québec (RAMQ).

Last year, the invoice for these five drugs has reached$ 52.9 Million (see tables on page 4). Hydromorphone (+34 %) and morphine (+32 %) achieved the highest increases in orders. Although the population ageing, this aspect can not explain by itself this phenomenon.

Dependency

While fatal overdoses of opioids (including fentanyl) wreak havoc with drug addicts in parts of the country, the opioids prescribed by physicians quebec also create an addiction that many struggle to overcome.

Usually, these powerful opiates are given to patients after surgery or for chronic pain (back pain, arthritis, etc). However, doctors are seeing more and more patients become downright addicted to their medication.

“Over the past 10 or 15 years, there has been a trivialization of the treatment of chronic pain, and pharmaceutical companies say that it was not addictive, said Dr. Jean-Pierre Chiasson, specialized in the field. The more we gave of opioids, more patients had poorly. It is a complex, chronic diseases, and it is multi-factorial. “

“Euphoria “

“It’s not just profits. It creates side-effects, a certain euphoria that goes beyond the physical relief. Lots of people have become dependent, ” says as Dr. Goyer.

“Their life becomes centred on their narcotics. They’re going to see three or four doctors, insist with the pharmacist, ” she said.

Moreover, the colleges want to improve the control of prescriptions.

“But the epidemic is made. You can’t go back, ” says Dr. Chiasson.

When a patient is addicted, a methadone treatment is available to counteract the addiction. Often, the patient takes this medicine for the rest of his life. The requirements for this treatment has increased from 14 % in three years.

“This is not a bad news. But it explains that, unfortunately, we were forced to counteract the effect of the last few years, ” said Dr. Yves Robert, Collège des médecins du Québec (CMQ). To date, 323 physicians have a exemption from the CMQ to prescribe methadone, which causes delays.

“The doctors are starting to be better aware of the risks, said Dr. Goyer. […] But there are still a lot of years before you catch up with all of these patients, and that they may see the benefits. “

Not a better way to intervene

Aware of the dangers associated with opioids, the professional orders of doctors and pharmacists want to provide better guidance on the prescription, and are demanding better access to data.

“What is frustrating is that we are to blame for not intervening. It is the sheer frustration “, responds Dr. Yves Robert, secretary of the Collège des médecins du Québec (CMQ).

“We want to monitor what is happening “, said Bertrand Bolduc, president of the Ordre des pharmaciens du Québec (OPQ).

Well aware of the growing problem related to opioids, these colleges want to have access to the data of the prescriptions of their members. However, the current law of access to information does not allow them to view these data, and the government will have to legislate to change the situation.

“We want to be the data in real-time orders. […] The goal is to ensure that there are no burdensome requirements, and physicians and pharmacists deviant, ” says Dr. Robert.

“We need to better protect the public,” judge said.

“Red light “

“We are encouraged because the minister [responsible for Access to information] is favorable. But, it is not done in 15 minutes, ” says Mr. Bolduc.

According to the professional orders, one of the solutions is to split up the doses of opioids given by the pharmacist to the patient.

“An prescription, this is not an obligation, it is an authorization, said Mr. Bolduc. Pharmacists can refuse it. There are categories of drugs with a high risk, including opioids. It turns on the red light. “

Moreover, the problem of fatal overdoses elsewhere in the country will soon touch the Québec, is afraid of the CMQ.

“The question is not whether [it will come], but when and at what speed,” says Dr. Robert. It was a golden opportunity to do the prevention before the street drug comes. “

Already, the CMQ has been working with the faculties of medicine to improve the training of future professionals.

Death by accidental intoxication with opioids in Quebec

• 2015 : 133*
• 2014 : 147
• 2013 : 117
• 2012 : 123
• 2011 : 101
• 2010 : 75
• 2009 : 82
• 2008 : 88
• 2007 : 68
• 2006 : 65
• 2005 : 62

Source : Bureau du coroner du Québec *incomplete

Prescriptions of opioids in Quebec

The requirements refer to the Number of times a pharmacist has provided medication to a patient

Hydromorphone

Number of prescriptions

• 2016 : 1 021 249
• 2015 : 936 176
• 2014 : 847 402
• 2013 : 760 877

+34 %

Patients segregated

• 2016 : 158 916
• 2015 : 148 384
• 2014 : 136 971
• 2013 : 125 658

+26 %

Total cost

• 2016 : 21 567 473 $
• 2015 : 20 404 635 $
• 2014 : 19 178 328 $
• 2013 : 17 703 238 $

+22 %

Morphine

Number of prescriptions

• 2016 : 480 807
• 2015 : 436 523
• 2014 : 405 400
• 2013 : 363 724

+32 %

Patients segregated

• 2016 : 111 280
• 2015 : 105 804
• 2014 : 101 434
• 2013 : 93 398

+19 %

Total cost

• 2016 : 5 701 238 $
• 2015 : 5 243 475 $
• 2014 : 5 027 398 $
• 2013 : 4 627 865 $

+23 %

Methadone (pain*)

Number of prescriptions

• 2016 : 53 469
• 2015 : 50 291
• 2014 : 44 094
• 2013 : 48 465

+10 %

Patients segregated

• 2016 : 2447
• 2015 : 2310
• 2014 : 2157
• 2013 : 2238

+9 %

Total cost

• 2016 : 1 481 140 $
• 2015 : 1 422 171 $
• 2014 : 1 334 534 $
• 2013 : 1 394 172 $

+6 %

Methadone (addiction*)

Number of prescriptions

• 2016 : 337 471
• 2015 : 309 654
• 2014 : 313 902
• 2013 : 294 938

+14 %

Patients segregated

• 2016 : 3866
• 2015 : 3578
• 2014 : 3473
• 2013 : 3398

+14 %

Total cost

• 2016 : 5 263 779 $
• 2015 : 4 801 335 $
• 2014 : 4 832 891 $
• 2013 : 4 505 586 $

+17 %

* Methadone is prescribed for two types of treatment: the pain and the treatment of addiction to opioids or drugs.

Oxycodone

Number of prescriptions

• 2016 : 425 520
• 2015 : 416 499
• 2014 : 421 073
• 2013 : 417 931

+2 %

Patients segregated

• 2016 : 58 321
• 2015 : 59 176
• 2014 : 62 275
• 2013 : 61 955

-6 %

Total cost

• 2016 : 9 680 528 $
• 2015 : 10 075 307 $
• 2014 : 11 140 142 $
• 2013 : 11 578 714 $

-16 %

Fentanyl

Number of prescriptions

• 2016 : 176 985
• 2015 : 176 241
• 2014 : 175 115
• 2013 : 164 545

+8 %

Patients segregated

• 2016 : 15 991
• 2015 : 16 520
• 2014 : 16 883
• 2013 : 16 516

-3 %

Total cost

• 2016 : 9 184 791 $
• 2015 : 9 298 440 $
• 2014 : 9 213 367 $
• 2013 : 8 921 330 $

+3 %

Total prescriptions of opioids*

• 2016 : 2 495 501
• 2015 : 2 325 384
• 2014 : 2 206 986
• 2013 : 2 050 480

+22 %

Total cost of prescriptions of opioids

• 2016 : 52 878 949 $
• 2015 : 51 245 363 $
• 2014 : 50 726 660 $
• 2013 : 48 730 905 $

+9 %

*includes : fentanyl, hydromorphone, morphine, methadone, and oxycodone

Source : Régie de l’assurance maladie du Québec