A novel approach to treating opioid addiction in British Columbia is attracting major international attention after being reviewed and featured in the prestigious Journal of the American Medical Association (JAMA). A Guideline for the Clinical Management of Opioid Addiction, a first-of-its-kind in Canada, aims to improve health professionals’ knowledge of the range of evidence-based treatments available for opioid addiction, one of the most challenging forms of addiction facing the health care system today. Untreated opioid addiction is a major driver of the recent surge in illicit drug overdose deaths, which prompted B.C.’s Provincial Health Officer, Dr. Perry Kendall, to declare a public health emergency earlier this year.
In the absence of evidence-based recommendations, dangerous practices like offering medical detoxification as an isolated strategy have been common for many years whereas methadone has been the primary first line medication for treating opioid addiction. With support from the Province of British Columbia, the guidelines were developed to articulate the diversity of possible treatment options that can be staged and tailored to individual patient needs. The guideline’s unique suggestions include recommending buprenorphine/naloxone (trade name Suboxone®), as the preferred first-line treatment for opioid addiction.
According to research summarized in the guidelines, Suboxone® is six times safer than methadone in terms of overdose risk, and permits more flexible “take home” rather than pharmacy dosing. The guidelines support using a stepped and integrated care approach where treatment intensity is continually adjusted to match individual patient needs and circumstances over time, and recognize many individuals may benefit from the ability to move between treatments.
“By incorporating principles of evidence-based medicine into addiction care, the province has the potential to realize a dramatic reduction in the public health and community concerns arising from untreated addiction,” said Dr. Evan Wood, guideline committee chair and Professor of Medicine at the University of British Columbia, Medical Director of Addiction Services at Vancouver Coastal Health and Providence Health Care, and Director of the Urban Health Research Initiative at the BC Centre for Excellence in HIV/AIDS. In August 2014, Health Minister Terry Lake announced an initial $3 million investment to support Dr. Wood’s research, education and clinical care guidance program in an effort to harness new ways to treat addiction and related health concerns. The guidelines are one example of the foundational work made possible through this partnership.
“It is great to see our investments in improving the addiction system of care are generating international recognition and, given the seriousness of the opioid overdose crisis, there is an urgent need to expand this work provincially and move on recent changes that have been made to improve access to evidence-based treatment,” said B.C. Health Minister, Terry Lake.
Most recently, in order to expand patient access to opioid addiction treatment in the province, the College of Physicians and Surgeons of B.C. lifted restrictions on prescribing Suboxone®. This regulatory change has been recommended by health researchers in the Canadian Research Initiative in Substance Misuse (CRISM), who issued a report calling for improved access to evidence-based treatment for opioid addiction as a strategy to address the provincial overdose crisis. Credited with an 80 per cent reduction in fatal opioid overdoses in France, Suboxone® can now be prescribed by primary care and generalist physicians in B.C.
“I’m pleased to see the province’s approach to addiction is moving towards one where care providers can be guided by the best available evidence for the prevention and treatment of addiction,” said Leslie McBain, community advocate and founding member of Moms Stop the Harm, whose son Jordan died of a prescription drug overdose. “If these new policies and expert guidelines were available provincially when my son was struggling with addiction, we may have been successful in our efforts to identify a physician who could provide life-saving treatment.”
The opioid addiction treatment guidelines were developed by an interdisciplinary committee comprised of individuals from Vancouver Coastal Health, Providence Health Care and representatives from the B.C. Ministry of Health. The guidelines were subsequently peer-reviewed by patient and family groups as well as local and international experts in the field. Authors of the opioid addiction treatment guidelines have partnered with the BC Association for People on Methadone to disseminate the guidelines and information to public and private clinics around the Lower Mainland, with additional outreach efforts underway in other B.C. health authorities.