Health officials in British Columbia are moving to improve access to an opioid addiction drug that experts say is "critically underutilized" in the province despite soaring overdose rates and a recently declared public-health crisis.
Suboxone is the trade name for a combination pill composed of buprenorphine and naloxone. Buprenorphine is an opioid substitute, which curbs cravings and withdrawal symptoms, and naloxone is an opioid antagonist, which blocks the effects of narcotics, making Suboxone less susceptible to diversion and abuse.
Currently, provincial rules dictate that physicians who wish to prescribe Suboxone must have an exemption under Section 56 of the Controlled Drugs and Substances Act – the same exemption required to prescribe methadone – even though this is not required federally. An exemption requires further training and a number of conditions, which has resulted in only a small subset of B.C. physicians being able to prescrib Suboxone. Provincial officials are in the process of changing this.
Health experts say Suboxone is safer than methadone and should be routinely offered as an alternative in treating addiction to heroin and other narcotics. Historically, it has been viewed as a second-line treatment.
Ailve McNestry, deputy registrar for the B.C. College of Physicians and Surgeons, said the college observed an increased demand for the drug after it and its generic versions were added to B.C. PharmaCare last summer, making it more affordable.
"When we realized that there was increased demand for Suboxone, and the federal government – Health Canada – doesn't require an exemption for Suboxone, we realized that we should probably move toward not making the methadone exemption a requirement to prescribe [it]," she said.
The college is now revising its methadone and Suboxone guidelines, with the goal of submitting it to the college's methadone panel by the end of the month. The guidelines will then be forwarded to B.C.'s Ministry of Health, which is expected to make the necessary changes to PharmaNet in July, allowing for prescription of Suboxone without a Section 56 exemption.
A new report from the B.C. Centre for Excellence in HIV/AIDS and the Canadian Research Initiative in Substance Misuse, citing studies from other jurisdictions, describes Suboxone as being much safer than methadone. Detection of Suboxone in accidental overdose deaths in New York was "extremely rare," and calls to U.S. Poison Control for methadone-related issues was nearly seven times higher than calls for Suboxone-related issues, for example.
Thomas Kerr, who co-authored the report, added that Suboxone has very little abuse potential.
"This is just a way safer medication," he said. "We allow any physician to prescribe an opioid, and those are far more dangerous drugs than Suboxone. So why create all these restrictions and bureaucracy around Suboxone prescribing which will only reduce access in the midst of a public-health emergency?"
The report also called for Suboxone guidelines tailored to clinical practice in B.C., and public and professional education campaigns to increase knowledge of the drug.
B.C.'s provincial health officer declared a public-health emergency in April amid a surge in overdoses. There were 480 apparent illicit drug overdose deaths in 2015 – a 31-per-cent increase from 2014 – and already 256 as of April 30 this year. Fentanyl, a powerful synthetic opioid, was detected in a third of these deaths last year.
Since it received Health Canada approval in 2007, Suboxone has consistently been prescribed significantly less than methadone. In 2013/14, just 2,000 people in B.C. were on Suboxone, compared with more than 15,400 on methadone. Methadone has been available in Canada for treating opioid addiction since the 1960s.