ADDICTS SUBVERTING METHADONE TREATMENT

Prescriptions for Other Opioids "'Big Hole' In System

Nearly one in five addicts undergoing methadone treatment manage to
get prescriptions at the same time for other opioid narcotics,
potentially risking their lives and costing taxpayers millions, a new
Ontario study suggests.

The review of patients whose medication costs are entirely paid for
by the provincial government - about 40% of total methadone users -
is some of the starkest evidence to date of a system rife with doctor
shopping and other abuse, experts say.

"This, I would assume, has a few people rattled," Benedikt Fischer,
an addiction expert and professor at Simon Fraser University in
Vancouver, said in an interview. "We're looking at an
individual-health, a public-health and a regulatory-policy mess....
There are a lot of big holes, clearly on a systemic level."

Methadone itself is a type of opioid - potent opium-related
substances employed chiefly to lessen pain - but administered legally
to addicts to help keep them off more dangerous drugs in the same class.

Once prescribed mainly to heroin addicts, methadone is being used
increasingly and now meted out chiefly to patients hooked on
OxyContin and other prescription opioids, whose use and abuse has
soared in recent years.

That thousands of those methadone patients are still convincing
doctors to pre-scribe them other opioids of the kind they are
supposed to be kicking is unsettling, say the study's authors, led by
Dr. Paul Kurdyak, an emergency psychiatrist in Toronto.

It is likely the same phenomenon is happening in other provinces,
too, the study in the journal Addiction concluded.

In Ontario, just over 36,000 residents are receiving methadone
treatment for opioid addiction, said Kathryn Clarke, a spokeswoman
for the Ontario College of Physicians and Surgeons, which oversees
the methadone program with a detailed set of guidelines.

Canada's consumption of prescription opioids has grown in the last
decade to become second in per capita volume only to the United
States, with more than $600-million of the drugs sold in 2010,
according to the IMS-Brogan marketresearch firm. With the boom has
come a flood of abuse and addiction. Figures from the coroner's
offices in just four provinces indicate that more than 250 people
died in 2009 from overdoses related at least partly to oxycodone -
the active ingredient in OxyContin.

The Ontario study used records from the province's drug benefit plan
and other databases to look at 18,759 methadone patients, all on
social assistance, over a seven-year period ending in March, 2010.

Researchers found that more than 18% of them, or about 3,400 people,
were being prescribed opioids simultaneously, averaging about 12
prescriptions a year each for drugs ranging from codeine to oxycodone
and the even more powerful Fentanyl. It is possible at least some of
the drugs were sold by the methadone patients on the street, the
study says. Those who consumed the opioid cocktails themselves would
face heightened risk of respiratory depression - their breathing
slowing to a halt, with potentially deadly consequences.

"If the individual [on methadone] is taking these other opioids,
there is the risk of fatal overdose," said Dr. Kurdyak, with the
Centre for Addiction and Mental Health. "Easy access to opioids to my
mind counters the benefits of a methadone program."

There are circumstances where additional opioids could be reasonably
prescribed to a methadone patient, such as to treat the short term
pain of a tooth extraction, or cancer-related pain - but those cases
would be relatively limited, Dr. Kurdyak said.

In fact, mixing methadone with other opioids is "universally
discouraged," pointing to widespread duplicitous, drugseeking
behaviour by those studied, either for personal use or to sell on the
street, the paper concluded. About half the opioids were prescribed
by doctors overseeing the methadone treatment, the rest by different
doctors the patients also visited. Ms. Clarke said the regulatory
college is "concerned" about the study's findings, but said the dual
prescribing might in some cases have legitimate pain-relief reasons.
The college does advise methadone doctors to talk to their patients'
family physicians to co-ordinate care and prevent unsafe drug use, she said.

The researchers say tracking prescriptions electronically in real
time - so doctors and pharmacists can check on patients instantly -
is likely the only way to effectively combat the problem. A handful
of provinces have implemented prescription-monitoring programs in the
last few years, though Prof. Fischer said it can take as long as a
month for information to be passed along in some jurisdictions,
somewhat defeating the programs' purpose.

Ontario just implemented prescription-tracking legislation, but its
database will not be up and running until next spring, said David
Jensen, a spokeswoman for the province's Ministry of Health. The law
does already require doctors and pharmacists to keep detailed records
on patients using opioids, he said.

"It is this type of inappropriate activity [uncovered by the study]
that led the Ontario government to take action last year," said Mr. Jensen.