Haida Gwaii doctors have joined what is now a Canada-wide effort to quit over-prescribing opioids.
“All of us are working with our patients to reduce doses, reduce prescriptions,” says Dr. Andrea Wilhelm, who works at the Haida Gwaii Health Centre in Queen Charlotte.
“We’ve come together as doctors on island and we’re committed to making sure we’re not part of the problem.”
Used to relieve pain, the most commonly prescribed opioid drugs include morphine, hydromorphone, oxycodone, and codeine.
Recent headlines have focused largely on misuse of fentanyl — an opioid that is extremely potent, available as a street drug, and increasingly linked to overdose deaths in B.C.
But Dr. Wilhelm said fentanyl is only one part of a larger problem.
Haida Gwaii has seen several overdose deaths involving opioids in recent years, and the Masset and Queen Charlotte hospitals have a high number of related emergency-room visits — more than the hospital in Prince Rupert.
Dr. Wilhelm said Haida Gwaii patients have died from accidentally taking too much of a prescribed opioid, or by mixing it with alcohol or other medications.
Other islanders have died because after taking a family member’s prescription and using it recreationally.
Last weekend, provincial and federal health ministers met in Ottawa to talk about the epidemic of opioid addiction, overdose, and deaths across Canada, which now has the world’s second-highest per capita use of prescription opioids.
One recent study showed Canadian doctors write an average of 53 opioid prescriptions for every 100 patients.
At the conference, health officials agreed to set up a Canada-wide database that tracks opioid prescriptions, something B.C. already has.
Dr. Wilhelm said that locally, Haida Gwaii doctors started reviewing all their long-term opioid prescriptions this summer — something that B.C.’s College of Physicians and Surgeons made mandatory in June.
“There is increasing evidence that opioids can often cause more harm than good, especially when used for long periods of time and at higher doses,” said a letter sent by local doctors to their patients.
Dr. Wilhelm said even though opioids have several side effects, are more addictive and riskier than previously thought, it can be difficult for patients to stop or slow their use.
“It’s an addictive substance, and it plays with people’s minds,” she said.
Especially for people with chronic pain, Dr. Wilhelm said another problem is that other treatments, such as physiotherapy, are often hard to come by on island.
In July, new regulations made it much easier for B.C. doctors to prescribe suboxone — a drug used to treat opioid addiction.
Before, doctors needed to have federal authority to prescribe methodone before they could also prescribe suboxone. Wilhelm said that for Haida Gwaii doctors, that involved a two-day course in Vancouver and spending six weeks with another mentoring doctor off-island.
Now, local doctors are able to prescribe suboxone after finishing a six-hour online course and following guidelines from the College of Physicians and Surgeons of B.C.
Other barriers remain, especially in Masset, where there is no pharmacist to supervise suboxone doses.
More recently, Haida Gwaii also joined a provincial take-home naloxone program — local public health nurses can now give the anti-overdose drug to patients at risk of overdose, and train them and their families on how to use it at home.
Besides changing prescriptions, Dr. Wilhelm said Haida Gwaii doctors are challenged by the illegal use of opioid drugs on island.
Moreover, while it is true that no marijuana found on island has been tested positive for fentanyl (chemical testing of street drugs is not a common practice in B.C.), Dr. Wilhelm said local patients who say they only ever smoke pot have tested positive for fentanyl, as well as methamphetamine and cocaine.
A local patient who admitted to using cocaine has also tested positive for fentanyl, she said.
Even if it’s only a possibility at this point, Dr. Wilhelm said islanders should know that even ‘soft’ drugs like marijuana can be laced.
“Some people are thinking twice, and that’s a good thing,” she said.
Update: This article has been updated to reflect the fact that previous training requirements for prescribing suboxone were due to the fact that all B.C. doctors were formerly required to have federal methodone-prescribing authority before they could prescribe suboxone.