Sidelined program aims to reduce drug abuse
Health department says it doesn't have funding to bring in long-promised prescription monitoring oversight
 | Killer on the streets Part IV of IV:
Yellowknifer is investigating fentanyl's toll. |
Shane Magee
Northern News Services
Wednesday, April 27, 2016
SOMBA K'E/YELLOWKNIFE
A long-promised program doctors, the coroner and politicians say would crack down on prescription drug abuse has been quietly put on hold due to lack of funding.
The planned program would establish a computer link between pharmacies around the territory and those issuing prescriptions. It would track who is getting what, how often and from who.
The overuse of prescriptions has been linked to the rise of fentanyl in the city, a Yellowknifer investigation into the opioid's prevalence found.
Fentanyl is a painkiller about 100 times more powerful than morphine and has been linked to at least five deaths in the territory since 2009 and hundreds of deaths in Alberta and British Columbia.
Yellowknifer sought to find out how users become addicted. Interviews with doctors and addictions care providers revealed it often begins with legal painkiller prescriptions.
When the legally obtained drugs are no longer available, such as when the crushable form of OxyCotin was removed from the market, users move to other drugs. Two years ago, RCMP warned of counterfeit OxyCodone pills - the generic name of OxyCotin - laced with fentanyl.
Dr. Jennifer Harris, a family doctor who can prescribe methadone to treat opioid addiction in Yellowknife, said the path to fentanyl addiction is often a progression beginning with a legally prescribed opioid. Harris said the patients she has helped often start with a prescription - whether another person's or their own.
According to the International Narcotics Control Board, Canada and the United States have the highest levels of consumption of opioids in the world.
A 2010 report by the College of Physicians and Surgeons of Ontario, for example, said that province was in the midst of public health crisis stemming from inappropriate prescription of painkillers.
It noted patient education, screening and monitoring has been a challenge, despite physician education.
"As a result, these drugs are sold, bartered, shared and stolen," the report states. It recommended taking immediate steps to make prescription information available to all prescribers and dispensers, such as a monitoring program.
Inuvik Boot Lake MLA Alfred Moses, now a cabinet minister, said in May 2014 the territory has a "fragmented, unsystematic and insufficient data and monitoring of prescription drug use, misuse and the death that's caused by overdose from prescription drugs."
An NWT coroner's report that year raised alarms over overuse and misuse of prescriptions and how people are being prescribed potentially dangerous numbers of legal drugs.
The territory's Department of Health and Social Services committed to bring in a paperless prescription system along with a monitoring program. Health Minister Glen Abernethy said the program would follow a tweak to the Pharmacy Act.
The tweak was made.
The program was expected to be in place by fall 2015, Yellowknifer was told in 2014. The program doesn't exist.
Several people in the pharmacy industry approached for interviews said they had not heard about such a program and so declined interviews.
It appears to have quietly stalled due to funding issues.
"It is still our intention to move forward with work on prescription drug abuse, and to advance the design of a monitoring program," Abernethy said in statement provided in response to an interview request. "Given the current fiscal environment, it is not possible to state with certainty when we will be able to move forward."
No estimated cost has been provided despite several requests.
The department instead is "educating clinicians" about appropriate prescribing practices and teaching them to identify patients who may be addicted or at risk of becoming addicted to opioids and other drugs, health department spokesperson Damien Healy wrote.
Harris said she has spent time working to educate other doctors about the risks of over-prescribing opioids. She also developed guidelines for the territory four years ago.
"I think we have been working on it at a physician level," Harris said. "Do I think a prescription drug monitoring program would be helpful? Yes I do. We are kind of looking at different programs and what would work here. That's certainly something that is actively being looked at."
She's not the only one who supports the creation of a monitoring program.
NWT Chief Coroner Cathy Menard has made broad recommendations aimed at reducing prescription drug abuse, although not a specific one to create a monitoring program. However, Menard said she supports such a project.
"I think it would have a significant effect on the prevention of abuse and prevention of death for sure," she said, adding it would limit the ability to patient-doctor shop. That's when someone from one community gets a prescription in one place, then goes to another to get another. There are electronic medical records but that hasn't gone territory-wide yet.
And because the prescription dispensers aren't linked, a pharmacist may not be aware of other prescriptions a person may have from other parts of the territory or down south.
Daryl Dolynny, a pharmacist and former MLA for Range Lake, pushed the GNWT to implement a prescription drug monitoring program before and while in public office.
As a pharmacist, he said he's seen people abusing the system to get more than they should.
"It's not rampant but it's done. A prescription drug monitoring program would almost eliminate that right away," he said.
He wasn't surprised to hear the program is stalled. He said an earlier paper-based proposal was sidelined and "went through a slow death" because of cost issues.
"To do it properly, they're right, it will require integration of a lot of different computer systems to a single source," he said.
Dolynny said education is the most cost-effective way to respond but he has observed the status quo for decades.
"We are no further advanced on this file than we were 24 years ago," he said about prescription drug abuse.
Minister's statement on monitoring program
In the 17th Legislative Assembly, I announced the department's intention to develop a prescription drug monitoring program, as part of our broader response to concerns about prescription drug abuse. Amendments were made to the Pharmacy Act in the term of the 17th assembly to support this work.
In 2014, I established a Controlled Substances Working Group. Membership on that group includes physicians, pharmacists, the RCMP, advocates and department staff. Its mandate is to discuss and propose solutions to issues associated with prescription drug abuse, including monitoring, prevention, education, treatment and enforcement.
The working group has looked at options for prescription drug monitoring and I have asked them to come forward with a recommendation as to the best approach. The most effective monitoring method needs to be consistent with our emerging suite of e-health tools, such as the Electronic Medical Record. At this time, there has not been a final recommendation about a system. But we do know that implementing an effective program will require additional resources that are not currently in the department's budget. For example, a monitoring program would require some dedicated staff time and a computer system linked to all NWT pharmacies that can offer real-time access to patients' prescription histories, for both prescribers and dispensers.
It is still our intention to move forward with work on prescription drug abuse, and to advance the design of a monitoring program. Given the current fiscal environment, it is not possible to state with certainty when we will be able to move forward.
Glen Abernethy
Minister of Health and Social Services
April 8, 2016
