It’s the conclusion of a two-part series on the relatively new harm reduction technique known as safe supply, in which doctors prescribe the same drugs that some people have become addicted to to reduce overdose deaths. illicit toxic drugs. Proponents say it’s also a way to manage health and allow patients to focus on the social aspects of their lives.
Not all doctors agree that providing people with a safe supply of drugs they have become addicted to is effective treatment for some addicts.
It is increasingly being considered an option and studies are beginning to show its effectiveness, but it is only available to a small number of patients in Nova Scotia, in part because very few doctors are willing to prescribe a secure supply.
But that can change.
Dr Margaret Fraser, a family doctor and emergency physician in Sydney, said there are medical, legal and regulatory issues with prescribing a safe supply of medicines.
“If I were to prescribe a large dose of narcotics to a patient who subsequently overdosed, I could be held medico-legally liable for that person’s death, either by the patient’s family or by regulatory agencies, and I could lose my license for that,” she said.
“You can completely lose your license to prescribe narcotics if you are considered a problem prescriber. This has happened to several doctors in our area.
“We are pulled in two directions and honestly sometimes we feel like we are going to be torn in two by the demands of regulators and the demands of patients. There is absolutely no middle ground in narcotics and other controlled substances and it’s a very difficult position to be in as a doctor.”
Many people who have become addicted have also become tolerant to drugs and require high doses, which can be dangerous and expose doctors to increased liability, Fraser said.
Doctors would also have little control over the cleanliness and safety of unsupervised injections, which could increase disease transmission and lead to illness or death from sepsis, she said.
Additionally, physicians want to avoid conflicts with the College of Physicians and Surgeons and the province’s prescription monitoring program regarding overprescribing.
Fraser said she would need to see “meaningful” safeguards in place before considering a safe supply for a patient, including changes by regulators, access to safe consumption sites and collaboration with d other health care and social service providers.
Dr. Leisha Hawker is a family physician and works part-time at an addiction clinic in Halifax. She is president of Doctors Nova Scotia.
Like other doctors, she prescribed a safe supply to some patients in Halifax during the pandemic to help slow the spread of COVID-19.
Doctors Nova Scotia is working on a harm reduction strategy that includes safe supply, Hawker said, with results expected in the coming months.
But for now, she prefers to prescribe a substitute for addictive drugs.
“In our current state, we need to focus on what has the best evidence for patients with addiction and particularly with opioid use disorders, the best evidence is for opioid agonist therapy, c ie Methadone or Suboxone,” Hawker said.
Doctors Nova Scotia is pushing for primary care reform to make collaborative practices much more widely available, which Hawker says helps addiction patients with a wider range of medical and social issues.
“There are a few patients who have failed other opioid agonist therapies which I could then consider for safe supply, but that would be something I would do very carefully and would like to know the patient well and discuss all the risks with them and with their other providers and kind of collaborate with the pharmacist just to do it in a way that minimizes as much risk as possible,” she said.
Increase training opportunities for physicians
Until recently, there weren’t many addiction medicine training opportunities, Hawker said, but those are increasing.
Dalhousie Medical School has added addiction medicine to its curriculum, and physicians are helping train medical residents at the Ally Center Cape Breton Collaborative Clinic. The establishment has a secure consumption site and its facilitators are working to find a prescriber for a secure supply.
Last year, 39 Nova Scotians died of confirmed or probable opioid poisoning. So far this year, 38 people have died.
Janet Bickerton, registered nurse and health services coordinator at the Ally Center, said the health clinic has everything in place to provide a safe supply, including supportive counselling, drug testing, drinking materials safe and a safe place for users. to take pills.
But it still needs a doctor willing to prescribe for the small number of patients who have no other alternative.
“Across the country, we’re starting to recognize that the research is pretty clear that this is an option for a certain segment of the population who use drugs,” Bickerton said.
“It’s not talking [about] throw a party and ‘Whoopee, we’re going to get high and have fun.’ It’s just about being able to put your feet on the ground in the morning.”
The center has two part-time doctors, one of whom has prescribed a safe supply to a “very small” number of clients, Bickerton said.
“At the time, the doctor thought she could kind of handle it, but realized after a few clients that it was a lot…and we had to put the brakes on and that was about all we could handle,” she said.
“This population by itself is not for everyone. The doctors we were able to recruit…are special. They really are and they really want to work with this population. They see the value. They find it rewarding, but it’s exhausting.”
Giulia DiGiorgio, executive director of the Cape Breton Association for People Empowering Drug Users, has been trying for years to have a safe supply available on the island.
CAPED is run by people with lived experience of illicit drug use and receives funding from Health Canada to deliver programs to reduce the stigma associated with the criminalization of people who need medical help to lead a productive life.
The group had been approved to participate in the MySafe program, which dispenses opioids to approved users from a secure, purpose-built vending machine.
Like the Allied Center, DiGiorgio couldn’t find a doctor who would prescribe for the program, but she didn’t give up.
Insufficient access in rural communities
She said the machines work well in urban settings with large concentrations of people who use drugs, but would also be useful in Cape Breton.
“While Halifax has access, not all of our communities, especially rural ones, have access and I think every community could potentially have a peer-led, low-barrier safe supply model with the MySafe vending machine in every community, in Glace Bay, in New Waterford, in Sydney, in Inverness,” DiGiorgio said.
“Wherever the population of people who need it, there could be a service offered by people with lived experience, so people can get an alternative to the illicit supply of toxic drugs that people get so sick and die.”