In BC, methadone will get ten times stronger in just a few weeks – but most patients don’t know about it – raising the spectre of accidental overdose and death.
People on methadone, those getting help with addiction and patients prescribed opiates are marginalized. Paternalistic programs give them little control over their care regimes and less agency than other groups of patients. Some say they feel they’re treated more like criminals than people with legitimate medical conditions.
The same kind of thing happened in 2012, when Indigenous communities across Canada found themselves careening toward a “mass involuntary opiate withdrawal.” The federal government abruptly cut access to Oxycontin, a highly addictive medication, with little consultation.
Changes in policy around both methadone and Oxycontin, though made at different levels of government, have far reaching implications for patients and those dealing with addictions. Such decisions are often made without consulting the affected patients.
The health and very lives of people is put at risk by the unilateral decisions and poor communication of remote authorities.
BC’s Methadone: Getting 10x Stronger
In BC, major changes are coming to the methadone program. On February 1, methadone will get ten times stronger.
If people on methadone don’t know, they could take too much, overdose and die.
I have been to too many funerals of friends who died of opiate overdoses. I don’t want to go to any more, especially when it is preventable – with a little information.
Laura Shaver, president of the BC Association of People on Methadone is worried people will die. She has been petitioning authorities to get the word to methadone patients – a group that can be hard to reach, especially in remote northern communities and reserves.
Any other group of patients would be consulted and receive news of this change well in advance. But just weeks ahead of the roll out of the new, stronger methadone, there has been no official communication to patients and users.
When methadone is bought on the black market, anyone who doesn’t know about the new, stronger product could face the potential for overdose and even death, by accidentally ingesting a dose ten times stronger that which they intended.
Aiyanas Ormond of the Vancouver Area Network of Drug Users (VANDU) is also troubled: “Methadone patients, more than any other large patient group…have very little voice in how the program works and how the rules are going to be set.”
The official silence is deafening. One addictions doctor I spoke to said she had not received any information on the coming changes. She thinks the move is principally a cost saving measure. Mykle Ludvigsen, Director of Public Accountability and Engagement of the College of Pharmacists of BC, said they intend to do something to get the word out but had no concrete plan when I spoke to him. The BC Ministry of Health had “nothing to announce at this time.”
Laura Shaver and BC Association of People on Methadone plan to put up posters and alert people on Vancouver’s Downtown Eastside, where Indigenous people are overrepresented. In Canada’s poorest postal code, Indigenous people make up 10% of the neighbourhood, while in Vancouver generally, account for only 2% of the overall population.
Shaver remains concerned that not everyone will hear about the stronger methadone and people will die. Her organization does not have fancy offices, paid staff or much funding. It has limited capacity to address a serious province-wide public health issue.
VANDU’s Ormond said that patients must “actually have some power over the decisions” and that he’s seen “lots of supposedly benevolent improvements in treatments that…ended up marginalizing people further.”
A Mass, Involuntary Opiate Withdrawal
Another supposedly “benevolent improvement” happened two years ago when Health Canada suddenly cut off access to an opiate being prescribed by thousands and purchased on the black market by thousands more. There was no real plan for when people suddenly found themselves without the habit-forming drug. It was cold turkey by way of federal health policy.
Without the dependency-forming Oxycontin, patients quickly enter the hell of withdrawal. This can mean restlessness, the sweats, anxiety, nausea, vomiting, diarrhea, muscle spasms, bone pain, increased blood pressure, faster heart rate, depression and even suicide.
Substitute medications are considered on a “case by case basis.” But patients had no choice or agency in this decision.
In February 2012, Oxycontin was delisted from Health Canada’s Non-Insured Health Benefits Program, which covers prescription drug costs for nearly a million “registered First Nations” and “recognized Inuit.” Federal drug and dental coverage for some Indigenous people is rooted in the right to access the medicine chests of Indian agents, promised as part of some treaties.
In Indigenous and non-Indigenous communities around Canada, Oxycontin addiction has become a serious problem. In 2009, the Nishnawbe Aski Nation declared a prescription drug abuse state of emergency. At that time, a nation representative estimated that fully one third of the Northern Ontario territory’s Indigenous residents were addicted to Oxy.
Community leaders have long called for government action on this issue and for more harm reduction and drug treatment capacity. But the sudden cut-off of such a medication only creates the potential of withdrawal crisis, and a panic to find substitutes – like heroin.
Metatawabin said that “problems are intensified in the remote northern communities for those who are addicted to Oxycontin and do not have access to drug treatment programs.”
The decision to cut Oxy was made despite the risk of serious health crisis in many communities.
Control of some health programs are slowly being transferred to the control of band councils and in BC, to the First Nations Health Authority. Though, the national authority to add and delist prescription drugs, like Oxycontin, largely remains with Ottawa.
Methadone patients and drug users in Indigenous country are not afforded the communication and consultation that other patient groups receive from health practitioners and government authorities
In the case of prescription opiates, like methadone and Oxycontin, this marginalization can mean serious public health impacts, overdoses and even death.