Sask. needs more harm reduction services for people living with addictions: doctor

·4 min read

Dozens of people have died from overdoses this year in Saskatchewan. Dr. Brian Brownbridge says the sad, grim statistics will continue to get worse unless more harm reduction supports are rolled out.

Brownbridge said addiction is complex and doctors are seeing more patients dealing with it, but that it can't just fall to physicians to handle the crisis.

"It needs a whole social support, legal support, food stability, housing stability for these people, as well as all of the social, psychological and medical support that these people need — and I think we are falling behind," said Brownbridge, who is president of Council of the College of Physicians and Surgeons of Saskatchewan.

"We need to all work together. Can you imagine if at St. Paul's [hospital] we had all those services under one roof, so when a person needed help, they could easily access that?"

Brownbridge raised concerns about overdose deaths stemming from opioid use at the College of Physicians and Surgeons council meeting in November. Members agreed they needed to elevate the calls for more harm reduction.

Harm reduction is typically viewed as measures put in place by public health to limit the potential negative consequences of drug use — like fatal overdoses — but it also includes more access to mental health programming, financial support or providing access to sterile supplies.

The Saskatchewan Coroners Service said that as of Dec. 1, 323 people have died or are suspected to have died from overdoses in 2020. Of those, 122 are confirmed to be deaths by overdose and 201 are presumed to be but are still under investigation.

Brownbridge said people with addictions need to decide to seek help, but the health system needs to help them get to that point.

"If we don't have the harm reduction strategies in place to support them until they've actually made the decision that abstinence is the best course, then we're going to lose a lot of people."

He said that there also aren't enough resources for people who do decide to seek help. The government has recently put money toward more detox beds, but the overall effort has been "inadequate" and more support is needed, he said.

Prescribing partly to blame

Brownbridge said physicians are partly to blame. He's been a doctor since the late '80s and said in the '90s doctors became more liberal with prescribing opiates for chronic pain management.

"That's certainly part of where the major problem came from, and now it's very difficult now to go backwards," he said. "Now we've tightened up and that's driven people to other sources of drugs."

He said North American doctors still prescribe opiates at a much higher rate than other places like Europe. He suggested better, more affordable access to physiotherapy and pain clinics could help reduce the prescribing even further.

Saskatchewan statistics for accidental overdose deaths in 2019 show 53 died from an accidental hydromorphone overdose, 44 from an accidental methadone overdose and 41 from fentanyl. Early stats for 2020 show 43 fatally overdosed on acetyl fentanyl and 50 on fentanyl this year, compared to the 17 who died from methadone and the 42 from hydromorphone. But fentanyl only started to shoot past the prescription drugs like morphine, methadone and hydromorphone as the lead cause of accidental overdose deaths in the last few years.

There are prescriptions that can help: opioid agonist therapies, like methadone. The drugs are prescribed to help stabilize people trying to get off harder drugs. Brownbridge said they're needed, but the numbers show methadone can also be deadly.

He said there's a push to shift toward Suboxone prescriptions to help stabilize people with addictions instead of methadone. The Saskatchewan government significantly boosted its spending on Suboxone in 2019-20 compared to the year prior, spending $717,790 compared to $259,423.

But Brownbridge reiterated that medical therapies are only one piece of care.

"We need more support in this province for evidence-based harm reduction strategies and they are not simply giving methadone or Suboxone to patients with addictions," he said.

"We have to take the approach and say 'these people have a disease and we have to put the services in place to help with the chronic disease, which relapses just like many chronic diseases and we have to be willing to support them.'"