‘PEOPLE ARE DYING BECAUSE OF THESE RULES’
Doctor pushes for drug treatment centres to accept patients on opioid replacements
A new treatment has a dramatically higher success rate for people trying to kick their opioid addiction, so much so that Edmonton doctor Kim Kelly is pushing the Alberta government to adopt a radical rethink for care at drug treatment facilities.
Many drug treatment centres now insist on abstinence. When patients enter, they have to swear off all drugs, including Suboxone, a far less potent opioid that is prescribed by doctors as part of opioid replacement therapy. Suboxone doesn’t get patients high, but makes them feel normal and helps fend off cravings for fentanyl and other dangerous opioids.
“Essentially, we know people are dying because of these rules,” Kelly says of the insistence on abstinence.
Fentanyl has cut a deadly path from Alberta’s inner city to its suburbs and towns. As of August, there have been 315 fentanyl deaths this year.
Kelly has been on the front lines of opioid crises since she got a job at the Addiction Recovery Centre in downtown Edmonton five years ago. Many of her clients were homeless, while others were social workers, nurses, dentists, oil workers, students — folks from all walks of life.
The standard method of treatment has long been abstinence, but Kelly and her colleagues found it has less than a one-in-10 success rate. For most opioid users, the withdrawal symptoms are too strong.
“When these people come into my office, they look sick,” Kelly says. “Sometimes they are puking. They have diarrhea. They’re sweating. They feel horrible. They are so focused on their physical illness that they can’t fully engage in treatment very well.”
After a day or two of abstinence, most quit treatment, Kelly says.
“It did work for some people, but it was very frustrating and disappointing and saddening to see these people who are seeking help and you really can’t do much for them.”
Things changed in March 2016 when the Alberta government started to allow treatment with Suboxone, which is a safer, less stigmatized opioid replacement than methadone.
“It was shocking to me. People felt better in about six hours,” Kelly says of the new treatment. “I would start them on the medication and I’d see them the next day and we were able to have a normal conversation and talk about what the next steps would be. All these people who were leaving suddenly were staying.”
About one in every two patients stay off opioids after this treatment, Kelly says.
“I’ll take one in two over less than 10 per cent.”
Kelly now works at Opioid Dependency Program clinic, where she treats patients who have left detox and are struggling to stay off drugs. It was there she saw some patients forced to go off Suboxone to get into longterm treatment programs. They had to adopt an abstinence regimen, but they relapsed as soon as they got out on a weekend pass. A few of them died.
“I just thought it was devastating,” Kelly says. “They were on a treatment that was working for them.”
Kelly is on the Alberta Medical Association board. At the AMA’s general meeting in September, there was near-unanimous support for her resolution for the Alberta government to require all provincially funded treatment programs to accept patients who are on opioid replacement therapy.
For its part, Alberta Health strongly supports opioid replacement therapy.
“We will continue to work with AHS and other partners to further expand access,” says associate minister of health Brandy Payne.
Of course, the concern around fentanyl isn’t just for longtime opioid users, it’s for inexperienced youth who might overdose as they experiment with drugs.
Kelly suggests parents talk with young teens about the dangers of such drugs, including sharing stories of first-time users overdosing.
“I think it is helpful with kids, a little bit of fearmongering, that they can die,” she says
Another idea is to talk to teens about putting off any decision to use drugs until they’re more mature, their brains are more fully developed, and they are more able to make a sound choice.
It’s also good to forbid drug use so that kids can use a parent’s stance as an excuse to avoid peer pressure to use, Kelly says.
“Just say, ‘My mom or dad will kill me.’ If you can get them out of that impulsive, scary situation, I think that’s helpful.”
Finally, Kelly says, if you’ve ever had surgery and have old, unused opioids around the house, get rid of them so they don’t fall into the hands of a teen.