Opioid prescriptions 'drying up,' doctor concerned where patients will turn

Prescriptions for pain pills in St. John'shave become scarce since a rash of overdoses from the deadly opioid fentanyl, says an addictions doctor.

Bruce Hollett, divisional chief of family medicine, chronic pain and addiction at the Waterford Hospital, is concerned with where patientswill turn when their prescription is not renewed.

"Here in the last three weeks in St. John's, a lot of the prescriptions foropioidshave started to dry up," he said during aFacebooklive special with CBC.

"What ends up happening is they find out it's being abused, they stop it immediately, and then the person is left [wondering] where do I go?"

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People have augmented their income orsupported drughabits by the "rule of thumb," Hollett said keeping one third of the pills for themselves and selling the rest.

Even though there will be fewer prescription pills on the street, Hollett anticipates overdoses and deaths will continue at the same rate or higher.

There have been 21 reported overdoses and one death related tofentanylin the metro St. John's area since April 1, according to Eastern Health.

Prescriptions go down, deaths go up

In March 2016, the American Centers for Disease Control and Preventionintroduced new guidelines for prescribing opioids.

Street naive individuals started going into the street.- Dr. Bruce Hollett

Those guidelines included lower doses for patients a maximum of 90 milligrams per day, Hollett said.

Four Canadian provinces, including Newfoundland and Labrador,immediately followed suit and endorsed the guidelines.

While the number of prescriptions plummeted, Hollett said,the death rates increased.

Pain patients had developed addictions and turned to other methods to get their fix.

"Street naive individuals started going into the street," Hollettsaid.

Hepoints to the seizure of fentanyl packed into fake percocet pills found across Canada, and here in this province.

• Fake Percocet pills containing fentanyl seized in Stephenville area

While a streetdrug user might know the difference between a fake pill and a real one, Hollett said someone who usually gets their fix from a pharmacy might not.

Overprescription a longtimeissue

While prescriptions are becomingsparse in St. John's, it hasn't always been that way, Hollett said.

He recalls receivinga fax in 1997 promoting the prescription use of opioids by saying doctors could cure pain without sparking addiction.

He blames drug manufacturer Purdue for leading the charge, with drugs like OxyContin.

The prescriptions not only started a destructive habit for the patients, he said, but also for the doctors prescribing them.

Even though it was widely recognized there was an opioid addiction epidemic, Hollett said doctors continued to prescribe them.

"It's difficult to get physicians to do things," Hollettsaid."Once they do, it's difficult to get them to stop."

Government eyeing options

During the live special, Health Minister John Haggiesaid the provincialgovernment is trying to improve ways to care for people with opioid addictions.

He pointed to St. Paul's Hospital in Vancouver, where patients who do not need emergency attention or a hospital bed can go to a 24/7detox area with comfortable chairs, a welcoming environment and a dose of suboxone an anti-addiction drug deemed safer than methadone.

Haggie also said the provinceis looking at improving the continuing care for a patient who comes to the emergency room for a drug-related matter, but is not ready to face their addiction.

"We're getting there," he said.

"We're not there yet. We're trying to get ahead of the wave. That's sometimes difficult because the wave keeps changing speed."