December 31, 2014

Exchange program reduces fentanyl misuse

As published in The Erin Advocate

In an effort to reduce the black market supply of the lethal prescription drug fentanyl, Wellington County is promoting an exchange program that requires patients to return all their used medication patches before getting new ones from a pharmacist.

Modeled on a successful program in North Bay, it is an initiative of the Wellington Guelph Drug Strategy (WGDS), which tries to reduce substance misuse through prevention, treatment, harm reduction and law enforcement.

“There is a lot of concern because of the lethality of the drug,” said WGDS Manager Adrienne Crowder, noting that the patch exchange reduces risks to individuals and the community. “The program creates a partnership between patients, doctors and pharmacists. It’s a more connected care pathway that is good for everyone.”

Use of the program is optional for pharmacists and doctors, but WGDS is urging them to participate. The County has produced a video on the issue, created by Ironcloud Productions of Hillsburgh, which can be accessed at or through a “fentanyl patch” search on YouTube.

It says police and health care providers in Guelph and Wellington are seeing increased misuse of the drug. It includes a first-person account of a recovering addict, an 18-year-old girl who started by taking painkillers from the family medicine cabinet at age 14, then moved on to stronger substances. Addicts may end up selling their possessions and resorting to crime in order to buy more of the drug.

In North Bay, where fentanyl addition was a particularly severe problem, a patch exchange program has made the drug much more difficult to obtain on the street – forcing dealers to import it from other areas.

In October, Nipissing MPP Vic Fedeli proposed a private members bill that would mandate the Patch-for-Patch program for pharmacies across Ontario. Patients who do not return their used patches undamaged would have to provide an explanation, and their doctor could refuse to authorize a further supply.

Known by the brand name Duragesic, fentanyl is a painkiller 100 times stronger than morphine and 50 times stronger than heroin. It was originally an operating room drug and a treatment for terminally-ill patients, but is now used for various types of chronic pain.

In 2011, it caused 102 overdose deaths in Ontario. It has come into wider use since then, after the Canadian government pulled OxyContin from pharmacy shelves in 2012, due to its high level of abuse. Fentanyl is intended for slow release through a patch over 72 hours, but addicts remove the drug from the patch so it can be smoked, injected, chewed or made into pills. Police say its potency is dangerously unpredictable.

It has become a street commodity, with some addicts stealing patches from legal users or retrieving used patches from garbage cans to get a residual amount of the drug.

Even legal use of the drug is risky, with 30 million tablets or patches of high-dose opioids (oxycodone and fentanyl) dispensed in Canada annually from 2006 to 2011. Statistics Canada estimates that approximately 1 in 10 Canadians suffers from a chronic pain condition.

A six-year study led by Tara Gomes at St. Michael’s Hospital, reported in the November, 2014 issue of Canadian Family Physician, showed that with Canada and the US leading the world in high-dose opioid prescriptions, Ontario had the highest rate of fentanyl dispensing – 112 patches annually per 1,000 population.

Some researchers believe it is being over-prescribed, with little evidence of safety or effectiveness at high doses, and with wide variations in provincial guidelines for doctors.

Methadone is used to treat addiction to heroin, oxycodone, fentanyl, percocet and morphine, blocking their euphoric effects and reducing withdrawal symptoms. Guelph has four methadone clinics; Orangeville has one and Georgetown will have one this January. Addicts can also be treated in residential rehabilitation programs, but there are waiting lists.