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+2014-+Visit our website for more detailsA10 | NEWS OTHEGLOBEANDMAIL | SATURDAY, NOVEMBER 2, 2019
B
ritish Columbia is quietly al-
lowing some methadone
users to switch back to an
old formulation of the treatment
five years after a new version it
had adopted led to relapses and
overdoses for some patients.
The province switched to the
new formulation, called Metha-
dose, in February, 2014, saying it
was supposed to be safer. But pa-
tient advocates said it was not as
effective for some patients in
keeping withdrawal symptoms at
bay. Many went back to using
street drugs at the same time fen-
tanyl began supplanting the illic-
it opioid supply, fuelling a crisis
that has killed more than 5,
people in B.C. since.
“People absolutely died as a
result of this change,” said Garth
Mullins, a drug-user activist, host
of the podcast Crackdown and a
member of the B.C. Association
of People on Methadone, which
has lobbied for a return to the old
formulation. “How much did it
contribute to the overdose cri-
sis?”
Last May, the province made a
third version of methadone,
Metadol-D – a clear, colourless
and unflavoured methadone for-
mulation – eligible for regular
benefit coverage through Phar-
maCare. And in October, it made
the old compound methadone
formulation available in excep-
tional circumstances to those
who do not benefit from Metha-
dose or Metadol-D. The 2014
change was announced publicly
with news releases and notices to
pharmacists, while the province
made no announcements about
the two changes this year.
Methadone is an opioid medi-
cation that, when taken daily,
prevents withdrawal symptoms
in people with opioid-use disor-
der. It can reduce the risk of
harm associated with illicit
opioid use – such as involvement
in crime, sex work, unsafe drug
consumption and blood-borne
illnesses – and can help patients
live a more stable life. About
15,400 people in B.C. are current-
ly on methadone.
Christy Sutherland, education
physician lead with the B.C. Cen-
tre on Substance Use (BCCSU)
and a family doctor specializing
in addiction, estimates that she
had more than 100 patients on
methadone at the time of the
change and all responded poorly.
“They would come into my of-
fice and say, ‘This doesn’t have
legs,’ and what they meant was
that they woke up every morning
in withdrawal,” she said. “Pa-
tients reported that the new
methadone formulation didn’t
last the whole 24 hours, and they
were having cravings, and often
relapse, and requested changes
in their dosing.”
Patients generally reported
that the old formula staved off
withdrawal symptoms for at least24 hours, and sometimes more.
With Methadose, many reported
withdrawal symptoms in 12 to 16
hours, according to studies and
independent user accounts.
The original formulation con-
sists of a white, crystalline powd-
er that is diluted in a liquid – of-
ten an orange-flavoured juice –
before it is dispensed daily to pa-
tients. Methadose is a cherry-fla-
voured liquid that does not re-
quire mixing. It is 10 times stron-
ger than the old formulation,
which means patients get the
same amount of methadone in 1/
10th the amount of liquid.
The B.C. Ministry of Health,
along with the colleges of phar-
macists and physicians and sur-
geons, said in 2014 that Metha-
dose was safer because it does
not require manual mixing and
doses are therefore more likely to
be consistent. It also does not
need refrigeration.
But at least three published
scientific studies of the change
found that it disrupted treat-
ment, led to an increase in illicit
drug use and produced “consid-
erable health and social harms.”
Ryan McNeil of the BCCSU and
colleagues followed 34 people for
six months after the change andfound that about three-quarters
reported increased withdrawal
symptoms that fostered “severe
suffering.” Some patients
“toughed out” the symptoms un-
til their next dose, but about two-
thirds relapsed into illicit drug
use, according to the Vancouver
study, which was published in
2015 in the academic journal So-
cial Science and Medicine.
As well, some reinitiated or in-
tensified illegal activities such as
drug dealing or sex work so they
could buy the street drugs, the
study found.
A related study published in
2017 in the International Journal
of Drug Policy looked at the unin-
tended effects of the change on
addiction and HIV-related out-
comes. Of 331 HIV-positive opioid
users in Vancouver, the study
found the formulation change
led to “an immediate 11.5 per cent
increase in heroin injection, and
15.9 per cent drop” in keeping to
the required schedule in their an-
ti-retroviral therapy.
Dr. McNeil, who was also a co-
author on the second study, said
the regulatory changes under-
mined treatment outcomes.
“The increased withdrawal
symptoms after the methadone
formulation change led many
people to re-initiate, or increase
their use of, illicit opioids,” he
said. “This threw many people’s
lives into chaos and made it diffi-
cult to access or adhere to HIV
treatment.”
A 2016 study published in the
journal Substance Abuse Treat-
ment, Prevention and Policy sur-
veyed 405 methadone patients
from 50 harm-reduction sites in
B.C. during the change and found
that more than half “reported
having worse pain, feeling more
dope sick, and supplementing
their methadone with other
opioids.”
Chereece Keewatin had been
stable on methadone for several
years and relapsed into illicit
drug use after the change. She
tried other medications – slow-
release oral morphine, buprenor-
phine – and spent much of hertime fighting withdrawal before
dying of an overdose this past
February. She was 40.
“She was very frustrated, try-
ing to find her way back to where
she was before the change,” Mr.
Mullins said. “Person after per-
son got up at her memorial and
said, ‘If they hadn’t switched her
methadone, she would still be
here with us.’
“It’s hard to describe the feel-
ing of feeling so sad, and so grief-
stricken for losing someone, and
so angry all at the same time.”
Mr. Mullins viewed the prov-
ince’s move to allow some pa-
tients to return to the old formu-
la as a small first step and said
work continues to make it more
widely available.
“I think they’re doing this to
try to throw us a bone, or shut us
up, because they’re not reintro-
ducing it widely,” he said. “It’s on
a last-resort basis. It’s actually
quite hard to get.”
The Ministry of Mental Health
and Addictions did not make
anyone available for an inter-
view. A short statement provided
by the ministry and attributed to
Justine Patterson, executive di-
rector of the Overdose Emergen-
cy Response Centre, acknowl-
edged that the province “heard
from people with lived or living
experience that this transition
did not work for everyone.”
The statement said that the
province is “working with all
partners to provide a full spec-
trum of treatment options to
help people find a pathway and
to hope,” but provided no details.
Dr. Sutherland described the
change as a “catastrophe” that
could have been avoided by in-
volving people who use drugs in
the planning and implementa-
tion process.
“It’s important that we, as clin-
icians and policy-makers and
politicians, reflect on this and
how badly it went, and to think
about the future,” she said. “With
vulnerable populations, you
can’t change things in this way
without a lot more caution and
thoughtfulness.”B.C.quietlyalterscourseonmethadonetreatment
Fiveyearsafterchanges
toopioidaddictioncare,
provinceallowssome
patientstorevertto
previousmedication
amidrelapses,overdoses
ANDREA WOOVANCOUVER
Garth Mullins, a drug-user activist and a member of the B.C. Association
of People on Methadone, has lobbied for a return to the old formulation
of methadone and views B.C.’s move to allow some people to return to it
as a small first step.RAFALGERSZAK/THEGLOBEANDMAILOTTAWAThree recounts will take place in ridings where the
runners-up are hoping a court-ordered review could snatch
victory from the jaws of ever-so-narrow defeat.
Courts in Quebec and British Columbia have made the
orders days after hearing challenges to the results of the Oct.
21 vote.
The first recount will take place next week in the B.C.
riding of Port Moody–Coquitlam, where NDP hopeful Bonita
Zarrillo lost to Conservative Nelly Shin by just 153 votes.
The New Democrats argued that there were 516 rejected
ballots – an unusually high number – along with evidence of
a counting error in one poll and more than 250 unaccounted
ballots.
Combined, the party believed a judicial review was war-
ranted.
Canada says the recount will take place on Nov. 6. with
the results to be published online once complete.
A second recount is being set up for the Montreal riding
of Hochelaga, where Liberal Soraya Martinez Ferrada bested
Bloc candidate Simon Marchand by 328 votes.
A Bloc Quebecois source who was not authorized to
speak publicly told The Canadian Press there were dis-
crepancies between the final result and the number of votes
counted in the ballot boxes.
Elections Canada says the recount will take place Mon-
day, Nov. 4, in Montreal.
Also on Friday, a Quebec court ordered a recount in the
riding of Quebec where Liberal cabinet minister Jean-Yves
Duclos won re-election by 325 votes to Bloc candidate Chris-
tiane Gagnon.
Details are not yet available about when that judicial
recount will take place.
Overturning any of the results wouldn’t change the over-
all outcome from the election, where the Liberals won a
plurality of seats in the House of Commons, but failed to
earn a majority.
Nor would the Conservatives be bumped from their spot
as Official Opposition.THECANADIANPRESSCOURTSORDERRECOUNTSINB.C.,QUEBECRIDINGS
AFTERNARROWFEDERALELECTIONRESULTS