On the street it is known as "Hillbilly Heroin." But OxyContin isn’t the scourge in Saskatchewan that it is in other jurisdictions — largely because of Doug Spitzig’s eagle eye.
A powerful narcotic prescribed for patients with moderate to severe chronic and acute pain, OxyContin is one of many prescription drugs Spitzig tracks.
The contract pharmacist manages the province’s prescription review program, administered through the College of Physicians and Surgeons. Spitzig developed the program in 2006 to review inappropriate prescribing and usage of prescription drugs.
"We don’t have the problems that other provinces do, but we had a little bit of a head start with regards to some of the other provinces," Spitzig said. "Our program is a ground-up program where you’re dealing with one pharmacist, one patient, one doctor at a time."
Over four years, Spitzig has reviewed about 107,000 prescription files. A review can be triggered by many factors — a complaint, a physician’s prescribing practices, or high use of prescription drugs in a specific location.
Spitzig educates physicians about appropriate prescribing and teaches them how to identify patients who legitimately need narcotics for pain control and those who try to get drugs by faking pain or double doctoring.
"They’re probably the best actors in the world," Spitzig said. "You want to try and control illicit use, but you don’t want to create narcophobia, because then the people who really need it don’t get access to it."
Illicit users crush the pill into a powder and snort it, or dissolve it in a liquid and inject the solution into the bloodstream.
As Spitzig reviews files, he looks for red flags such as the prescriptions of large quantities of immediate-release narcotics.
"Immediate release is for short periods of time and is absorbed fairly quickly into the system, but it doesn’t last very long," Spitzig said.
"With sustained release products, you get better pain control and you don’t need as much drug and there’s less chance of abuse."
While the opiate drugs of choice in Saskatchewan are dilaudid and morphine, the abuse of OxyContin is a grave concern in Manitoba, said Dr. Bill Pope, registrar of Manitoba’s College of Physicians and Surgeons.
"OxyContin has become the designer drug of choice in the 30-somethings, so it’s not just people in poor situations," Pope said.
OxyContin abuse occurs in various age groups and primarily in Winnipeg, but rural Manitoba and some First Nations communities are no strangers to the problem, he said.
Pope said OxyContin is an excellent drug for those in pain, but individuals who take it as a party and recreation drug "can find themselves addicted after a single dose."
"It does produce a high and, of course, like all of those medications, you don’t get the same high the second time around so you take more and the first thing you know is (you’re) hooked," he said.
Two senior Manitoba health officials were in Saskatchewan last month to learn more about the province’s review program.
Pope credits Spitzig as a "proactive educator" who helps doctors learn more about appropriate prescribing and double doctoring.
To get narcotic prescriptions, users sometimes "double doctor" by travelling between large and small centres.
"We send out double-doctoring letters every month where patients have seen three or four doctors in a month," Spitzig said. "It varies from month to month, but when I first started, there was probably 300 to 400 letters and now there’s 200 or so."
Since the program began, prescriptions for benzodiazepines, which include sedatives such as Valium, have dropped by 63 per cent.
"You have to realize that just cutting the supply off with individual health-care professions isn’t going to solve the problem," Spitzig said. "You have to have all of the stakeholders together. You need the prescribers, the pharmacists, law enforcement, social workers, addictions counsellors — they all have to be working together."
Spitzig would like to see photo ID on Saskatchewan’s health cards so people can’t obtain multiple health cards and misrepresent themselves.
"They become a commodity themselves," Spitzig said.
Regina Police Service spokeswoman Elizabeth Popowich said police do see some illegal possession and trafficking of OxyContin, but it’s difficult to provide an exact tally without reading a year’s worth of reports. The narcotic isn’t in a crime category by itself.
However, a police officer who, until recently, worked in the Integrated Drug Unit and developed expertise in investigations involving pills, told Popowich that OxyContin is not as prevalent in Regina as other drugs.
According to the investigator, OxyContin makes it to the street in several ways — including pharmacy thefts.
"It’s my understanding that a number of pharmacies are taking proactive measures like no longer stocking any large amounts of OxyContin," Popowich said.
The drug can also be stolen from a person who is issued a prescription for legitimate use.
"Cases like this are sometimes reported to us, but there may be cases where we don’t hear about it because the victim of the robbery may be too intimidated to contact police," Popowich said. "An example may be where a person, prescribed OxyContin, relies on a family member or other caregiver for his or her daily needs … What if the caregiver is taking the drugs and threatens to stop providing care if the victim goes to police?"
Like any other medication, OxyContin has an expiry date.
"Expired, unused medications are destroyed, but it could be brought in from jurisdictions where there are not as strict measures to destroy expired pills," Popowich said.
Police undertake complicated drug investigations, but their efforts are not always visible to the public.
"The information is always taken seriously and evaluated," Popowich said. "But people may not immediately see the result of that call."
A recovering drug addict describes the illegal use of OxyContin as "a new epidemic" in Regina.
A man who wished to be identified only as Trevor says, "Not everyone knows about it, it’s a hidden disease and people are ashamed to talk about it. However it is way worse then (sic) people think … It is extremely difficult to quit the drug because of the withdrawal symptoms associated with it, which are compared to heroin withdrawals."
Kathy Willerth, the Ministry of Health’s director of mental health and addictions, said residents can access addiction services through their regional health authority. Physicians refer patients to addiction centres, but individuals can refer themselves for outpatient drug treatment services. Inpatient services are usually developed in collaboration with an outpatient alcohol and drug counsellor.
Depending on the urgency, wait times vary depending on what services are required. "For example, the wait for detox services can be 12 to 48 hours," Willerth said.
Generally, she added, it takes one to two weeks to receive outpatient services.
Methadone treatment, a harm-reduction strategy, is used when other treatment hasn’t worked. In Saskatchewan, 1,800 patients are currently on methadone. The wait to be treated is about 10 days, with some variation across the province.
The College of Physicians and Surgeons in Saskatchewan requires new physicians wishing to prescribe methadone to be trained at a recognized established clinic and at a College-approved training program. Currently, 42 Saskatchewan physicians are licensed to prescribe methadone.
The Regina Qu’Appelle Health Region’s methadone program treats 200 people a year. Four people used the region’s methadone program specifically for an OxyContin addiction in the past year.
Jerry Fitzgerald, program manager brief and social detox, said the region doesn’t have statistics specifically on OxyContin abuse, but the most prevalent drug problems at the addictions centre are alcohol, marijuana and cocaine.
"Talking to the Detox staff, we have people who are coming in who have used opiates and OxyContin is certainly one of those opiates," Fitzgerald said.
Formerly located at 2110 Hamilton St., the region’s new addiction treatment centre at 1640 Victoria Ave. provides assessment, counselling and day patient programs and also houses the Detox Centre, which was formerly on the 2800 block of Victoria.
"It’s a safe place for people to come in, so they can come down from the drugs that they’re taking and if they need a little bit of medication for withdrawal, we have a doctor who would prescribe that," Fitzgerald said. "The doctor comes to the centre twice a week and we send people to his office in the meantime."
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