Manitoba launches online guide aiming to improve treatment for opioid use disorder
A new guide aiming to make treatment for opioid use disorder more accessible across the province is being launched by the College of Physicians and Surgeons of Manitoba this week.
The manual, which was locally written and officially launches Thursday, provides a detailed look at recommended practices around opioid agonist therapy (OAT) in Manitoba.
“Opioid addiction is a life-threatening illness and it just affects every part of the affected individual’s life, and opioid agonist therapy is a really evidence-based and safe treatment,” said Dr. Marina Reinecke, who has worked in addiction medicine in Manitoba since 2009 and is a medical consultant to the prescribing program at the college.
“It’s the standard of care and should be the treatment offered to every patient who presents with opioid addiction.”
The therapy involves prescribing medication, such as Suboxone, which can help people feel more stable physically and emotionally, explained Reinecke.
Prescribers in Manitoba require some additional training to offer the therapy. When dosed correctly, Reinecke said medication can help eliminate withdrawal symptoms and reduce cravings.
Toll of drug-related deaths
While official counts of overdose deaths require all toxicology reports to be finalized, preliminary numbers for Manitoba show at least 39 people died a drug-related death in January 2023, according to the office of the chief medical examiner.
At least one opioid was present in 27 of those deaths, and 22 of those deaths involved fentanyl.
Preliminary numbers for all of 2022 — as of last month — showed at least 418 drug-related deaths in Manitoba. The medical examiner’s office said there were at least 432 drug-related deaths in 2021.
WATCH | Manitoba launches new tool to help with opioid addiction:
Reinecke said illicit drugs have become more unpredictable, more toxic and more lethal.
“We have a true medical and public health crisis on our hands. I know that word is used a lot but our overdose numbers are truly a crisis,” she said.
“We are seeing so many deaths. Numbers that we haven’t seen in Manitoba and for every death, you know, there’s a human being and a family who’s profoundly affected.”
Currently, there are more than 230 access points where someone can receive OAT therapy in Manitoba, which is up from nine in 2015, according to the College of Physicians and Surgeons of Manitoba.
Reinecke says there are still people who can’t access OAT in their community, and she wants to see that change.
“We need an opioid agonist therapy prescriber and a support in every community where we have a family doctor and in every community where we have a nursing station,” she said.
Guide connects to services
Reinecke said treating opioid use disorder involves a team that can help support people with everything from counselling to family life to finances and employment.
She acknowledged primary care offices don’t have all the extended resources, but says the new guide proveds guidance and information around which services are available.
“The manual strives to guide people that as long as you can prescribe opioid agonist therapy safely in that environment, you can still connect your patients to a lot of the provincial and even publicly-funded resources around you and you can still make a huge difference in terms of expanding our capacity,” she said.
Dr. Erin Knight, an addiction medicine specialist and the medical lead for Manitoba Shared Health’s Rapid Access to Addictions Medicine Clinics, said while alcohol is the number one substance they see people seeking treatment for at RAAM clinics, opioids — including fentanyl — are a close second.
About 38 per cent of RAAM clinic’s clients last year were seeking treatment for alcohol use, according to Shared Health, while 35 per cent were seeking help for opioid use and about 24 per cent were seeking care for stimulants, which includes methamphetamine. The RAAM clinics can also prescribe medications like Suboxone.
Knight said when it comes to addictions care for all substances, it’s important to make sure there’s a wide variety of services available so people can choose what’s going to fit in their lives.
“Certainly when people have a severe substance use disorder from any type of substance, if they’ve done something like a 28-day or a four-week program and had difficulty with return to substance use afterwards, then looking at a more intensive and a longer-term treatment would make sense,” said Knight.
“I kind of bring it back to that idea of thinking about substance use disorders as a chronic disease where even if we are hooking somebody up with an intensive live-in treatment program, we really also want to think about … what does treatment look like after they leave that program to be able to support them in their long-term recovery.”
There are plans to expand RAAM services in Winnipeg in the coming weeks, with a new clinic opening in the Aboriginal Health and Wellness Centre. Knight said there are also plans to open a walk-in clinic on Saturdays at the RAAM clinic located at the Crisis Response Centre.
Despite these advances, Reinecke said there are still gaps in addictions care in Manitoba.
While tackling the overdose crisis requires a number of different interventions, she said reducing barriers so more people can access opioid agonist therapy would help make a difference.