Ontario Health Minister Deb Matthews says the province has no immediate plans to put Suboxone on the Ontario Drug Benefit, which would make it more readily available to treat addicts who can’t get methadone, a more common treatment for opioid addiction. Health-care practitioners, especially in remote areas, want to use Suboxone more in cases where there are simply no licensed methadone doctors around, or no spaces available. Buprenorphine, the active ingredient in Suboxone, is supposed to be safer and easier for others (nurses, for example) to give out. It’s also really expensive.
Methadone and Suboxone treatment have been in the news more since the province took OxyContin’s replacement, OxyCodone, off the ODB, making it available only in exceptional cases in order to clamp down on growing prescription-opioid addiction. In February, assistant deputy minister and executive officer of Ontario Public Drug Programs Diane McArthur said the province was in talks with Suboxone manufacturer Reckitt Benckiser.
Nothing new on that since then.
Update: Diane McArthur, assistant deputy minister and the person in charge of Ontario’s public drug programs, says Suboxone manufacturer Reckitt Benckiser has submitted a raft of new documents laying out “a whole raft of economic and efficacy models” of Suboxone and its impact. Ontario’s Committee to Evaluate Drugs is going through those documents now, and should come back with a recommendation either way within a couple of months, Ms. McArthur says. She also noted that many of the most remote areas in Ontario where methadone’s hardest to get (and alternatives like Suboxone needed the most) are reserves that’re under the federal government’s purview when it comes to medical coverage.
(slightly condensed) transcript of Deb Matthews conversation below.
Deb Matthews: Right now [Suboxone is] on the exceptional access program. We are prioritizing the applications, so we now have a turnaround of three business days. We think it’s really important people who are choosing to kick the habit, kick their addiction, get the support they need. So we are looking at potentially expanding access to Suboxone. But right now, we’re very focused on making sure that when there are applications, we get an answer back to the physician as quickly as we can, so when we have applications that are, you know, fully completed and there’s not a problem with the application, we can turn them around within three business days.
Anna Mehler Paperny: Ok. What would, I guess, the deciding factor be, in terms of expanding access to Suboxone?
DM: Well it’s always about the evidence.
DM: It’s always about the evidence. And we took away the ability of politicians to interfere with that. We do turn to experts to make those decisions for us. Are people doing better? And we do know that this is another tool for people who are fighting their addicitons. So the methadone treatment is where we start. And we want to be there for people, and we want to support them in their journey.
AMP: Ok. So is the concern, then, medical efficacy?
DM: So we look at the evidence. And that includes the cost.
DM: So we do look at, is this good value for money? Who responds well? What does the evidence tell us about how this works? I think anyone would agree that if this is a drug that will help people kick their addiction and get on with their life, then it’s pretty hard to put a price on that. I can tell you that I’ve met with some people from a fly-in reserve in the North. I actually had quite a wonderful encounter with a group of people who are getting treatment with Suboxone. And they are very enthusiastic about the treatment they are getting. … You can’t put a price on freedom from addiction.
AMP: So how do you decide? I know in Suboxone’s case it’s much more expensive – something like three times? I could be wrong – than methadone. Is that a deciding factor? It works but it’s so pricey it’s not, um, cost-effective to put on the ODB?
DM: You know it might be best if you actually spoke to Diane McArthur. … She could walk you through what the considerations are.
AMP: Okay. But fair to say there are no immediate plans to put it on the ODB.
DM: That’s right. But I can tell you also that it’s under active consideration.