Sask. 2nd highest province for fentanyl prescriptions

Saskatchewan pharmacists dispensed more fentanyl prescriptions than almost every other province in the country last year,according to data from the Canadian Institute for Health Information (CIHI).

If residents had "access to better specialized and multidisciplinary services we'd do better for them in their pain care,"said JuliaBareham. She's the pharmacist manager with the Prescription Review Program at theCollege of Physicians and Surgeons of Saskatchewan.

These should be medications of last resort when everything else has failed.- Julia Bareham

"Everyone says non-drug measures exercise, physio , massage should all happen first. How do you deal with that with a patient who is dealing with poverty and can't pay," she said.

"Yet because of their income level, they're insured through the province for their medication."

Bareham saw a notable shift when therapies like chiropractic services were no longer funded for everyone by the government.

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She said the gap between patients and alternative pain management options is growing.

"Our prescribers are left with very few options."

Health Minister: statistic 'concerning'

The province came in second in fentanyl prescriptions to Quebec, with22.4 prescriptions dispensedper 1000 Saskatchewan people in 2016.

"Anytime we're near the top in a troubling statistic, it's concerning," Health Minister JimReitersaid.

He said the Ministry of Health provides funding to the College ofPhysiciansandSurgeons ofSaskatchewan so it can monitor prescriptions.

"You never want to have the higher numbers," Bareham said."I'm happy to see it's a downward trend however, that we're at least moving in the right direction."

The number of dispensedfentanylprescriptions per 1000 population in Saskatchewan has declined over the last five years.

Fentanylis prescribed viapatches in the province, a methodBarehamsaid is easier for weak, physically traumatized and elderly patients. A patch is put on the patient once every three days for pain management.

"These should be medications of last resort when everything else has failed."

Patches over pills

Barehamsaid she isn't concerned that doctors are over-prescribing fentanylbecause the crisis happening in other parts of the country isn't happening here.

"I find our greatest challenge in Saskatchewan is hydromorphone."

It's the strongest opioidnext tofentanyl and is prescribed in a tablet or capsule form.

She said fentanyl prescriptions are typically ten patches for thirty days, but with hydromorphone people could be getting 60 to more than a hundred pillsfor the same time period.

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"At least the fentanyl patch limits or lessens rather the amount of drug that can be diverted."

That doesn't mean prescribers aren't mindful there is a risk the drug will end up in the wrong hands, Bareham said.

Still, shesaid the goal isn't to cut back because prescribers don't want to limit patients who need it,but new guidelines canhelp prescribers monitor and assess each circumstance better.

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"Our goal is more so to ensure that when we are using any of these opioids, we're using them appropriately and safety."

Bareham notedthe current data creates challenges.

"We can't tell who is appropriately on a medication, who'sabusing it, who's selling it," she said.

"I don't know if that's a good number or a bad number, because I'm not sure who it's representing."

She added that while the numbers show a trend, they don't tell the whole story.

Saskatchewan also had thelargest number of defined daily doses per 1,000 people. That's theamount a doctor recommends taking in a day and variesdependingon patient profile and symptoms.