MANITOULIN—There’s a new aid in the opiate addictions treatment toolbox that one area physician says can be a life changer for those living with substance use disorder. Buprenorphine—which goes by the name of Probuphine and is manufactured in Canada by Montreal’s Knight Therapeutics—takes the form of small implantable ‘rods’ that release a low dose of the medication for six months, allowing patients to gain their lives back.
“It’s been available in the US for years,” said Dr. Lionel Marks de Chabris, who specializes in addiction medicine and pain medicine with offices in Sudbury and Espanola. Dr. Marks de Chabris explained that he has several patients from Manitoulin.
Dr. Marks de Chabris acknowledged the opioid crisis and the treatments that are most prevalent—methadone, which has been around since the 1960s, and suboxone, which has been available in this country for just shy of eight years.
Both methadone and suboxone, while effective, mean that a patient is tied to their clinic and their pharmacy, the doctor explained. Those patients who are on either of these medicines must attend a clinic for regular urine tests, see their doctor on at least a twice-monthly basis and attend the pharmacy for their prescription if not daily, then weekly.
Dr. Marks de Chabris admits that this kind of routine is not conducive to healing and explained that medicine is just one step in a patient’s journey to wellness.
Probuphine comes in the form of four matchstick-sized rods that are implanted under the skin of the inner arm using local anaesthetic in the implant process. He explained that the rods are only good for patients who are on a low dose—eight mgs or lower—of suboxone and who are stable in their recovery. The rods last six months and can be implanted in the opposite arm once the initial six months are up.
A second option is not yet available in Canada but Dr. Marks de Chabris said it will be within a month or so. Sublocade is also an extended release medicine, but takes the form of an injection in the abdomen and lasts for one month. It’s used for those patients on a dose of eight mgs or higher.
Both of these medicines, however, come with a significant price tag for those who are not covered by private drug coverage. Probuphine costs $1,500 every six months while Sublocade rings in at $500 a month, the equivalent of the cost of 16 mgs per day of suboxone. Probuphine is covered by the Department of Indigenous Services Canada’s Non-Insured Health Benefits Program, the doctor noted.
“It liberates people from the pharmacy and the clinic,” Dr. Marks de Chabris enthused. “A lot of people are trying to get their lives back. People are often treated at the pharmacy like they’re drug addicts, and that’s not the mindset they need.”
Dr. Marks de Chabris acknowledged that those patients who are unstable, who relapse and can’t maintain a steady dose of either methadone or suboxone, need that structure of clinic and doctors’ visits in their life, but for those who are stable, it can be counterproductive. Not to say that follow up is not a good thing for all patients, he added, as those living with substance use disorder will always face the possibility of relapse.
“Once a month is still a good way to check in and this gives the patient the satisfaction of knowing there is someone coaching you and in your corner,” Dr. Marks de Chabris said.
The doctor could not extol enough the virtues of being free to live a life that is free of the ball and chain of pharmacy and clinic visits.
“With all of that gone, you’re basically free to get on with your life,” he continued. “It opens up people’s lives and gives them back.”
Dr. Marks de Chabris said he was aware of some First Nations band council resolutions that state that those living on-reserve cannot have ‘carries.’ One receives carries (take-home medication), in either methadone or suboxone form, once they have proven themselves stable for a period of time and have passed the requisite urine tests
If you’re not allowed carries, “how do you get on with your daily life?” he asked. “The new options allow you to work, travel, go out on the land, hunt. It’s a perfect medication for people who are stabilized.”
Dr. Marks de Chabris said that recovery is what one puts into it.
“You see very different populations,” he continued. “Some people come in and really want to fix it. They’ve lost a job, partner and they’ve had enough. It’s like their hair is on fire. The drugs only treat the physical symptoms of addiction. It does a great job, but it doesn’t treat the social, spiritual, psychological aspects of addiction. It’s about medicine in a care environment.”
He likened treating those with substance use disorder with only medication to treating diabetics with drugs but not mentioning eating habits or exercise. Addiction requires a multi-faceted approach that includes counselling, often to address underlying emotional issues or trauma.
Dr. Marks de Chabris said that not everyone will totally get away from the medicines used to treat the disorder, but he has dozens of patients who have.
“There are people who don’t,” he continued. “They don’t have the ability to pull themselves back completely. There are all kinds of people. We’re not fixing everyone, but we’re doing the best we can.”
Dr. Marks de Chabris has over 100 patients in the Espanola-Sudbury area, including some from Manitoulin. Three of those patients have had the Probuphine rods and all are doing exceedingly well, he said.
The Sudbury specialist began his career in pain treatment, but soon realized that addictions and pain management go hand in hand and if he “didn’t have a handle on addiction in this field, I was going to be in trouble.”
Dr. Marks de Chabris emphatically said there is a place for opiates in medicine. Nothing can beat opiates for short-term pain management, like kidney stones or a broken leg, he said, but longer-term use, even weeks, spells trouble and puts the risk of overdose and addiction so much higher.
Dr. Marks de Chabris will soon be setting off to destinations across the country to speak on Probuphine and urges any addictions medicine physicians in the area to reach out to him for training on the implants or for more information.
“I’m hoping for uptake from the physician community,” he said.
