In December 2016, then B.C. health minister Terry Lake visited what at the time was an unsanctioned injection site in Vancouver's Downtown Eastside.Travis Lupick/Supplied
The health minister who oversaw the 2014 methadone formulation change in B.C. that led to relapses and overdoses for some patients had sought a review of the matter and been advised that the issue should sort itself out in time.
Five years and one government later, as the province quietly allows some patients to switch back, Terry Lake says he regrets not having consulted more with people who use drugs.
“In my view, everything was done absolutely in good faith,” Mr. Lake said in an interview. “But I think the missing piece was not listening to people with lived experience enough.”
In February, 2014, the province switched its roughly 15,000 methadone patients onto a new formulation called Methadose, saying it was safer because it did not require pharmacists to compound it manually.
But some patients soon reported that Methadose was less effective at keeping withdrawal symptoms at bay. Many went back to using street drugs at the same time that fentanyl began supplanting the illicit opioid supply, fuelling a crisis that since then, has killed more than 5,000 people in British Columbia.
At least three published scientific studies of the change found that it disrupted treatment, led to an increase in illicit-drug use and produced “considerable health and social harms.”
Last May, after years of lobbying from drug-user activists, the province made a third version of methadone, called Metadol-D, eligible for regular benefit coverage through PharmaCare. And in October, it made the old methadone formulation available in exceptional circumstances to those who do not benefit from Methadose or Metadol-D.
Mr. Lake said that within a few months of the 2014 change, he began hearing that some people were not doing well on Methadose. He sought a briefing and review from the ministry, which included advice from the College of Pharmacists of B.C.
“The signal to me was, ‘Let’s see how things go.’ It seemed to be heading in the right direction,” he said. “When you’ve got recommendations from the College of Pharmacists and people that are well versed in this stuff, I tend to put a lot of weight on that kind of expert advice."
This past spring, Crackdown, a B.C.-based podcast about drugs and drug policy, aired an episode about the formulation change and the devastating impact it had on drug users in B.C. The death of Crackdown editorial-board member Chereece Keewatin was attributed to the switch.
Mr. Lake, then two years removed from his role as health minister, listened and was surprised to learn the problem persisted. He phoned Judy Darcy, the current Minister of Mental Health and Addictions.
“I just wanted to give the benefit of my experience, that I was surprised that this was still an issue, and if people were in fact going back to using street heroin because they didn’t have a duration of action with Methadose, to me, that was information she needed to know,” he said.
Ms. Darcy recalled having a long conversation with the former health minister about the issue. “He indicated that, in hindsight, he felt he had been given bad advice and wanted to know what we were doing,” she said. “I said we’re on it – we’ve been on it for some time now.”
Ms. Darcy said her government’s work on the issue began in the spring of 2018, after a formal meeting with the B.C. Association of People on Methadone, an advocacy group that had been sounding the alarm about the switch since it happened. By then, there had also been several published studies on the unintended consequences of the change in treatment.
“When you hear that lives have been lost because the new medications didn’t work for people, and then they turned to street drugs and as a result were poisoned with fentanyl, that’s pretty compelling," Ms. Darcy said.
Bob Nakagawa, registrar for the College of Pharmacists of B.C., said he was not personally involved in providing the ministry with advice following the 2014 change. But he said the college’s role is to maintain good standards of pharmacy practice and to ensure patients receive safe care, and that the methadone policy was developed with this in mind.
“The standard to use a manufactured product [over one that requires manual compounding] is one that we have in order to ensure that patients receiving it get good, safe and effective care,” Mr. Nakagawa said.
Asked if there were any lessons to be learned from the fallout of the change, Mr. Nakagawa said he would support postmarketing surveillance of new drugs, but that what happened with methadone appeared to have been unusual from other comparable drug changes.
“What I don’t know is whether methadone and some of the experiences with it are unique to methadone,” he said.
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