“Hillbilly heroin” arrives in Cape Breton

Illegal use of the prescription painkiller oxycodone has risen significantly in Cape Breton, calling into question the effectiveness of Nova Scotia's 10-year-old prescription program concerning opioid drugs.

“I was stunned to hear oxycodone is the number 1 street drug in Cape Breton,” says Dr. Richard MacLachlan, head of the Department of Family Medicine at Dalhousie University. “We obviously have a big problem. We have in Nova Scotia arguably the best program for monitoring prescription narcotics. … It's the tightest in the country, and it's obviously not working.”

The move of oxycodone abuse into rural Nova Scotia follows a similar development in the US, where “hillbilly heroin” has been blamed for numerous overdose deaths in several economically deprived states.

Nova Scotia's drug-monitoring program requires physicians who prescribe opioids such as oxycodone to use a triplicate prescribing pad, with copies for the doctor's records, the pharmacist and the prescription monitoring program. The prescription, valid for only 7 days, carries the name and billing number of the physician as well as the patient's name and address.

“It's a sluggish system,” says MacLachlan. “Months can go by before patients and physicians come to the surface.” As a result, doctors who are overprescribing and patients who are double-doctoring can slip through the cracks.

Dr. Harry Pollett, an anesthetist in North Sydney, isn't convinced the oxycodone problem in Cape Breton is greater than elsewhere in the country. In fact, he says local pharmacists have told him that the number of oxycodone prescriptions is down from last year. “Where are the drugs coming from?” he asks.

MacLachlan says illegal manufacture is an unlikely option, and so is theft from a patient who was prescribed the drug, since doctors would learn about the thefts when patients requested new prescriptions. Robbery of a pharmacy — there were 2 in Cape Breton between December and March — and a prescription from a physician are the other options.

“I have to fear that my profession is being lax about prescribing,” says MacLachlan. — Donalee Moulton, Halifax