The territory’s chief medical officer of health says the newly-announced opioid funding from the feds and YG is a “welcome addition” to hopefully one day seeing suboxone treatment being offered more widely –­ but that may be years down the road.

That’s according to Dr. Brendan Hanley, who explained last week that suboxone is a form of replacement treatment, which can be helpful in harm reduction.

“What our vision is that the hubs eventually are able to support people and patients being on suboxone in communities,” Hanley said in an interview last Tuesday.

“But we’re not there yet.”

He suspected it may take a couple of years for the drug to be commonly administered in rural areas for opioid treatment, but remained hopeful after a combined $945,000 was confirmed by Ottawa and Yukon last Monday.

Part of that funding will see a full-time mental health nurse based out of the referred care clinic in Whitehorse.

Health and Social Services Minister Pauline Frost told the Star last Tuesday the recruitment for that position is already underway, with a federal webpage noting the position could begin as early as January.

“This gives more direct and immediate access to the counselling and support so that clients have more successful outcomes,” Hanley said.

“What has been lacking is more of that immediate or shorter-term access to mental health supports,” he added.

It should increase the capacity for the clinic to do its job, Hanley said.

A news release notes that the nurse role is important in enhancing the Yukon’s Opioid Treatment Service (OTS) as it will support agonist program services – a treatment for addiction of which methadone and suboxone are common.

These medications are administered in efforts to reduce cravings for opioids and prevent withdrawal.

The federal information is relevant because Ottawa will be kicking in about $500,000 of the $945,000 total funds (the Yukon is covering the remainder $445,104).

The funding was gained through Ottawa’s Emergency Treatment Fund (ETF). That was announced as part of its 2018 budget and saw $150 million put aside for jurisdictions to improve access to treatment services.

Another goal of the funding is to allow for the long-term prescribing of methadone as an alternative to opioids (methadone maintenance treatment).

“We know the standard of care is not just suboxone, because that is the first line of treatment for opioid addiction,” Hanley added.

That’s perhaps reflected in a presentation given to physicians at Whitehorse General Hospital in April 2017.

That presentation suggested considering a switch to methadone if a patient is still experiencing cravings while on the dose for suboxone.

Meanwhile: the confirmation of the funding came just over a month after the Yukon released its own opioid action plan in November.

In that plan, it notes that coverage is provided for Yukoners without insurance or funding for suboxone or methadone prescriptions to manage addictions.

When it comes to prescribing, maintaining and screening, it notes that YG and its partners have tried to improve knowledge in addiction management among health providers – including the use of suboxone.

That was done in part through the presentation, which is also made public via the action plan, and adds that “the basics for safe suboxone prescription are achievable within about six hours training.”

While it does include the caveat that it reflects the view of the presenter and not official views of the Yukon Medical Council, it asks some of the same questions Hanley considered last week.

That included whether it was best to carry out an initiation in a community or do it in Whitehorse, then follow up in the community while making backup expertise available.

Hanley said the long-term goal is the former, though he suspects that realistically it may be the latter for the beginning before suboxone is done more commonly in communities.

“In order to get there, you need at least two elements,” he said, noting that involves fully-staffed hubs and a more central support system.

“Starting someone on suboxone is the most intense phase,” he explained.

Consequently, beginning it here in the city may be easier because there are more resources to monitor the early stages.

“If you can, get them through the first few days or weeks – it requires a lot of hands-on support and supervision.”

Hanley continued that maintenance for suboxone “is a lot easier” as patients transition further into the treatment.

Asked what exactly makes the transition intense, Hanley explained the body is adjusting to the new drug, and reactions can vary.

“A person has to be on opioid withdrawal, ideally mild withdrawal,” he said, providing the example of somebody taking street heroin.

“They need to be at a point physiologically where suboxone will flood their receptors, they have to adjust so timing is a thing.”

Then comes the dosage adjustment, he said: “you’re kind of loading them with suboxone so it’s fairly frequent, like a daily dosage.”

Things like how tolerant their body is to the dosage, what other illnesses they may have or other medications and allergies all need to be factored in – something that can require time and inevitably money for the resources that allow it.

Pointing out the money for the nurse position for example is to be used for the next five years, Hanley said “that’s hardly enough to support one position.”

As the Star confirmed earlier this month, the funding will support the role by seeing money go toward the position for the next five years.

“The resources that a clinic needs to provide that care is more than just one position,” Hanley said.

He remained hopeful that investments are headed in the right direction, and guessed that shifting the attention toward the hubs could also go a long way in treatment.

“It’s not like this is a huge injection, but it’s certainly a welcome addition.”

Hanley concluded the gains in prevention are likely to be long-term – likely referencing the 18 opioid-related deaths that Yukon has seen since 2016.