With Canadians the second highest per capita users of opioids in the world, a team of doctors is recommending greater caution and lower prescription doses in new draft guidelines for all physicians.
Harm reduction techniques for street level drug users and people already addicted have captured much of the public's focus in recent months, as deaths mount and an opioid crisis marches through Canada.
This move attacks the other end of the spectrum — catching people on the prescription side, with a focus on curbing burgeoning addictions and having fewer drugs in circulation.
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The newly released draft guidelines come from a team led by McMaster University researchers from the Michael G. DeGroote National Pain Centre in Hamilton. The federally-funded project marks the first update these guidelines have seen since 2010.
"Opioids are powerful medications that must be used appropriately and only when necessary," said Jane Philpott, Minister of Health, in a statement.
"If we are going to solve the crisis we are currently facing with respect to opioids, healthcare professionals must be part of the solution."
Previous iterations of the nationwide opioid guidelines marked the equivalent of 200 mg of morphine a day as the upper end of the spectrum for what should be prescribed to patients. The new proposed guidelines lower that to 50 to 90 mg, except in "rare circumstances."
Lowering the dose
Those amounts would put Canada in step with guidelines in the U.S. that were published last year by the Centers for Disease Control and Prevention.
Dr. Norm Buckley, a professor and chair of anesthesia at McMaster University, said research shows that outside that 50 mg to 90 mg mark is where problems generally start to surface.
"Those are the points where you start to see complications … and it suggests that more caution should be applied sooner."
The new guidelines also say that doctors should work with their patients to get to the "lowest dose they can manage."
Buckley, who is a member of the guidelines' steering committee, also told CBC News that physicians have to make sure to not aggressively move people off opioids if the drugs aren't causing them problems
"Then you have the potential to make them aggressively worse instead of better," Buckley said.
Deaths rise across the country
According to preliminary reports from the provincial coroner's office, there were 47 deaths in Hamilton caused by opioids or a combination of opioids and alcohol in 2015.
That same year, there were 199 emergency department visits and 89 hospitalizations for opioid poisoning among Hamilton residents.
In fact, there have been more opioid-related deaths in the Hamilton LHIN over a five-year period than anywhere else in the province, according to a recent study from the Institute for Clinical Evaluative Sciences.
The report also shows that the Hamilton LHIN (which includes Niagara, Haldimand and Brant) had the highest number of opioid-related hospital admissions and emergency department visits in the entire province in 2014.
Those numbers still pale in comparison to places like B.C., where there were 914 drug overdose deaths in 2016 lone, according to the BC Coroner's Service.
The draft guidelines are open to public comment until the end of February. The team then issues a definitive guideline to Health Canada by the end of March.
Public comment to the proposed guideline recommendations is welcome until the end of February. The guideline team will consider all feedback and issue a definitive guideline to Health Canada by the end of March.
Anyone looking to give their feedback can do so on the National Pain Centre's website.