Doctors are prescribing more opioids to vulnerable people in three Atlantic Canadian provinces, despite years of warnings about the addictive prescription painkillers.
The number of publicly funded prescriptions for opioids increased by 26 per cent between 2010 and 2015, according to data compiled by the Canadian Institute for Health Information for CBC News.
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The drugs have cost governments in New Brunswick, Newfoundland and Labrador and Prince Edward Island nearly $52 million during the same six-year period.
While the numbers don't show the size or strength of the prescriptions filled, the increase is still "worrisome," according to David Juurlink, a drug safety specialist at the University of Toronto.
Opioids include codeine, morphine, oxycodone and fentanyl, among other drugs.
Doctors 'comfortable' prescribing
"The glut of opioids in medicine cabinets throughout Canada has a lot to do with doctors just being very comfortable prescribing them," Juurlink said.
"To be very blunt about it, that is a direct result of marketing by the pharmaceutical industry over the past 20 years. It's effectively changed the culture around opioids."
The numbers only capture prescriptions covered by publicly funded provincial health programs for people on low incomes, seniors and other groups.
It doesn't show the number of people who have filled opioid prescriptions out of their own pockets or through private health insurance.
Sudden cut in dose 'dangerous'
Without prescribing data that captures people using private insurance, it's hard to tell whether doctors are beginning to shift prescribing patterns in the midst of an opioid crisis, Juurlink said.
New national prescribing guidelines released earlier this year by the Canadian Medical Association Journal encourage doctors to avoid prescribing opioids for chronic pain not related to cancer.
Some provinces have their own prescribing guidelines, but doctors aren't always required to follow them.
The problem, Juurlink said, is when doctors suddenly cut a patient's dose of opioids. That could cause painful withdrawal.
"That's a very dangerous thing to do," Juurlink said. "It shouldn't be happening."
Without treatment, people who've gotten addicted could also turn to street drugs like fentanyl or heroin.
A matter of education
Across Atlantic Canada, governments have stepped up monitoring of opioid-related overdoses, preparing for an expected surge in overdoses related to fentanyl.
Nova Scotia's provincial government recently made naloxone, an opioid overdose antidote, available for free to anyone. The province has also started posting the number of opioid overdose deaths online.
In New Brunswick, public health officials have started tracking non-fatal opioid overdoses through paramedics and hospital emergency rooms.
Since March, at least 47 people were treated for opioid overdoses in the province and survived.
28% increase in N.B.
Publicly funded opioid prescriptions increased by 28 per cent in New Brunswick between 2010 and 2015, according to the data from the Canadian Institute for Health Information.
During that same period, public health plans in the province funded nearly $30 million worth of opioid prescriptions, more than any other Atlantic province.
That bought more than 760,000 prescriptions — at least one for every New Brunswicker.
"New Brunswick's doctors have noticed the trend and that there's an understanding that more education and understanding around the impacts of opioid prescribing is needed," CEO Anthony Knight said.
The society has launched education programs to help doctors understand the health impacts associated with long-term opioid use.
'There needs to be a strategy'
Knight hopes a long-awaited prescription monitoring program will help reduce misuse and over-prescribing of opioids.
But he suspects the national over-prescribing problem lies in having few ways to deal with chronic pain.
"There needs to be a strategy and there needs be an approach around how to provide better research and support to doctors who prescribe opioids," Knight said.
Dr. Jennifer Russell, New Brunswick's acting chief medical officer of health, has seen charts showing opioid prescribing trends across the country and said it's "not pretty."
Like Knight, she acknowledged New Brunswick has work to do on changing prescribing habits.
But she believes the problem goes further than that.
"What about people who develop addictions and what the risk factors are and the treatments that are out there?" Russell said.
"There are many, many lists of things that are contributing to the opioid issue."