Pain researchers who spent a decade studying patients in the Maritimes say they're concerned with the way doctors are prescribing narcotics to people with chronic pain.
"We're prescribing to some risky people, prescribing risky preparations in terms of immediate-release drugs and we're doing it in an idiosyncratic way as opposed to a guideline-based way," says Dr. Tom Evans.
Evans and Dr. Douglas French spent a decade observing nearly 700 patients in New Brunswick, Nova Scotia and P.E.I. The patients were receiving workers compensation or third-party insurance benefits for chronic pain and had been referred to the Atlantic Pain Clinic in Moncton.
The research found patients were usually prescribed immediate-release and short-acting opiates, despite having ongoing pain for more than two years.
Evans says more than 80 per cent of people were on short-acting drugs, either immediate-release codeine or immediate-release oxycodone. He says guidelines recommend putting people who've been on painkillers for a prolonged amount of time on long-acting agents, which are supposed to be lower risk for problems associated with narcotics.
The study also found 17 to 40 per cent of people had a history of substance abuse problems, some of who were still abusing substances while taking opiates.
"I think it's because physicians are really struggling with these complex chronic pain patients. - Dr. Tom Evans
"The demographics of the patients themselves were also concerning. They were a very high-risk group to be given trials with narcotics," said Evans.
He said there are screening tests to predict how people will behave with narcotics, for instance who may misuse prescriptions or change prescriptions. Evans says 80 per cent of patients already on narcotics tested as high risk to abuse them.
Despite taking the drugs, patients reported a poor quality of life and many weren't working.
The study also showed variations on how medications are prescribed depending on the regions of the province, which Evans says shows physicians aren't all following national opiate guidelines.
"I think it's because physicians are really struggling with these complex chronic pain patients," says Evans, adding existing guidelines are good but they might be "too cumbersome. They're not quick, they're very labour intensive, perhaps too much so for a very busy physicians in practice."
The researchers plan to present their findings at a meeting of the Canadian Pain Society Thursday and Friday in Charlottetown.