Education, monitoring of prescriptions and dispensing of the drug will all be a part of the new guidelines.Education, monitoring of prescriptions and dispensing of the drug will all be a part of the new guidelines. (CBC)

Guidelines are in the works to help family doctors stem the growing number of deaths linked to narcotic painkillers such as OxyContin.

The College of Physicians and Surgeons of Ontario reacted to a large-scale study published in Tuesday's issue of the Canadian Medical Association Journal that found 300 people die each year in Ontario as a result of taking opioid painkillers — three times as many as die from HIV/AIDS each year.

There was a five-fold rise in opioid-related deaths in the province between 1991 and 2004 after a new long-acting version of the drug oxycodone, sold as OxyContin, hit the market, Dr. David Juurlink, a medical toxicologist at Sunnybrook Health Sciences Centre in Toronto, and his colleagues found.

Opioid facts

Opioids are strong analgesics or painkillers that bind to receptors in the central nervous system, decreasing perception of pain and increasing pain tolerance.

Members of this class of drugs include morphine, heroin, codeine, oxycodone and its slow-release version, OxyContin.

About 35 per cent of OxyContin is released immediately. For someone who doesn't have tolerance, it can be like taking five Percocet pills all at once. The rest of the dose works eight to 12 hours later.

Suggested changes include:

  • Giving shorter prescriptions.
  • Improving safety warnings and product design, such as lower-strength versions.
  • Helping doctors and pharmacists become aware of when people go to several pharmacies and doctors to get multiple prescriptions.

Since such drugs can suppress breathing rates, family members need to know to call for help if the patient goes to sleep and appears unconscious.

Sources: Dr. Peter Selby, clinical director of the addictions program at the Centre for Addiction and Mental Health, The Canadian Press

The deaths were linked to an 850 per cent increase in OxyContin prescriptions, Juurlink said. The U.S. manufacturer, Purdue Pharma LP, aggressively marketed OxyContin to doctors, who often don't realize it is up to twice as strong as morphine, he said.

The college acknowledged that doctors need better information about opioid painkillers, registrar Dr. Rocco Gerace said.

The college and health regulators across Canada are creating new guidelines on the use of such painkillers to help doctors prescribe them more safely while making sure the drugs are still available for those in severe pain.

"Part of it will be monitoring prescriptions and dispensing of the drug, part of it will be education, and part of it will be ensuring patients have access to appropriate care," Gerace said.

The guidelines are expected to be in place early next year.

Accidental deaths

The surge in deaths was largely driven by accidental deaths, such as people who took the painkiller in combination with a sedative such as a sleeping pill or alcohol and didn't wake up, Juurlink said.

Before prescribing the medications, the study's authors say, doctors should examine factors including whether their patients are naturally prone to developing an addiction and whether they consume alcohol.

In another development, the U.S. Food and Drug Administration has approved a new tamper-resistant form of the drug, designed to prevent people from crushing and either snorting or injecting it to get high.

Health Canada won't say whether the manufacturer has applied to bring that formulation to Canada.