Generation Rx: Some Quick Thoughts

Eighty percent of world's supply of prescription opioid pain relievers are consumed in North America.  Canada is second only to the US in worldwide per capita consumption of these powerful prescription narcotics.  According to data from the Ontario Ministry of Health and Long Term Care, since 1991, prescriptions for medications containing oxycodone have risen by nine hundred percent.  Along with the increase in prescribing has come an increase in reports of abuse.  The non-medical use of opioids is now the fourth leading form of substance abuse in Canada, behind alcohol, tobacco and cannabis.  And with those reports of abuse have come reports of an increase in accidental and deliberate deaths associated with the use of prescription opioid analgesics. 

Last night, we hosted "Generation Rx - The Use and Abuse of Prescription Pain Medication", at Brockville Collegiate Institute in Brockville, Ontario.  That's the site of the province's first inquest into opioid-related deaths.  Tune in December 3 at 11:30 am (noon NT) and again on December 5 at 11:30am (3:30 pm NT) on CBC Radio One.

On stage with me were three terrific panelists:

*  Christine Bois is Manager of the OpiATE project with the Centre for Addiction and Mental Health.  The project raises awareness about the stigma of addiction and also develops resources to educate families and professionals about the appropriate use of opioids.

*  Detective Staff Sergeant Shawn White is with the Cornwall Police Service.  He's considered an expert in the field of opioid drug diversion in Eastern Ontario.  White is also a member of the "OxyContin Task Force" in Cornwall, Ontario.

*  Dr. Andrea Furlan is a chronic pain physician and a scientist at the Toronto Rehabilitation Institute.  Dr. Furlan led the research team that developed the Canadian Guideline for Safe Use of Opioids - released in May 2010.  For your information, I was a member of the panel that advised Dr. Furlan and her team.

To read more about our panelists, please click here.

I came at the town hall from several different points of view.  My role as host of WCBA is obvious.  In addition, for nine years, I had an office practice managing patients with chronic pain.  In some cases, I prescribed opioid pain relievers.  For some patients, the treatment worked.  For others, it didn't. 

Second, as I said at the town hall and have said in this space on other occasions, I have given many talks on how to manage pain to health care providers.  Some of those talks were paid for by pharma. 

Third, I have conducted peer assessments and medical inspections of doctors on behalf of the College of Physicians and Surgeons of Ontario.

Fourth, as mentioned, I was a member of the panel that advised Dr. Andrea Furlan and colleagues on approrpiate guidelines for doctors who prescribe opioid or narcotic pain relievers to patients with chronic pain.

Here are some of my quick thoughts about the evening. which was attended by concerned citizens, teens and parents:

1.  Some doctors prescribe narcotics to too many patients and with little solid clinical rationale. 

2.  What I heard again and again last evening is that when doctors prescribe powerful narcotics, patients say they aren't being informed of the risk of addiction.

3.  It appears to be commonplace that doctors prescribe a much larger number of tablets than needed to control the pain.  The leftover medication is open to being stolen and even sold directly to drug dealers.

4.  Teens are stealing unused opioid pills found in the medicine cabinet at home and bringing the pills to parties for recreational use.

5.  For years, doctors have received biased drug information from pharmaceutical companies on prescription narcotics.  The information has tended to play up the benefits and play down the risks of opioid therapy.

6.  It's hard to find an expert in pain management who hasn't received financial support from pharma at one time or another.

7.  Teens have "pill parties" in which they bring all manner of controlled substances pilfered from various sources into a large bowl.  The bowl is passed from teen to teen; participants are asked to reach into the bowl, grab a handful of pills and swallow them, without knowing what they've taken.

8.  Very few schools are educating kids about the dangers of addiction to prescription narcotics or the serious consequences of recreational use.  They say they don't have time in an already crammed  curriculum to discuss it.

9.  Dr. Andrea Furlan has spearheaded the development of guidelines on the correct way to prescribe narcotics.  But with the current system, there's no guarantee doctors are reading them.

10.  The panel of experts agreed that banning strong prescription narcotics will not end drug abuse.  Doing so will punish legitimate pain sufferers and will only encourage addicts to experiment with other drugs.

To learn more about the town hall, read an article in today's edition of The Recorder & Times.  And don't forget to tune in December 3 and 5 to listen to our fantastic town hall.

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