British Columbia

Overdose crisis gave prescription fentanyl an unfair rap, pain expert says

A pain specialist says there's an unfair stigma attached to legally prescribed fentanyl because the illegal strain caused an explosion of fatal overdoses across the continent.

But B.C. doctor argues that opioid epidemic has its origins in doctors' offices

Fentanyl-related overdoses have killed over 620 people in B.C. this year. (Darryl Dyck/Canadian Press)

A pain specialist says the explosion of fatal overdoses from illegal opioids across the continent has unfairly stigmatized prescription fentanyl.

As a result, doctors have become wary of prescribing the drug, and patients are leery of asking for a prescription to deal with physical pain, said Dr. Mary Lynch, a pain specialist at the Queen Elizabeth Health Sciences Centre in Halifax.

"Many of our patients who are using a medical opioid appropriately, their doctors are becoming frightened, and either stopping prescribing or refusing to see patients that are on opioids," Dr. Lynch told CBC's The Early Edition.

Lynch is in Vancouver to attend a pain conference.

"We have our patients saying, 'I don't want it,' even in situations where they are terribly disabled with severe pain and a medical opioid might help them," Dr. Lynch said.

Fentanyl is a powerful opioid used to treat severe pain. In prescription form, it is often used as a patch that releases the drug into the bloodstream over time. Because it is a synthetic drug, it is cheap to make and transport. This has made it an ideal drug for illegal traffickers.

B.C. has seen a surge in fentanyl overdoses. Earlier this year, the provincial officer of health declared the drug deaths a public health emergency.

MDs warned to prescribe with caution

And recently, the B.C. Centre for Excellence in HIV/AIDS, urged doctors to exercise "extreme caution" when prescribing certain opioids, or even avoid prescribing them altogether.

Lynch described these public messages as "unfortunate," because they lump the legal use of opioids with illicit use.

"All opioids do have potential for addiction because they stimulate a reward circuit in the brain, and some people are at a higher risk of addiction than others," she said. But the vast majority of patients use fentanyl to treat chronic and acute pain, she said.

However, a doctor at the B.C. Centre for Excellence in HIV/AIDs repeated the warning about the potential danger of legal fentanyl use, arguing that the demand for street fentanyl is driven by addicts, many of whom became hooked on opioids from a doctor's prescription.

"The prescription opioid problem throughout North America now is totally out of control," said Dr. Keith Ahamad, a clinician at the B.C. Centre for Excellence in HIV/AIDS.

"And what we have created is a cohort of people that are physically dependent on this medication and have transitioned from needing this medication to treat a very acute illness ... to addiction."

In B.C., there are two deaths each day from illicit drug overdoses, Dr. Ahamad said. And 50 per cent of those deaths are now due to fentanyl. Last year, that percentage was one third.

Dr. Ahamad stands by the centre's warning that doctors pull back on prescribing opioids for pain relief. He said there is evidence that doctors have prescribed these drugs for periods that are too long, allowing dependencies to develop.

"Sometimes,the vast majority of people have an acute condition and they end up getting (drugs) prescribed much longer than they need them for."

Lynch said doctors and other health care professionals need more education on prescribing opioid pain killers.