Calgary

Chronic pain: opiate overuse makes the drugs less effective, doctors warn

Chronic pain doctors say there is little evidence that opiates work in long-term pain and that the over-prescription of these drugs is leading to addiction and fentanyl overdoses.

Little evidence long-term use helping patients, expert says

Dr. Lori Montgomery of Calgary Chronic Pain Centre says there's little evidence that shows opiates are helping people with chronic pain to live better and do the things they want to do in the long term. ( Kathleen Polyak)

​ When you feel pain, nothing makes it go away like a good shot of morphine.

"Finally, some relief. It took 30 per cent of the pain away. I just needed some relief," said Henry Kostynuik describing the day in an emergency room when he finally was given an opiate — morphine in his case.

It cut the chronic pain he felt in his arm, back and neck.

Family doctors are often trained to use opioids as much as you need to, use them in as high a dose as you need to get the patient to respond. There's no top dose. Just keep going until the patient says no.- Dr. Lori Montgomery

That immediate relief can come at a cost for many people coping with chronic pain.

There is growing evidence that even though the opiate can reduce pain in the short term, in the long term it won't help and might backfire.

And what's more, the over-prescription of this class of drug might be contributing to overdoses from other more dangerous opioids, such as fentanyl.

Fentanyl is a highly addictive drug, much stronger than morphine. It's often sold on the street to people who believe they're buying something safer.

It has been linked to 145 deaths in Alberta between January and June of 2015 — with 45 of those fatalities in Calgary. Experts say the number of deaths could rise to as many as 300 by the end of the year.

Dr. Lori Montgomery, medical director at Calgary's only clinic dedicated to treating people with chronic pain, the Calgary Chronic Pain Centre, has been calling for reduced opiate use for years. She says all the studies are short term, lasting six to 12 weeks.

Trouble with high doses and side effects

"We're having a hard time finding evidence that these medications five years down the road are helping people to live better and do the things they want to do. But they are getting into trouble with high doses and side effects and problems associated with those medications."

Dr. Montgomery says long-term opiate use can backfire, causing hyperalgesia, a hyper-sensitivity to pain.

She says now that the fentanyl crisis has people talking about addictions, they should be asking where the underlying addiction started.

She says it's often with poorly managed pain.

The first thing that physicians are supposed to do is 'do no harm'. I'm a lot more aware of the potential harm I can do with opioids.- Dr. Brian Cornelson 

"When you start to look at (the) cause of (a) problem. See a large population of people who have addiction to opioid pain killers. When you start to look at the reasons why those people have developed those addictions, you see that we've been overusing those kinds of medications in pain. If we're not training people in ways of managing pain that aren't effective then you can't be surprised that that problem evolved."

Dr. Montgomery says this shouldn't come as a surprise, given that "family doctors are often trained to use opioids as much as you need to, use them in as high a dose as you need to get the patient to respond. There's no top dose. Just keep going until the patient says no."

Dr. Brian Cornelson, medical director at the East Calgary Family Care Clinic, says family doctors are "flying blind" when it comes to treating chronic pain.

He says after 40 years in practice, he is only now learning more about chronic pain.

"The first thing that physicians are supposed to do is 'do no harm'. I'm a lot more aware of the potential harm I can do with opioids."

Dr.Cornelson says he's now more cautious about prescribing opiates for long-term pain and instead, focuses on other interventions. 

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