Curb 'rampant prescribing of opioids and reduce deaths,' Canadian doctors say

An analysis in the CMAJ calls for a "comprehensive approach to curb rampant prescribing of opioids and reduce deaths."

It's late, but not too late, for Canada to reduce the toll of opioid overuse and abuse

When oxycondone was implicated in a disproportionate number of opioid-related harms and deaths in 2012, several provinces pulled it from drug formularies and prescribing shifted to other potent opioids, such as fentanyl and hydromorphone. (George Frey/Bloomberg/Getty)

Use of prescription opioids in Canada has risen steadily over the past 20 years, with skyrocketing misuse, disorders and deaths, say experts who call for enforceable guidelines and a national strategy to address overprescribing.

In Monday's the Canadian Medical Association Journal, Prof. Benedikt Fischer of the Centre for Addiction and Mental Health in Toronto and his co-authors say it's late, but not too late, for Canada to reduce the toll of opioid overuse and abuse. 

National surveillance data is spotty, but surveys suggest that by 2010, more than 1 in 20 adults and as many as 1 in 6 adolescents were using prescription opioids for non-medical purposes.

At the same time, demand for prescription opioid-related addiction treatment has soared.

In 2012, several provinces pulled oxycodone from their drug formularies and prescribing shifted to other potent opioids, such as fentanyl and hydromorphone. 

Fischer and his team seek guidelines to prescribe opioids only in exceptional cases, with strict limits on dose and duration.

They'd also like to see real-time electronic prescription monitoring systems across the country. They want doctors and pharmacists to be required to consult these databases before prescribing or dispensing opioids.

Fischer noted that illicit fentanyl pills from China and Mexico that increasingly are being trafficked on the street in Canada — and have been responsible for numerous overdose deaths, particularly in B.C. — have been a distraction from the domestic crisis created by excessive prescribing of medical opioids, which often are diverted to recreational users.

"The fake fentanyl is filling and fuelling the demand that our medical system has created," he said, adding that a national strategy needs to deal with prevention as well as treatment for the thousands of Canadians who have become dependent on the drugs.

In a related commentary, M. Eugenia Socias and Keith Ahamad, researchers at the British Columbia Centre for Excellence in HIV/AIDS in Vancouver, also called for a national strategy in Canada to address overprescribing of opioids, and expand treatment facilities and services for addiction, especially through care providers.

 The federal government is holding a national summit on opioids in Ottawa on Nov. 18.

Here are some other key moments in Canada's recent history of prescription opioids: 

2000Dispensing of opioid prescriptions starts to riseDispensing of prescription opoids in Canada increased from about 10,000 defined daily doses per million population a day in 2001-2003 to more than 30,000 in 2012-2014.
2007Drugmaker guilty of misleading publicThree executives with the U.S. branch of Purdue Pharma pleaded guilty in a U.S. Federal Court to misleading regulators and an unsuspecting public about risk of addiction to OxyContin.
2010National Opioid Use Guidelines introducedGuidelines for safe and effective use of opioids include recommendations such as consider the use of a screening tool with little direction about when not to prescribe or limit doses.
2012Questions about oxycodone riskOxycodone was implicated in a disproportionate number of opioid-related harms and deaths, prompting several provinces to remove it from the drug formularies.
2012-2016Prescribing shiftsSome provinces shift to prescribing other potent opioids, mainly fentanyl and hydromorphone.
2013National roadmap strategyNational strategy on reducing harms associated with prescription drugs presents vague recommendations, but it's unclear how many have been effectively implemented, researchers say.
2015Draft federal regulationsFederal regulators present draft regulations to require a tamper-proof design for prescription oxycodone formulations that account for about 10 per cent of dispensed opioids.
2016U.S. guidelines introducedU.S. Centers for Disease Control and Prevention recommends that doctors prescribe opioids at the lowest effective dosage possible only when the benefits from pain reduction and bodily function outweigh the risks.
2016British Columbia declares public health emergency over opioid deathsOpioid crisis that has killed more than 370 people in the province in the first part of 2016 is declared a public health emergency and a task force is created.
2016Nova Scotia crackdown

Nova Scotia College of Physicians and Surgeons endorses CDC guidelines and recommends doctors cut in half the amount of opioids they prescribe for chronic pain.

With files from Canadian Press