The painkiller puzzle: How to solve a growing opioid crisis

A dramatically rising number of people are dying from opioids — such as OxyContin and codeine — but health experts and doctors say Canada's not doing enough to combat the crisis.

Painkillers help those with chronic pain, but strategies needed to rein in prescriptions

Canada exceeds all other countries except for the U.S. in its per-capita consumption of opioids such as OxyContin and codeine. (Toby Talbot/Associated Press)

A dramatically rising number of people are dying from opioids — such as OxyContin and codeine — but health experts and doctors say Canada's not doing enough to combat the crisis.

"We give these drugs to too many people, too generously, at too high doses, and we need to rein back this excessive dispensing and prescribing of opioids," said Benedikt Fischer, the Canadian Institute of Health Research chair who specializes in substance abuse. "If we do that effectively, we will reduce a lot of the harms, including deaths."

Opioids are a family of drugs that are typically used to treat pain, but are also known for giving users a feeling of euphoria, making them addictive.

Since one in five Canadians suffer from chronic pain, prescription painkillers such as codeine and morphine are attractive.

However, Canada exceeds most other developed countries in its prescription of the drugs. Recent data puts Canada as the world's second largest per-capita consumer of prescription opioids, just after the United States.

"These are not innocuous drugs," says Fischer. "They come with a lot of risks and harms."

A study released Monday addressed one of the worst harms: death.

The study, published in the Addiction journal, found the rate of opioid-related deaths doubled in Ontario to 41.6 deaths per million — or about 550 deaths a year —  between 1991 and 2010. Young adults fall victim the most.

For those in the addictions field, the rigorous study, which examined nearly two decades' worth of coroner reports, provided confirmation of a worrisome trend connected to the readily available type of painkiller.

"The writing's been on the wall on this for a long time. We've known that these drugs cause a lot of deaths, the numbers are rising. The question is: what are we doing about it?" asks Fischer.

Fastest-growing addiction

One way Health Canada plans to try to curb abuse of the prescription drugs is forcing companies to make opioids, particularly OxyContin, tamper-proof so addicts can't crush them for snorting or injecting for a quick high.

While painkillers such as opioids are neccessary in many cases, they can also be highly addictive and can lead to overdoses. Experts caution that doctors must weigh whether the risk is worth the benefit. (iStock)

That news came Monday and coincided with questions being raised about whether Canadian pills in the older form of OxyContin, which the U.S. banned last year for its crushing capability, are trickling south of the border.

Addictions researcher Thomas Kerr dismissed the move by Health Canada as a "minor strategy" that fails to address the larger issue in what's become a public health crisis.

Not only can addicts still get their high from taking the drug in the prescribed fashion, studies show that they often simply move on to another drug, said Kerr, who is co-director of the Addiction and Urban Health Research Initiative in B.C. 

"The reality is the federal government doesn't really know what's going on with drugs in this country," said Kerr. 

Countries such as Australia and even the United States have "far more sophisticated drug monitoring programs" than in Canada, such as the annual U.S. survey on drug use and health, he says.

A study by Fischer did find that demand for prescription opioid-related treatment doubled in Ontario in five years ending in 2009.

It's the fastest growing problem for addiction services in the province. By 2011, nearly 20 per cent of those in Ontario seeking treatment for addiction were there for prescription opioids.

At a federal standing committee on health hearing earlier this year, Dr. Meldon Kahan, an addiction specialist, described the public health crisis as one caused by physicians. 

"The good news is that since the crisis is caused by physicians, it can be solved by physicians, with the help of policy-makers and the public," he told the committee.

The doctor suggested a slew of possible solutions, including that provincial drug plans put limits on reimbursement for high opioid doses, medical regulators such as colleges of physicians establish explicit standards and the federal government increase oversight of the information on prescriptions given by drug manufacturers to doctors.

'Question the necessity'

For Fischer, the biggest challenge is reducing the sheer amount of opioids dispensed in Canada. 

While the medication can be necessary to manage chronic or severe pain, he says doctors need more education on when not to prescribe the painkillers. In many western European countries, he notes that they prescribe up to a third of what's prescribed in Canada.

Sometimes the risks, such as an overdose or addiction, can outweigh the benefits, he stressed. 

It's a lesson that mother Betty-Lou Kristy knows all to well. The Georgetown, Ont., woman lost her son at the age of 25 when he became addicted to OxyContin prescribed for pain and accidentally overdosed when it was mixed with other medications.

"My message would be is to really question the necessity of a prescription," said Kristy. "If you're getting prescribed an opioid, have a solid discussion with your doctor."

She said people don't understand how addictive opioids are — and automatically assume they're safe because they're prescribed by a doctor.

"It really frightens me," said Kristy. "It's so devastating. It's so hard to beat this addiction."


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