The Problem With Painkillers: Managing Opioid Use in Canada (1/3)

They come in myriad colours and sizes, their names unpronounceable. To many patients, prescription pills represent a respite from chronic pain and suffering, but to the approximately 200,000 Canadians hooked on painkillers, the medicine cabinet has led to what doctors are calling a national prescription drug crisis.

The Problem With Painkillers: Managing Opioid Use in CanadaPhoto: Thinkstock

Last year, the Canadian Centre on Substance Abuse (CCSA) introduced a strategy to combat the problem. Facing particular scrutiny are opioids, the classification of narcotics made from opium and that include household names Oxycontin, codeine, Vicodin and Demerol. Far from harmless, they are similar in chemical makeup, addictive quality and impact on the body to heroin and can have long-term physical effects that range from sedation to hormone interference.

A decade ago, Canada was sixth in the world for prescribing opiate drugs to patients. Today, it’s a close second to the United States. Michel Perron, CEO of the CCSA, says there’s no one specific reason for the jump, although effective marketing by opiate manufacturers and the addition of some drugs to public insurance plans are factors. “We saw a doubling of unintended overdose deaths in Ontario from 1991 to 2004, and a doubling of people seeking treatment for addiction to these drugs from 2004 to 2009,” he says. “This is not about going opiate-phobic or reversing the advances we’ve made in better pain management. It’s about minimizing the risks while allowing for the benefits.” The strategy, entitled “First Do No Harm: Responding to Canada’s Prescription Drug Crisis,” contains 58 recommendations, ranging from regulatory policies for prescribing physicians to reducing the availability of high-risk drugs.

About 20 years ago, as some research began to emerge on the positive effects opioids could have in treating intense, chronic pain and improving patients’ quality of life, drug com­panies started to lobby the medical community to use more of the drugs more liberally. Soon, doctors were prescribing opioids freely, often in high doses, and if the patient’s pain wasn’t improving, the dosage was upped, says David Juurlink, an in­ternist and drug safety researcher, and associate professor at the University of Toronto. “If you went to the doctor in 1990 with a bad knee, you’d probably be told to get some rest and take some Tylenol,” Juurlink says. “Now you’re much more likely to get a prescription for Percocet or Oxycontin.”

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