The Problem With Painkillers: Managing Opioid Use in Canada
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.
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.”
The face of addiction in Canada is changing, according to Perron. “When most people think of a drug addict, they see a street-involved person, a stereotypical user. The government’s new strategy is recontextualizing what drug addiction represents in Canada-it’s a health issue.” That shift hopefully means a more open conversation about treatment options and control for a problem that has, up until the past few years, gone largely unacknowledged. Despite one U.S. study out of the Geisinger Health Centre in Pennsylvania indicating that the common demographic for prescription painkiller abuse is older women in suburban and rural areas, Perron says addicted Canadians run the gamut from a patient visiting two pharmacies to fill a prescription to a high-school student sneaking pills from a relative’s medicine cabinet.
The legalities surrounding opioid addiction bear more resemblance to attitudes around drinking rather than hard drugs. And since picking up pills from a pharmacy with a doctor’s note isn’t a crime, the ability to intervene can be limited.
As the stigma of painkiller abuse starts to lift, discussions are turning to treatment options, but there’s a long way to go to establishing a plan that works. “It’s the last very hidden health disorder,” Perron says. “You’re more likely to admit to being a cancer survivor or a depression survivor than an opiate survivor.”
Warning signs of prescription drug abuse:
Physical: bloodshot eyes, dilated pupils, sudden weight loss or gain, slurred speech, tremors or impairment.
Behavioural: shirking responsibilities, using more of a drug than prescribed, and purposefully going to multiple pharmacies and doctors.
Psychological: sudden mood swings, changes in attitude, angry outbursts, anxious or paranoid behaviour.
How to handle a possible prescription pill addiction in your family:
First, talk to the person and express concern. Often, if a loved one is addicted, they won’t want to engage, says David Juurlink, drug safety researcher and associate professor at the University of Toronto. If they demur, talk to their doctor. “More often than not, I suspect the doctor doesn‘t realize there‘s a problem,” he says. Although patient-physician confidentiality means a doctor can’t divulge information, they’re entitled to receive details about a patient.
How to discuss dosages with your doctor:
Addiction implies a pattern of use despite harm to oneself. So while you may not be addicted, you can still have concerns about the doses of your drugs. Ask your practitioner if it’s conceivable to dial a dosage down gradually. According to Juurlink, high levels of some prescription painkillers have been shown to worsen pain. If you’re concerned for your safety, inquire.