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Unintentional Deaths From Prescription Painkillers on the Rise in Canada

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The combination of alcohol and the prescription painkiller oxycodone that proved lethal last month for 28-year-old NHL player Derek Boogaard of Regina is an increasingly common cause of death here and in the United States.

Ruled accidental by a medical examiner in Minnesota, the New York Ranger's demise is the latest in a series of high profile deaths linked to prescription painkillers. The Australian actor Heath Ledger, of course, also comes to mind.

In the United States last year, drug-induced deaths, led by prescription painkillers, were second only to car crashes in accidental fatalities, and prescription painkiller misuse is the leading cause of death in 17 U.S. states, according to the Centres for Disease Control.

Canada has also experienced an alarming increase in such unintentional deaths. For example, oxycodone-related deaths in Ontario increased nine-fold between 1991 and 2006 and, in most cases, the deceased had taken a non-opioid depressant (alcohol, benzodiazipines, antidepressants) along with the pharmaceutical, according to recent research.

But where is the national leadership on this issue? We would do well to look to Australia as a model.
Canada and the United States have by far the highest per capita consumption of the painkiller oxycodone in the world -- more than double the rate in Australia, which is the third ranking country, according to 2008 figures from the International Narcotics Control Board.

But Australia has taken action. Last year, it initiated a National Pharmaceutical Drug Misuse Strategy, with a focus on opioids, benzodiazepines, and over-the-counter medications containing codeine, since these medications "are associated with greatest levels of harm," according to background documents. (Opioids include drugs such as codeine, morphine, hydromorphone and oxycodone. Prescriptions written for drugs containing oxycodone, which is 50 to 100 per cent more potent than morphine, have increased significantly in Canada and internationally over the past 15 years.)

The Strategy, supported by all states and territories in the commonwealth, is due to report later this year. But it was not Ledger's 2008 death that prompted action -- Australia has long acknowledged the risks of prescription drugs, and since 1985 included them in its National Drug Strategy.

In contrast, Canada's National Anti-Drug Strategy concerns itself solely with illicit drugs. The five-year strategy, launched in October 2007 by the Conservative government, is led by Justice Canada and devotes the majority of its funding to law enforcement.

As the National Anti-Drug Strategy comes up for renewal, it is time to acknowledge the problems associated with prescription painkiller misuse. These drugs obviously have legitimate uses, especially for people suffering from acute pain and cancer.

But the past 10 to 15 years have seen a huge increase in prescribing opioids for chronic pain not related to cancer. The evidence supporting the effectiveness of long-term use of opioids for chronic pain is, however, not robust and the benefit to risk ratio is unclear.

Many Australians "may have developed unrealistic expectations of what medications can offer in terms of ameliorating pain, discomfort and dysphoria," states a background document for Australia's National Pharmaceutical Drug Misuse Strategy. "Over-reliance on medications may have resulted in their use as a first line response when often non-pharmacological interventions may be more appropriate."

No doubt the same is true in Canada.

Prescription painkiller related harm is not a new issue. Alarmed at rising numbers of deaths, Sudbury had a narcotics abuse task force in 2004 and Newfoundland and Labrador had an Oxycontin Task Force the same year (Oxycontin is a slow release form of oxycodone).

In 2004/5, Health Canada led national consultations that resulted in the creation of a National Framework for Action on Substance Abuse. The framework, which called for a broad approach to the issues of drug abuse (including pharmaceuticals) and alcohol abuse, was re-endorsed by key signatories in 2008.

As a top priority, those who took part in the consultation felt that "a significant paradigm shift is needed in order to frame substance abuse as first and foremost a health and social issue (their emphasis) rather than a criminal one, and to dedicate funds accordingly," according to the report.

If we in Canada want to prevent more accidental deaths like that of Derek Boogaard, we should learn from Australia's example and launch a high profile national initiative to address a situation described, by the normally cautious College of Physicians and Surgeons of Ontario, as an "opioid public health crisis."

Ann Silversides is the recipient of a Canadian Institutes for Health Research grant to study prescription painkiller issues. She is also a media advisor with EvidenceNetwork.ca, a comprehensive and non-partisan online resource designed to help journalists covering health policy issues in Canada.

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