Non-medical use of prescription opioids is now the fourth most-prevalent form of substance use in Canada; it trails only alcohol, tobacco, and cannabis. Between 2000-02 and 2010-12 Canadians' use of prescription opioids more than tripled. We may now have surpassed Americans to have the highest per capita use of prescription painkillers in the world.
It has been estimated that between 500,000 and 1.25 million Canadians a year use prescribed opioids for non-medical purposes. In the United States over the last several years, 9.4 million individuals have taken opioids for long-term pain; of these, about 2.1 million have developed dependence.
In 2000, retail pharmacies in America dispensed 174 million prescriptions for opioids. By 2009, that figure was 257 million -- a 48 percent increase. Despite the alarm over widespread misuse there is evidence that number of opioid prescriptions are continuing to climb in Canada.
This dependency has left tragedy in its wake. The federal and provincial governments are struggling to bring this epidemic and the havoc it has wreaked under control.
In marked contrast, large numbers of people the world over are deprived of pain relief. A Report from the Global Commission on Drug Policy, The Global Crisis of Avoidable Pain, documents this deprivation and its causes and consequences.
An estimated 5.5 billion of the world's population (over 75 per cent) have poor-to-nonexistent access to adequate analgesics, in particular morphine. Just 17 per cent of the earth's population, mostly in northern countries, consume 92 percent of the global supply of that drug.
As a result, millions experience otherwise avoidable suffering. Among them are terminal cancer patients, end-stage AIDS patients, and women in labour suffering from uncontrolled pain. All of this takes place even though international drug laws and international human rights laws require states to ensure that controlled medicines are made available to their populations; failure to provide such access constitutes a violation of the right to health.
As the Report indicates, a number of factors impose barriers to availability, including weak healthcare systems and the lack of trained clinicians working on the ground. However, the international drug control system also bears significant responsibility for the continual undersupply of restricted medicines. Governments and UN bodies emphasize the prevention of diversion of controlled substances for illicit purposes at the expense of ensuring access for medical and scientific needs. Both the International Narcotics Control Board and the United Nations Office on Drugs and Crime have a dual obligation to maintain a balance between preventing diversion and ensuring access. But they have historically privileged the former over the latter.
At the national level, some governments continually emphasize a criminal justice approach to drug control rather than a public health perspective. Thus, access to controlled medicines is impeded. In some countries, physicians operate in a climate of cultural and legal uncertainty, real or perceived, regarding their ability to provide relief. They are afraid of prescribing pain medicines due to the risk of criminal prosecution or of being charged with professional misconduct for failing to adhere to stringent regimes.
There are many instances of such restrictive control: in Georgia, pharmacies dispensing opioid medicines must be based in police stations. Ten African countries limit prescriptions of opioids to no more than two weeks' duration; in Ghana, the limit is two days.
We must confront the prescription painkiller epidemic in Canada. It is a crisis that must not happen again. But as we face these huge challenges we need to bear in mind the larger context and the lack of management of suffering in so many other countries. We should encourage our governments to promote adequate pain management as a universal need in all societies even as they struggle to stem the flood of opioids in this one.
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