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Canada's Letting A Fear Of Opioids Trap Patients In A World Of Pain

Opiophobia has resulted in very severe prescribing guidelines that make it difficult to obtain adequate pain relief.
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Our government spends money every year to help destigmatize mental illness for the one in five Canadians who are estimated to have one. It does so through the Mental Health Commission of Canada and events like the recent Mental Health Awareness Week. But when it comes to chronic pain suffered by another estimated one in five Canadians, the government stigmatizes them rather than helps.

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I am referring to the opioid-prescribing guidelines which were revised in 2017 as a response to the overdose deaths of people who are addicted and take illegal substances. The assumption behind these new, highly restrictive policies is that overdoses are the result of doctors prescribing too many opioids, leading many to become addicted. When challenged to provide evidence of this, former Health Minister Jane Philpott was incapable of providing answers. Every difficult question she was asked was answered with "that's a very good question."

The data shows the opposite of this assumption — prescribing opioids is not a problem.

Sally Satel, a highly respected addiction psychiatrist writing in National Affairs, had this to say:

"The vast majority of people prescribed medication for pain do not misuse it, even those given high doses. A new study in the Annals of Surgery, for example, found that almost three-fourths of all opioid painkillers prescribed by surgeons for five common outpatient procedures go unused. In 2014, 81 million people received at least one prescription for an opioid pain reliever, according to a study in the American Journal of Preventive Medicine; yet during the same year, the National Survey on Drug Use and Health reported that only 1.9 million people, approximately two per cent, met the criteria for prescription pain-reliever abuse or dependence."

A recent article in the Canadian Pain Society pointed out the following facts:

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Despite those statistics, pain patients are having their doses reduced against their wishes. I've pointed this out before, and doctors are being investigated for their prescribing practices. But now, as of Oct. 1, pharmacists in Alberta have a new mandate to re-evaluate all patients coming into their pharmacies with a prescription for opioids. They will now re-assess those people and determine if their doctor should have given them the prescription in the first place.

Not to be outdone, pharmacists in Ontario are now requesting the same for themselves and wish to charge the government an extra $75 per prescription to do what the doctor already did.

Morphine (an opioid) is so crucial for pain control that the British medical journal, the Lancet, just completed a special report on its use (or lack of use) worldwide. They found that "more than 25 million people, including 2.5 million children, die in agony every year around the world, for want of morphine or other palliative care." Poor people are not getting proper pain relief either because their needs are overlooked or there is fear about potential illicit use.

It is time to end this war on pain patients and to start treating them with respect and compassion.

Professor Felicia Knaul, co-chair of the commission, said, "The world suffers a deplorable pain crisis: little to no access to morphine for tens of millions of adults and children in poor countries who live and die in horrendous and preventable pain," and this is "one of the world's most striking injustices."

That injustice, the commission said, is compounded in developed countries by "opiophobia" — the fear that allowing the drugs to be used in hospitals and for pain will lead to addiction and crime in the community.

This opiophobia has resulted in the very severe prescribing guidelines we are now seeing in North America. In a recent podcast by the Canadian Medical Association Journal with one of the authors of the new Canadian guidelines, Dr. David Juurlink, it was declared that the prescribing of opioids is a society- wide crisis that has killed a lot of people. However, they can provide no data to back up that claim, just as former Health Minister Jane Philpot was incapable of providing it. And yet, recently released data on the United States' top-selling drugs found that opioids did not dominate. The leading drug is a thyroid replacement.

What is killing people painfully and ruining the quality of life of so many others, however, is the difficulty that people have getting adequate pain relief thanks to the opiophobia.

It is time to end this war on pain patients and to start treating them with respect and compassion.

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