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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.

10/16/2017 17:33 EDT | Updated 10/16/2017 17:35 EDT

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:

  • Recent evidence has demonstrated a very low risk of persistent opioid use after medical exposure to opioids following major elective surgery. Of 39,140 opioid-naïve patients who had undergone surgery in Ontario, only 168 (0.4 per cent) continued to receive an opioid prescription one year later. (Page 4)
  • The American College of Surgeons made a public statement online in a press release stating that: opiate pain killers prescribed after severe injury do not lead to long term use, citing a study on 7,302 patients who had sustained major traumatic injuries. Forty-nine per cent filled at least one prescription for an opioid after hospital discharge and only 0.9 per cent were still taking an opioid one year later. (Page 5)
  • Statistics from the 2015 U.S. National Survey on Drug Use and Health are also revealing for what they say about addiction to prescription pain relievers. The survey, comprising 68,073 face-to-face interviews, showed that 36.4 per cent of the U.S. population over the age of 12 years reported using prescription pain relievers, and 4.7 per cent reported misusing them in the past year. Note that the definition of misuse includes use in any way not directed by a doctor, including: use in greater amounts, using more often or using longer than told to take a drug. (Ref. 18, Page 9). Among the 4.7 per cent who misused prescription pain relievers, the most common reason given for the misuse was to relieve pain which was reported by 62.6 per cent of respondents with only 2.3 per cent endorsing because I am hooked or have to have it. (Page 5)
  • Using these numbers, it is estimated that about 0.12 per cent of the population of the United States over the age of 12 years is addicted to prescription pain relievers. According to the Canadian Tobacco and Alcohol and Drug Use Monitoring Survey opioid use has dropped from 20.6 per cent of Canadians reporting use of an opioid in 2010 to 15 per cent in 2013, while use to get high has remained at 0.2 per cent. (Page 5)

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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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