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Canada's New Opioid Prescribing Guidelines Are Causing Patients More Pain

Trying to control overdose deaths among addicts by targeting patients who are suffering from legitimate pain is flawed.

08/25/2017 15:43 EDT | Updated 08/25/2017 16:10 EDT
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In attempting to deal with opioid deaths among addicts, our federal government is engaging in a moral failure of epic proportions. They have no coherent strategy to deal with addictions but, instead, have turned their focus onto patients who are in chronic pain and are being treated by physicians.

As I pointed out in my last post (and a number of earlier ones), the government commissioned McMaster University in Hamilton, Ont. to develop opioid prescribing guidelines for doctors to drastically reduce the amount of pain medication that patients can acquire legally. Patients who are stable on opioids and are not having bad side effects from them are being forced by their doctors to lower their doses. The result is increased pain for them.

The Hippocratic Oath that doctors take stipulates that they should do no harm, but that is what they are doing when they force their patients to again experience pain.

The Alan Edwards Pain Management Unit at McGill University advises doctors that "pain patients have the right to be cared for by health professionals with training and experience in assessment and management of pain" and that failure to do so "violates the United Nations (UN) Single Convention on Narcotic Drugs (1961) and Article 5 of the UN Universal Declaration of Human Rights (1948)."

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ACTISKENAN capsules (morphine sulfate).

By forcing patients to lower their effective prescribed opioids as doctors are being forced to do by these new guidelines, patients are being forced into pain. Article 5 of the Declaration of Human Rights says that "No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment."

When these guidelines were being developed, no one from the McGill pain unit is listed as having been involved.

In my last blog, I cited Dr. Sally Satel and other medical specialists that prescribing opioids does not normally result in addiction. Dr. Satel is one of the leading addiction psychiatrists in the U.S.

She sent me a link to an article that she and a colleague just published on Aug. 17. Called "Some People Still Need Opioids," it describes the deaths and suicides that are resulting from patients who are stable and well managed in their pain control because they have been cut off.

Those who suffer from addiction continue to suffer and to die while those who have treated pain and are coping and enjoying life are being thrown into despair by failed policies.

Her colleague, Dr Stefan Kertesz, wrote earlier this year that the strict limits on opioid prescribing is resulting in inhumane treatment. He said that "There have been no prospective clinical studies to show that discontinuing opioids for currently stable pain patients helps those patients or anyone else." And he said that "pain patients currently taking opioids long-term have become involuntary participants in an experiment, with their lives at stake."

The Canadian situation is no different. I've been told by a number of people that their only recourse to the pain they are expecting when they will be cut off is suicide as some have already done. In my last blog, I cited the case of one patient in B.C. who requested assisted suicide for her previously well-managed pain.

So where is the proof that lowering doses from the higher recommended doses in the 2010 guidelines for people who are stable will benefit anyone? Those guidelines suggest 200 milligrams of morphine equivalent per day (MED) and even higher if it helps, but the new guidelines set 90 MED as the maximum. B.C. follows the U.S. guidelines of only 50 MED.

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In 2010, the highly respected Cochrane Review, which studies the efficacy of medical treatment, reported that in studies of close to 5000 patients, opioids resulted in "clinically significant reductions in pain" and that addiction occurred in only 0.27 per cent of the cases. Opioids work and few become addicted. This study was not referenced in their guidelines that I could find.

The bottom line in all of this is that trying to control overdose deaths among addicts by targeting patients who are suffering from legitimate pain is flawed. Those who suffer from addiction continue to suffer and to die while those who have treated pain and are coping and enjoying life are being thrown into despair by failed policies.

I do not know of any area of medicine where you suddenly state that patients who are stable on a treatment regimen and enjoying a reasonable quality of life might be in danger of unspecified risks and reduce or remove the medication against their wishes that gives that stability and quality of life.

This is a government policy worthy of Dr Mengele.

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