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It's Time For Ottawa To Listen To The Evidence About Opioid Use

06/14/2017 12:00 EDT | Updated 06/14/2017 12:03 EDT

It's time for Justin Trudeau to start teaching Dr. Jane Philpott, his health minister, about the value of evidence in formulating policy. Let me explain.

My last blog post dealt with the Ontario war on pain patients and it garnered considerable attention. As the result of that blog, I was twice invited to be on the Roy Green Talk Show -- the second time to give my impression of his interview with the minister of health. Green has also taken up the challenge of defending people who are in chronic pain from the misguided policies of the government.

jane philpott

(Photo: Adrian Wyld/CP)

By way of background, there are two problems faced by society. The first is the use of drugs for reasons other than to treat a medical condition. Those drugs include marijuana, cocaine, heroin, hallucinogenics and opioids. Those who take these do so for a variety of reasons and, because they are buying drugs from criminal dealers, do not always get what they expect. Increasingly, these drugs are laced with counterfeit fentanyl and many die from overdoses.

Then, there are a lot of people who suffer from pain that does not go away. They are under the care of doctors who have provided them with a series of treatments usually starting with more benign strategies like physiotherapy, exercise, biofeedback, up to the use of prescription medications ending with opioids for those for whom nothing else helps.

For those with the most serious pain, the opioids usually help to varying degrees and allow these patients to enjoy a better quality of life. They are seen regularly by their doctors and are monitored. They are not abusing the medication and, as I pointed out in my previous blog, very, very few are addicted.

As Halifax writer Dawn Rae Downton wrote in theGlobe and Mail, she uses fentanyl not to get high but to have a life despite her chronic pain. As she said, "One in five Canadians suffers miserable chronic pain; many have used opioids safely for years. They don't abuse, sell, overdose or continually raise their doses." When the pain is undertreated, she said, "patients risk immense physical and emotional dysfunction, endocrine failure, cardiac collapse, immune problems, dementia and early death, sometimes by suicide."

Unfortunately, what the government is doing is confusing the two problems into one and going after legitimate pain patients who use their opioids responsibly under the care of physicians as a way to reduce overdose deaths amongst the population of illicit drug users.

Decisions are being made even though Dr. Philpott claims to be a follower of evidence-based practice.

Dr. Lynn Webster is a past president of the American Academy of Pain Medicine with many years experience treating chronic pain. He told Green that the efforts to reduce the use of opioids actually began with U.S. insurance companies and Workers Compensation Boards attempts to reduce costs by convincing regulators that opioids are bad. (June 11, hour 1 segments 1 & 2, about 8 minutes in).

He also pointed out that the result of the government policies to reduce the legitimate use of opioids for people in pain will likely result in an increase in suicides amongst this population. Pain, he said, can be so unbearable that sufferers will do anything to end it, including taking their own lives. To get some understanding of what these patients endure, watch the trailer for his documentary or listen to the descriptions by pain patients on the Green show.

Dr. Webster actually requested that he be on the show after he heard Green's interview with Dr. Philpott because he did not agree with what she said. You can hear her interview on June 3 in hour 2 segments 1, 2 and 3 followed by my critique of her immediately after.

She did say when forced to by Green that what a patient is prescribed is really up to the patient and his/her health-care provider. If that is the case, then why is the government interfering with that by imposing limits on the prescriptions? They have no right to just as Trudeau's father once said "there's no place for the state in the bedrooms of the nation."

But what is even more telling is that she has no clue how many of the overdose deaths from opioids occur in pain patients. Without knowing that, there is no basis to target pain patients. She also does not know what portion of pain patients become addicted and, again, without knowing that, there is no basis to what they are doing. Dr. Webster commented that if a pain patient overdoses, then it is most likely suicide rather than accidental.

In the absence of evidence, decisions are being made even though Dr. Philpott claims to be a follower of evidence-based practice. Her boss, Justin Trudeau, told the Vancouver Sun editorial board that "I'm a big fan of evidence-based policy. " As Vice reported, Trudeau said that he is not philosophically opposed to legal heroin. The reason that he is decriminalizing marijuana is because "safety is his top priority, and he doesn't want to give money to gangs and dealers."

Evidence from Portugal which was the first country to decriminalize heroin has resulted in that country having the fewest number of overdose deaths of any country in Europe. The Portuguese death rate is three per million compared to 17.3 per million in the European Union. The Independent reports that "Transform Drug Policy Institute says in its analysis of Portugal's drug laws, "The reality is that Portugal's drug situation has improved significantly in several key areas. Most notably, HIV infections and drug-related deaths have decreased, while the dramatic rise in use feared by some has failed to materialize."

The evidence for decriminalizing is there, but there is no evidence that attacking pain patients will do anything but make vulnerable people miserable, prone to suicide and destroy their lives.

It is time to listen to the evidence.

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