Across Canada, the tragic spike in opioid-related deaths has brought to national attention the large and complex issue of drug use and misuse. As fentanyl-related overdoses are gripping the country, there is a connected, but separate crisis of doctor-prescribed opioids being increasingly used on a regular, long-term basis.
Hundreds of codeine tablets stolen from the medicine cabinet of an elderly person living alone in a rural community. Hydromorphone tablets being distributed at weddings and high school parties. Fentanyl patches being cut up and sold for a profit on the street. This is the reality of the opioid crisis in Canada today.
What distinguishes this epidemic is not only its catastrophic toll --hundreds of thousands dead, uncountable millions harmed -- but also the fact that, unlike SARS, Ebola or influenza, this epidemic has no end in sight. The "why" is complicated, but it relates in part to prevalent beliefs about the role of these drugs in medical practice.
Canadians might be surprised to learn that many health and social services widely available in the community are not available in most of Canada's correctional facilities -- this needs to change. We are missing a critical window of opportunity to reframe the period of incarceration as a time to help people improve their health and well-being before returning to our communities.
In my practice, I have seen the terrible impact addiction can have on people of all backgrounds. It destroys jobs, families and personal health, often in the span of just a few months. This level of complexity and quick-moving consequence is something you don't often see in many other conditions, which makes finding solutions that much harder. Addressing addiction requires approaching treatment in a much more integrated fashion across different parts of the health care system and groups of providers.
Critics have begun pointing the finger at the medical system and its prescribers -- well-meaning doctors and specialists who've been giving too many patients excessively powerful opioid medications to deal with modest pain. But we can dig deeper and look at the relationship between medical education and pharmaceutical company influence as a significant contributing factor.
Despite recent headlines, Canadian rates of suicide and attempted suicide have remained largely unchanged over the last several decades. What has changed is that we've seen increasing rates of suicide in the Canadian military recently, after stable rates for decades. The problem of suicide is not limited to the military in Canada; indigenous populations, especially in northern remote communities, have high rates of suicide. We need a unified approach across provincial and federal sectors to reduce suicides in the military, among veterans and civilians.
Today, doctors' offices are inundated with people who have been harmed more than helped by these drugs. Thousands more are dead. And yet the marketing continues, with pain specialists and advocacy groups opposing moves to curtail opioid prescription, their efforts financed by the very companies that make these drugs.
he false notion that opioids are safe, effective treatments for chronic pain was inculcated by the companies that manufacture them, with self-styled "experts" preaching this gospel to front-line physicians. Incredibly, this happened in the absence of good evidence that the benefits of long-term opioid use outweigh the risks.