06/30/2017 12:48 EDT | Updated 09/24/2018 09:24 EDT

B.C.'s New Opioid Standards Don't Respect Our Right To A Pain-Free Life

We are now starting to see the unintended consequences of the recent move by government to solve the so-called opioid crisis. It will likely get worse if the government does not listen to reason and modify its attack against legitimate pain patients as a way to deal with an addiction problem, as I've written on the War on Pain Patients and on Ottawa's failure to follow the evidence. And Canada may be in violation of international treaties with its actions.

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Fentanyl citrate.

"Unintended consequence" is a concept first described by the American Sociologist Robert Merton as outcomes that were not foreseen and intended by some action or policy. These consequences can be positive, negative or perverse. Perverse consequences are those that are opposite to what was anticipated.

One example of a perverse outcome is the temperance campaign in 19th Century Ireland, where thousands pledged not to drink alcohol. To keep their pledge, many began drinking the highly combustible and dangerous diethyl ether. The best example is Prohibition, which was intended to create a healthier, more moral society with less crime and violence, but led to the opposite.

And that is what the rules governing the prohibition of prescribing opioids for people who need it and are under the care of doctors will do (if they aren't already). British Columbia has introduced new guidelines on the prescribing of opioids that are mandatory and remove any discretion from a doctor to prescribe for his/her patient based upon the needs of that patient. Doctor have to blindly follow or risk losing their licenses.

That happened to 60-year-old Lorna Bird, whose doctor was forced to cut her off her pain medication. Faced with increasing and unbearable pain, she is buying drugs from pushers in the Downtown Eastside neighbourhood of Vancouver. CBC News estimates that thousands of people are being forced to take a similar route.

Pamela Moore

Halifax journalist and chronic pain patient, Dawn Ray Downton, wrote recently in the Ottawa Citizen that "I depend on fentanyl. I'd get sick if I were yanked off it. I'd suffer excruciating pain, then suicide without it."

She repeated that on the Roy Green Show and said that she has suicide plans in effect in case she can no longer get medication for her chronic pain. Her husband, Bob Haagenson, appeared on the show with her (June 25, hour 3, segments 3 and 4) and told the listeners that he estimates that there are 5.6 million chronic pain patients in Canada and, if they are cut off their medications, we could see suicides amongst about one per cent of them, or 56,000 people.

If anyone doubts that guesstimate of suicides, just imagine if you had horrible pain and what actions you might take to relieve that pain.

In 1961, governments (including Canada) signed the Single Convention on Narcotic Drugs which addressed the control of illicit drugs and obligated countries to ensure that its citizens had access to narcotics to alleviate pain and suffering. In the preamble, it states that "the medical use of narcotic drugs continues to be indispensable for the relief of pain and suffering and that adequate provision must be made to ensure the availability of narcotic drugs" (p. 15).

We have many physicians that have walked away from opioid prescribing completely because they're afraid of having their licenses taken away.Dr. Mary Lynch, on CBC Quirks and Quarks

The World Health Organization clearly believes that being able to be pain free is a basic human right. They state that "According to international human rights law, countries have to provide pain treatment medications as part of their core obligations under the right to health; failure to take reasonable steps to ensure that people who suffer pain have access to adequate pain treatment may result in the violation of the obligation to protect against cruel, inhuman and degrading treatment."

And the reasons they cite for failing to provide that basic human right is "the existence of unnecessarily restrictive drug control regulations and practices; fear among health-care workers of legal sanctions for legitimate medical practice."

These new guidelines do just that and, in the case of B.C., they are mandatory. Dr. Mary Lynch, a professor in the Department of Anesthesia, Pain Management & Perioperative Medicine at Dalhousie University in Halifax, told the CBC program, Quirks and Quarks, that not only has she had two patients in the last year commit suicide (compared to only one in the previous 25 years) but that "physicians are frightened to prescribe. We have many physicians that have walked away from opioid prescribing completely because they're afraid of having their licenses taken away."

Dr. Lynch also reported in the Canadian Journal of Pain that the College of Physicians and Surgeons of Ontario sent out 86 simultaneous Section 75 investigation notifications to physicians who have at least eight patients on a dose above 850 mg oral morphine equivalents of opioid therapy per day. This involves a compulsory 20- to 25-patient-chart review that takes a long time to complete and is labour-intensive for busy clinicians.

What could be more intimidating to a busy clinician that something like that? It certainly appears to be a violation of the international treaty that Canada signed.

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