THE UNINTENDED VICTIMS of the WAR on OPIATE ABUSE- LEGITIMATE PAIN PATIENTS
November 4th, 2017
We all feel sympathy for lives lost from overdoses and the pain felt by their family and friends. Addiction is complicated as are the solutions, but care must be taken to ensure that collateral damage to innocents with chronic pain does not result.
EDMONTON, Alberta - Oct.30, 2017 - PRLog -- November 5 is the start of Pain Awareness Week and so we should consider the new plight those with chronic pain are suffering as the result of the opiate deaths being experienced throughout North America. One of the more common solutions for those with chronic pain is opiate medications.
These medications are effective and enable those with chronic pain to have an improved quality of life. With the careful prescribing by physicians, addiction and abuse is limited and is estimated to be less than 1%. According to Dr. Sally Satel, a psychiatrist experienced in addictions writing in National Affairs:
"The vast majority of people prescribed medication for pain do not misuse it, even those given higher doses. A new study in the Annals of Surgery, for example, found that almost three-fourths of all opioid pain relievers 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."
The deaths we are seeing from opiate abuse occur with drugs bought from dealers rather than prescription drugs and involve illicit rather than prescribed fentanyl. This fact has been attested to by the coroners for both Alberta and British Columbia.
In a recent webinair by the Canadian Agency for Drugs and Technologies in Health (CADTH), Dr. Hakique Virani, a public health specialist from Alberta, pointed out that prescriptions for opiates are declining. Despite that decline, deaths from opiates are increasing. Clearly, prescriptions from doctors are not the problem, nor have they ever been. He also mentions the starting opiate of choice for those addicted is heroin. Heroin is not a drug prescribed by doctors.
The Canadian Pain Society cites statistics from the Canadian Tobacco and Alcohol and Drug Use Monitoring Survey. They show that opiate use has dropped from 20.6 per cent of Canadians reporting use of an opiate in 2010 to 15 per cent in 2013, while use to get high has remained at 0.2 per cent.
Despite the fact that people in pain are not the cause of the addiction problem and the deaths that we are seeing, governments have decided to make it difficult for these patients to acquire medications they need to make their lives bearable.
The former Canadian Minister of Health, Jane Philpott, commissioned a new set of guidelines for the prescribing of opiates by doctors from McMaster University, which did not include any specialist in pain treatment. These guidelines resulted in 4 patient representaives involved refusing to have their names associated with it. The guidelines severely limit the amount of opiates that a patient can have to 90 mg of morphine equivalent per day when the median dose is actually 180 mg. These guidelines recommend that patients be tapered from their current stable doses, many have been on for years.
While this tapering of patients is supposed to be agreed upon between the patient and his/her doctor, the Colleges of Physicians and Surgeons (the regulatory bodies in each province) are investigating doctors who treat pain patients and threatening their licenses. The Ontario Ministry of Health turned over the names of all high prescribing opiate physicians to the "College" for investigation.
What is happening is exemplified by the case of a 76 year old man in Ontario who has been stable on a dose of opiates for years. His doctor is forcing him to reduce his dose despite the fact that it is causing him considerable pain and restricting his quality of life. Also the case of a middle aged man being tapered suffering a heart attack and who is now blind in one eye. There are many more.
As a solution, the doctor suggested to the 76 year old man go to a methadone clinic. These clinics are usually for those addicted so, as a retired police officer, he was reluctant to do that.
Some pain experts have warned the policy to limit opiates for legitimate use will increase overdose deaths as pain patients will be forced to get their medications from the street. This is already happening. The CBC in Ottawa recently reported on one person who has been forced into street heroin at $80 per day from his usual $2 per day prescription. He had been taking opiates for the pain of Crohn's and Colitis since the age of 12 successfully and had a good quality of life until his doctor forced him to reduce his dose. Reports from other jurisdictions suggest this is a growing problem.
In B.C., the CBC also reports thousands of people are being forced to take street drugs including a 60 year old woman because their doctors have cut them off their pain medications. This simply compounds a street drug problem this province has had for years.
Government does need to react to the opiate abuse situation and attempt to ameliorate it, but it should not be done on the backs of innocent people who suffer from chronic pain. In fact, limiting the availability of medical narcotics to patients is a violation of the UN Single Convention on Narcotics, which Canada signed. The present approach to this probem is reminescent of the 1930's and Prohibition. The only winners were those involved in criminal activities, much the same as today.
For more information about chronic pain and The Chronic Pain Association of Canada, please visit: www.chronicpaincanada.com.