Opioid Deaths, Most Inadvertent Since Oxycontin Hits Markey

By chillinwill · Dec 8, 2009 · ·
  1. chillinwill
    Accidental deaths due to opioid use in Ontario have soared over the past couple of decades, increasing dramatically after a new long-acting version of the drug oxycodone - sold as OxyContin - hit the market, a new study suggests.

    Opioid-related deaths claim more people each year in Ontario than HIV, with 27 in a million people dying from an opioid-induced overdose versus 12 in a million to HIV, the researchers reported Monday in the Canadian Medical Association Journal.

    Lead author Dr. Irfan Dhalla said there's been a suspicion among physicians that deaths due to prescription opioid use were on the rise, but this was the first effort to quantify it in Ontario. He admitted the effect was greater than he anticipated.

    "When you think about the fact that there are far more people dying from prescription opioids than from HIV, that to me is surprising," said Dhalla, who practises general internal medicine at St. Michael's Hospital in Toronto.

    A leading addictions researcher said the work underscores that the substantial increase in problems related to prescription opioid use is a "major public health challenge" for Canada.

    Benedikt Fischer, interim director at the Centre for Applied Research in Mental Health and Addictions at Simon Fraser University, said the findings are especially important as Canada and the United States have the world's highest rates of medical opioid use.

    "Thus, emphasis should be given to the questions of why these extensive increases in the use of prescription opioids ... have occurred, whether these compounds are necessary for the intended health outcomes and what may be done to reduce the use of prescription opioids to maximize pubic health without undue collateral damage," Fischer wrote in a commentary that accompanied the study in the journal.

    Opioids are strong analgesics - a.k.a painkillers - which bind to receptors in the central nervous system, decreasing perception of pain and increasing pain tolerance. Though morphine and heroin are also members of this class of drugs, opioids used in pain control include codeine, oxycodone, and its slow-release cousin, OxyContin.

    Dhalla and his colleagues examined trends in the prescribing of opioids in Ontario from 1991 to 2007 and went over coroners' reports of deaths in which opioid use was listed.

    Over the period, all opioid-related deaths doubled, to 27.2 per million in 2004 from 13.7 per million in 1991. But after OxyContin hit the market in the mid-to-late 1990s, deaths involving that specific drug increased fivefold.

    Over the period, opioids were implicated in 3,406 deaths. Most appeared to be accidental; coroners ruled the deaths were unintentional in 52.4 per cent of the cases and suicide was listed on only 23.6 per cent of death records.

    The majority of the deaths involved other substances that also serve as a nervous system depressant, such as alcohol or sleeping pills.

    Dhalla said opioids on their own can slow breathing to the point where a person slips into a coma; when combined with alcohol or sleeping pills, the risk is even greater.

    "I think the saddest cases are probably where somebody has gotten into a friend's OxyContin or relative's OxyContin and just taken what appears to have been a very small amount just for kicks and then not woken up," he said.

    "And we did see some of those cases."

    He stressed, however, that the problem isn't simply about recreational or illegal use of the drugs - it's also about over-prescription of the drugs.

    "I think there is a perception that this is a recreational drug use problem. And what our data have clearly shown is that most of the people who are dying are not outside the health-care system. They are seeing physicians frequently and they are more often than not receiving prescription opioids by prescription," he said.

    Helen Branswell
    December 7, 2009
    Metro News

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  1. Canmedaa
    This is a topic that is particularly irritating to me and these persons and hospitals are very close to home and I am a little embarrassed by this article.

    #1: Drug-Overdose and Immunodeficiency are not related medical conditions. They may have well as compared the number of people who die of cancer to the number of people who die from a gunshot would to head. Yes, they have death in common. No, the mode of death is not related.

    #2: Anyone who has taken a basic statistics course has learned that people are impressed by numbers, especially big numbers, or numbers that look they really must be significant when statistically, they are not. 27 deaths out of a million is 0.000027%. This number should no longer be particularly alarming to anyone who understands what a decimal is. Phrased another way, that is roughly 1 in every 37,000 persons who uses opiates dies from an overdose, give or take a few hundred.

    This, to me, is a perfectly acceptable oopsie-rate for some of the most effective analgesic medications we have. I am personally appalled with practitioners in Ontario right now, particularly in the GTA who are taking long-term pain patients off their opiates and downgrading them to prescription levels of acetaminophen or expecting them to rely on OTC 222's.

    If Canadians are going to start demonizing opiate analgesics and crying bloody murder everytime the prescription rate jumps I'd like them to stop treating the public like idiots and actually present the relevant data.

    If prescription rates for opiate analgesics go up for the management of long-term pain in a province, I might be tempted to ask seemingly obvious questions such as:

    "well what proportion of pain-patients are those wonderful, elderly baby boomers we're all struggling to figure out how to care for? How many of them have painful morbidities common amongst their age group?"

    "Have the rates of any other conditions requiring narcotic pain management gone up as well? How is the cancer ward these days with the aging population? With the regular population?"

    "How does the number of deaths related to opiate-analgesics compare to the number of deaths from acetominophen-induced hepatotoxcity? How many of those toxic patients were pain patients compensating for the lack of an appropriate analgesic by be mowing down several thousand milligrams of OTC analgesic every day?"

    #3 If the article clearly states that the majority of opiate-analgesics are obtained through a physician, then I fail to see how that constitutes over-prescription alone, and it clearly indicates that opiate-analgesics seem fairly well controlled in Ontario. If a physician deems it necessary to prescribe a medication like an opiate-analgesic to releive the pain and suffering of a patient, I have to ask, who the hell else has any business in the matter?

    #4 Opiate-analgesics are designed to combat pain, and they do it very well. Why decide to demonize a medication that is so effective and so reliable? I personally am of the opinion that its just the popular thing to do right now; take pain medicine away from patients in pain. From an ethical standpoint I am far less worried about the 1 in 37,000th guy that drops dead from opiate-analgesics than I am about the 37,000 people who might not be able to get their medication anymore because it's currently fun to flip-out over pain medication.

    I'm sorry for being insensitive, but choosing to keep prescribing opiate-analgesics even in light of the whole 27 out of a million people who died this year isn't irresponsible, it's triage. The pain of 37,000 patients is more important than the death of one man or woman. The needs of the many do outweigh the needs of the few and personally I think it's pretty $%#!ing irresponsible of physicians not to stand up and say "Enough is enough. Patients are in pain and it's my job to treat them. Now GTFO out of my practice."

    Sorry for the long not-so-neutral post. This just irritates the Maple Syrup out of me.

    Best Wishes,
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