A new study indicating overdose deaths have risen in close parallel with the country’s soaring consumption of prescription narcotics is more evidence the painkillers have become Canada’s most dangerous drugs after tobacco and alcohol — and need concerted, national action, says a leading addiction researcher.
“We’re giving them to quite a number of people who don’t really need them that urgently,” said Benedikt Fischer of Simon Fraser University. “There is a reason why other, highly developed industrialized nations from the G8 survive and seem to have rather healthy populations — with 25% or 30% of the amount of opioids as we dispense.”
Prof. Fischer and his colleagues suggest in another new study that one in six teenagers use pills like oxycodone and Percocent “non-medically,” yet lawmakers are still not taking the issue seriously enough, Prof. Fischer argued. That just-published research comes on the heels of a third Canadian study released this week, pointing to a link between serious car crashes and taking even low doses of opioids.
This country is second only to the U.S. in per-capita consumption of the drugs. Provincial governments and medical regulators have tried to curb abuse of opioids recently, with measures such as electronic monitoring of prescriptions, while most government drug plans are ending coverage of OxyContin and its tamper-resistant replacement. Those policies are piecemeal, however, and have likely had limited impact, said Prof. Fischer.
Canada needs a comprehensive plan that curbs inappropriate prescribing of the drugs and educates patients about their dangers, he said.
Yet some physicians see a different problem: many Canadians with severe, chronic pain going untreated. Dr. Roman Jovey, a prominent Ontario-based pain specialist, questioned the significance of the new research, and warned against rash action.
Most of the overdoses documented in one of Prof. Fischer’s studies are likely of people who abused opioids — probably along with other drugs that would make the cause of death questionable, said Dr. Jovey.
“It’s a tragedy when anybody dies using a prescription, but let’s keep the big picture in mind here,” he said. “Who’s dying?… Is it innocent people — they’re just using the drug like their doctor told them to and they die? I would suggest that’s extremely rare.”
Dr. Jovey, who receives consulting and speaking fees from the maker of OxyContin and other drug firms, argued for balanced solutions, such as better communication and monitoring around opioid use.
Canada rose from sixth to second-largest prescription-opioid consumer in the world over the last decade, with sales reaching $768-million in 2011, according to IMS-Brogan, a market research firm. Meanwhile, evidence points to a rising toll of addiction and overdose death, both among drug addicts and those prescribed by a doctor.
An expert advisory council set up by the federally funded Canadian Centre on Substance Abuse is planning to release a prescription-drug-abuse strategy this March.
The recommendations will strive to ensure cancer patients and others who truly benefit from the drugs can access them, while lessening prescription to people who could be treated in other ways, said Michel Perron, the centre’s CEO. “Everybody would agree that the status quo cannot carry on,” he said.
One of the two new studies compared coroners’ statistics on deaths related to use of four opioids in Ontario and B.C., and levels of consumption of the same drugs from 2005 to 2009.
In Ontario, the number of fatalities linked to Fentanyl, a highly potent painkiller usually delivered through a time-release patch, climbed from 34 to 57, while those for oxycodone, the active ingredient in OxyContin and its replacement OxyNeo, jumped from 96 to 143. The number of oxycodone-related deaths leapt to 173 in 2010, and 166 last year, the chief coroner’s office said this week.
In B.C., overdose deaths related to hydromorphone, commonly known by the brand name Dilaudid, almost tripled to 20 from seven, while oxycodone fatalities ballooned three-fold, to over 30.
In each case, the deaths increased or shrunk in almost perfect unison with the amount of the drugs consumed, noted Prof. Fischer.
Still, Dr. Jovey said, evidence from other jurisdictions suggests that most of those deaths were likely among addicts using the drugs illicitly, while the actual death rates are relatively small — about 30 times less, for instance, than for suicide.
Dr. David Juurlink, co-author of the study on road crashes and opioids with Tara Gomes of Toronto’s Institute for Clinical Evaluative Sciences, argued the problem is serious, and not shrinking in the face of recent regulatory measures.
“We still have a pervasive sense amongst patients that they are entitled to their opioids, they need their opioids, and we have doctors, including some very prominent ones, arguing that is the case,” he said. “Doctors do all kinds of things that are not supported by great evidence … but we do very few things as dangerous as this.”
Tom Blackwell | Jan 16, 2013 11:06 PM ET