On August 17, 2010, the Ontario Minister of Health and Long-Term Care made an announcement in London, Ontario about actions the McGuinty government will take to curb the problem of inappropriate use of narcotics or opioids, such as OxyContin. On September 8, 2010, the College of Physicians and Surgeons of Ontario (CPSO), which is responsible for the licenses of all doctors practicing in this province, delivered a lengthy and comprehensive report regarding the Ontario’s opioid public health crisis.
Why all this fuss? Is there a problem in Ontario with the use of these very strong medications for pain? And if there is a problem, is it just an Ontario problem or does it affect all areas of our country?
Opioids are a very strong class of painkillers. You may be more familiar with generic or commercial names such as Percocet, Oxycocet, Endocet, OxyContin, Oxy-IR, Statex, Hydromorph, Morphine, Demerol, etc. These drugs are of great value in the treatment of cancer-related pain. As well, over the last 15 years or so, they started to be used in non-cancer pain, such as back pain, neuropathic pain, headaches, arthritis and all kinds of painful chronic, conditions. Today, we face a very difficult situation that affects Canada and the USA in particular (as these two countries use opioids much more liberally than most European countries and countries in South America, Africa or Asia). These drugs seem to be prescribed more often than they should for certain patients with chronic non-cancer pain who may have the tendency to abuse them. Additionally, they have now become the drugs of choice for addicted people who may not even have pain. A recent Canadian study showed that opioids are preferred over heroin as a street drug of choice. A recent study from the Coroner’s Office in Ontario showed that high doses of these drugs may lead to death in some cases. We are indeed facing an opioid public health crisis in Ontario.
But Ontario is not alone. In a meeting I attended at the CPSO headquarters early in 2009, doctors, pharmacists, nurses, police forces, coroners and First Nations representatives from all Canadian provinces agreed that this is a Canada-wide problem that needs a serious approach. In May of 2010, a document titled Canadian Guideline for the Safe and Effective Use of Opioids for Chronic Non-Cancer Pain was released in the country, the product of collaborative efforts between healthcare practitioners and regulatory colleges throughout the country. This document spells out what physicians should do or not do when it comes to prescribing opioids for non-cancer pain, as well as preventing and treating addiction in patients with chronic pain.
This opioid public health crisis, however, is a monster with two faces. One is that of abuse, overuse and diversion of opioids. The other one is a very sad face of hundreds and thousands of Canadians with pain, who can be helped by opioids, but physicians refuse to prescribe them. My clinic is overwhelmed in one hand by patients who are on high doses of narcotics and should not be, and on the other hand, by worthy patients with serious medical problems for whom these drugs can make the difference between laying in bed with pain or getting up and living a life of good quality and even manage to work.