Doctors are working to solve opioid crisis they helped to create
Fewer prescriptions and more treatment options a good start, Dr. Scott McLeod says.
Overuse of opioids is an ongoing crisis. Nearly 500 Albertans died from accidental opioid poisoning in the first nine months of 2017. Three-quarters of those deaths involved illicit fentanyl, which is commonly laced into other drugs. We have two inter-related problems: overuse of opioids and other drugs, and an illicit drug supply that is toxic in a way we’ve never seen before.
Over-prescribing of opioid painkillers contributed to the crisis, in part because physicians were told to treat pain more aggressively, and that opioids were a safe way to do it. Doctors didn’t set out to do harm but we helped create the crisis, and now we need to help solve it. Canada has the second-highest prescription opioid use per capita in the world, and Alberta is the highest among the provinces.
We need to prescribe opioids more appropriately, and that means less. In Alberta we have the most current data in the country, and it shows a remarkable change is happening. In just 12 months from September 2016 to September 2017, the number of Albertans prescribed the five main opioid painkillers dropped by seven per cent — that’s 9,000 fewer people prescribed opioids in a given month (mainly codeine). Total volume prescribed dropped 14 per cent (measured in oral morphine equivalents.)
These are big changes, and they’re broadly similar to the latest data from Ontario. Physicians are changing their practices in response to new evidence and guidelines, and guidance from provincial regulators.
The reduction in prescribing is good but it brings risks of its own. Lowering an opioiddependent patient’s dose too fast or withdrawing the medication altogether risks leaving the patient to turn to illicit drugs; we never want to see that happen. We want physicians to prescribe based on the latest evidence and guidelines, not to stop prescribing opioids altogether, or make sudden changes in the care of individual patients to meet any numerical target. The welfare of the individual patient comes first. Any patient or doctor with concerns or questions should contact us directly.
Prescribing responsibly also will reduce prescribed opioids diverted to the street, which may result in more demand for illicit supply. We need to reduce diversion but the transition puts some people at risk.
We must greatly expand access to treatment for people with opioid use disorder. The number of patients receiving the two main opioid replacement therapies, methadone and Suboxone, increased more than 20 per cent in the latest 12 months to September 2017, and the number of physicians prescribing the treatment drugs increased by 33 per cent.
Reducing prescribing of opioid painkillers and increasing access to treatment are encouraging trends. They reflect the commitment of individual physicians across the province to do the right thing for patients, but there is much more to be done.
We’ve removed regulatory barriers to prescribing Suboxone, allowing more primary care physicians to provide this treatment. We’re also working with experts to streamline methadone prescribing and enable emerging evidence-based treatments for opioid use disorder such as sustained-release oral morphine and supervised injectable opioid agonist treatment, provided by trained physicians in appropriate settings. These steps are intended to support actions Alberta Health and Alberta Health Services have taken to expand access to treatment.
We need to identify people at risk and get them whatever help is appropriate. Physicians have the same duty to provide compassionate care to people who use substances as they do to every patient; appropriate care includes harm reduction, e.g. overdose prevention and response training, and naloxone kits for patients presenting with an opioid overdose.
Most importantly, we must address the stigma faced by people who use substances when they need care. We must seek to understand the challenges patients who use substances face when they interact with our health-care system. Only when we truly understand our patients can we garner the trust needed to provide safe, effective and compassionate care.