DON’T FORGET ABOUT CHRONIC PAIN SUFFERERS

For years, says Lynn Cooper, people like her have been viewed as “complainers, malingerers or drug seekers.” They are, as it happens, none of these things.

The club they actually belong to — the one they would desperately love to quit — is the community of one in five Canadians suffering from chronic pain. Pain so bad they can’t work, can’t sleep, often battle depression and live 24 hours a day with grinding, energy-sapping suffering. And because many of them are treated with opioids, they can add “stigmatized’ to the list of symptoms they endure.

This is the side of the opioids debate that doesn’t get much press. As Ottawans, understandably and rightly, mourn the death of young people in our city from drug overdoses that may involve potent opioids such as fentanyl, and as lawmakers explore how to crack down on these poisons, our policies threaten to catch a whole class of innocent sufferers in the dragnet.

We know the daunting statistics: 655 deaths in Canada were linked to fentanyl between 2009 and 2014. In 2015, 48 people in Ottawa alone died of drug overdoses, 29 of these linked to opioids. Counterfeit drugs, whose active ingredients are unknown, often turn out to be deadly. Something must be done.

So something is. But it’s also often done to legitimate users, those sometimes prescribed very high opioid doses so they can function at all. “We do not abuse,” says Cooper, president of the Canadian Pain Coalition. “We take our medications as prescribed for the sole purpose of helping manage our chronic pain.”

That has not stopped governments from targeting legitimate users. As of Jan. 1, Ontario no longer pays for high-strength, long-acting opioids for patients, and has tightened restrictions on fentanyl pain patches. Regulatory bodies are inquiring into the practices of individual doctors. The federal government has announced an Opioid Action Plan. As part of the federal crackdown on illicit drug use, the Michael G. DeGroote National Pain Centre at McMaster University is developing new prescribing standards that would discourage higher-dose treatment.

The DeGroote guidelines have already drawn more than 265 responses, says Jason Busse, who is chairing the project to update standards in place since 2010. He’s mindful that many chronic pain patients are worried by a key recommendation: a suggestion to limit the maximum daily dose of opioids to less than half of the current guideline. The recommendations are carefully worded, however — and will be further reworked — to try to ensure doctors have flexibility to treat pain patients as individuals, rather than cram them into one-size-fits-all formulae. Tapering longtime opioid users off high doses of an addictive drug can be tricky. No one wants pain patients “compelled to seek (drugs) from an alternative source,” says Busse, referring to the black market that is proving so deadly.

This is scant comfort to some, though. Dr. Ellen Thompson, a retired Ottawa-area anesthesiologist and pain specialist, argues that with governments and professional colleges scrutinizing all things opioid, many doctors will think twice about keeping patients on higher dose opioids even if results were good. “A large number of people treated did well; they could live and work. With the new guidelines, it may no longer be so.”

It’s not that opioid prescribing is without problems; on the contrary. Opioids have been overused, and dosages have varied wildly, in part because physicians are so poorly trained — if at all — in treating pain. If we want to crack down on opioid prescriptions and addictions, we need to crank up medical education and assure access to wider resources for pain treatment. We need to pay for options, such as physiotherapy, not currently covered by OHIP.

Dr. Peter MacDougall, head of the pain medicine program at The Ottawa Hospital, believes the challenges of dialing back high-dose opioid prescriptions, while complex, ultimately can be managed. “The vast majority of providers are committed to the well-being of their patients,” he notes.

The drug epidemic killing our young rightly requires robust action. Chronic pain, meanwhile, “has been in epidemic proportions for many, many years,” says Cooper. Can we treat both epidemics, successfully, at the same time? Christina Spencer is the Citizen’s editorial pages editor.