Canada needs opioid strategy: docs
Addiction experts call for national opioid strategy as overdose deaths rise
TORONTO — Canada needs a comprehensive national strategy to curb rampant overprescribing of opioids and to reduce escalating numbers of deaths caused by overdoses of the powerful narcotics, addiction experts say.
Writing in Monday’s edition of the Canadian Medical Association Journal, Dr. Benedikt Fischer of the Centre for Addiction and Mental Health (CAMH) and co-authors say an estimated 2,000 Canadians died from opioid overdoses in 2015, and many provinces are on track for an even higher number of deaths in 2016.
“It’s a real public health disaster,” Fischer said. “Over the last 10 years, we’re looking at somewhere between 10,000 and 20,000 dead people in Canada just from opioid overdoses alone.”
In a separate report last Monday, the Toronto centre urged Ottawa to launch a review of all prescription painkillers sold in Canada and said high-dose opioid medications should be pulled from the market.
Worldwide, Canada is the second-highest consumer of prescription opioids like oxycodone, hydromorphone and fentanyl, after the U.S.
“We have hundreds of thousands of people now who are dependent on these drugs because of misuse or overprescribing or excessive exposure,” said Fischer.
Medical evidence suggests opioids should be restricted to patients with acute pain, such as that related to cancer or following surgery, and should be given in limited doses and for a short duration to prevent dependence.
But instead of focusing on overprescribing — the major driver of opioid misuse and abuse — Fischer said governments and the medical system have instead tinkered with downstream effects, such as increasing access to naloxone, a drug that can reverse an opioid overdose, and treatment of dependency with another medication called suboxone.
While Ontario has delisted Oxycontin on its provincial drug benefit program, that move merely shifted the problem to other prescription opioids like morphine and fentanyl patches, said Fischer.
“Regulators and authorities have been watching this problem not just unfold but grow and get worse and worse, and didn’t really take effective action,” said Fischer.
“It is late — but not too late — to move toward reducing the toll of opioid overuse and abuse in Canada,” Fischer said.
He said illicit fentanyl pills from China and Mexico that increasingly are being trafficked on the street in Canada — and have been responsible for numerous overdose deaths, particularly in B.C. — have been a distraction from the domestic crisis created by excessive prescribing of medical opioids, which often are diverted to recreational users.
The federal government is holding a national summit on opioids in Ottawa on Saturday, which will include addiction experts and organizations such as CAMH.
In a related CMAJ commentary Monday, Drs. M. Eugenia Socias and Keith Ahamad, researchers at the B.C. Centre for Excellence in HIV/AIDS, say changing prescribing practices may help protect patients in the future.
“However, we’re in the middle of an opioid overdose epidemic due to untreated addiction .... We need to act now: Canada can no longer afford to be a witness to this devastating epidemic,” they write.