Expert sees strict opioid rules coming to Sask.

A Saskatoon addictions specialist expects Saskatchewan will eventually adopt opioid guidelines even stricter than those newly prescribed by the Ontario government.

“This is an interesting process we’re going through within the medical profession as they try to get a handle on the rampant overprescribing of opioids,” Dr. Peter Butt said.

Last week, the Ontario government said it would no longer cover morphine 200 milligram tablets, hydromorphone 24 mg and 30 mg capsules, and fentanyl 75 microgram/hour and 100 mcg/hour patches.

“The ministry is committed to continuing to monitor the prescribing and dispensing of narcotics and to bringing forward further modernization in funding under the (Ontario Drug Benefit) Program to reduce the risk of addiction and death resulting from the abuse, misuse, and diversion of these products,” according to a notice from Ontario’s health ministry.

“We recently learned of the Ontario approach and will be watching to see whether it would make sense in Saskatchewan,” health ministry spokesman Tyler McMurchy said in an email.

The Ministry of Health’s Pharmaceutical Information Program and the Saskatchewan College of Physicians and Surgeons’ Prescription Review Program are intended to help reduce abuse and diversion of high-risk prescription medications, he said.

Prescription of strong opioids can lead to people becoming addicted, Butt said. The drugs can cause a higher level of dependency and craving until they become a patient’s primary coping mechanism for pain.

Another issue is the amount of opioids in unlocked medicine cabinets that are available to other people in the household, particularly teens or visitors.

There’s also a market for people to sell their medication on the street, Butt said.

The Centers for Disease Control in the United States has also adopted a new opioid prescription guideline — but it cautions doctors against increasing dosages up to 90 mg of morphine per day.

Butt said he expects that at some point Saskatchewan will adopt guidelines similar to those, rather than Ontario’s.

“This is really trying to set a more routine standard at a lower level of prescribing,” he said.

High-strength opioids have crept from the realms of acute care, palliative care and cancer care to noncancer chronic pain management, he said.

Meanwhile, pharmaceutical companies have sent their pain specialists to talk up an aggressive approach with family doctors, he said.

“So the really assertive use of opioids in chronic non-cancer pain hasn’t borne up to greater scrutiny. There isn’t a lot of evidence that high levels of prescribing generally improve function. If the goal is to chase pain levels down to zero out of 10 on a scale, that’s a recipe for disaster with chronic non-cancer pain.”

Instead, the focus should be on maximizing a patient’s ability to function, Butt said.

That could mean drugs targeting nerve damage or the perception of pain, or blocks put in by anesthesiologists; counselling to help people live around the pain and decrease the side effects of high doses of drugs; or increasing interventions such as physical therapy, massage, yoga, relaxation therapy and mindfulness.

“So if they’re having a bad day, they ramp up other interventions rather than just the dose of their drugs. And if they have a good day, they can increase their exercise level, and certainly graduated exercise is another intervention.”

However, Saskatchewan doesn’t have a publicly funded chronic pain clinic, Butt noted.