Change strategy on pain drugs

A new window has opened on the epidemic of overdose deaths engulfing our province. It is being alleged in the U.S. that some manufacturers of opioid drugs misled physicians about the addictive power of these medications.

Several states, including Ohio, are suing pharmaceutical firms on that basis. They claim physicians were told that later generations of opioids such as oxycontin — a powerful painkiller — were much less addictive than earlier versions. In 2012 alone, pharmacies in Ohio dispensed 790 million opioid pills.

There have also been allegations in the U.S. that drug-distribution companies knowingly sold opioids to shady pharmacies that dispensed medications without proper precautions.

These developments are important for two reasons. First, opioids such as oxycontin are highly addictive, assurances to the contrary notwithstanding. Second, there is substantial evidence that patients who become addicted to oxycontin and other potent painkillers sometimes move on to illicit fentanyl.

We tend to think of overdose victims as street users with long-term drug habits. But research published by the B.C. Centre for Disease Control shows that about half of all overdoses, provincewide, occur in private residences.

That led provincial health officer Dr. Perry Kendall to note that many of those dying at home are not stereotypical drug users, but professionals and parents. It’s a reasonable presumption that at least some of these victims began their addiction after receiving an opioid prescription from a GP.

That’s why those lawsuits south of the border are so concerning. They point to a concerted effort by big pharma to mislead physicians into prescribing more of their product.

So has this happened in Canada? Apparently, it has. Published research suggests that one of the companies sued by Ohio sponsored pain-management lectures at the University of Toronto’s medical school, where the addictive qualities of medications were repeatedly downplayed.

What about B.C.? There are mixed opinions within our medical community as to the extent of misleading marketing here. Certainly, we have tougher rules than some American states as to the tactics that are permitted.

However, some authorities believe it’s likely that corporate sales techniques have played a part in boosting opioid use here. And our prescribing rates might back that up. In 2015 — the most recent figures — opioids were the second most commonly used class of drug in the province.

According to the Canadian Institute for Health Information, a stunning 452,718 patients received an opioid prescription that year. That’s one in 10 British Columbians.

It’s impossible to say with precision how many doses this amounts to. Some patients might be on the drug for only a few days. Others might be on it all year.

However, we are likely talking about tens of millions of doses, some of which inevitably leak onto the street.

To be fair, the oversight body for doctors in B.C., the College of Physicians and Surgeons, is aware of the risks. Tough guidelines have been issued, backed up by fines as high as $100,000 for doctors who don’t comply. That has likely reduced the volumes being prescribed.

But the question remains: Has enough been done to persuade physicians they should change their approach to managing chronic pain?

With an epidemic of opioid deaths sweeping, the answer appears to be no.