Men­tal health, pain, be­hind opi­oid abuse

Peo­ple need help early on to deal with is­sues, be­fore they be­come de­pen­dent

The Hamilton Spectator - - COMMENT - VI­VIAN TAM AND JACQUELINE CARVERHILL

A call to the emer­gency room an­nounced that the am­bu­lance was on its way. Joey, a mid­dle-aged oil­field worker, was ex­pe­ri­enc­ing a sus­pected toxic in­ges­tion of the opi­oid fen­tanyl. He had been ad­min­is­tered nalox­one — the drug used to re­verse opi­oid over­doses — and was con­scious.

When he ar­rived in the emer­gency de­part­ment, he re­vealed that he’d been hav­ing trou­ble cop­ing with the re­cent dis­so­lu­tion of his mar­riage.

And ear­lier that day, he’d been laid off from work. A friend of­fered him fen­tanyl and he agreed to try it, just this once, to get through the day. Joey’s story is not iso­lated. A re­cent re­port by the Cana­dian Cen­tre on Sub­stance Abuse (CCSA) and the Cana­dian In­sti­tute for Health In­for­ma­tion (CIHI) found that 13 Canadians are hos­pi­tal­ized ev­ery day from an opi­oid over­dose. In Bri­tish Columbia and Al­berta, prov­inces par­tic­u­larly hard-hit by opi­oid ad­dic­tion, the rate of fa­tal fen­tanyl over­doses in­creased ten­fold be­tween 2012 and 2015 alone. And Saskatchewan has the high­est rate of hos­pi­tal­iza­tion from opi­oid poi­son­ing.

Na­tion­ally, the pic­ture is dire. Canada has the high­est rate of pre­scrip­tion opi­oid use in the world.

There are many rea­sons for the overuse of opi­oids and as fu­ture physi­cians, we’re aware that in­ap­pro­pri­ate pre­scrib­ing prac­tises are a clear and stud­ied cul­prit. Yet for many pa­tients across the coun­try, there’s more to the story.

Marc was in a car ac­ci­dent eight years ago. It left him with chronic neck and back pain. In the emer­gency room, he was given a pre­scrip­tion for Per­co­cet (a com­bi­na­tion of Tylenol and the opi­oid oxy­codone). Af­ter a year of fol­lowup pre­scrip­tion opi­oids for his pain, his fam­ily physi­cian told Marc it was time to step down his pain con­trol to Tylenol or Advil.

But by this time, Marc was de­pen­dent on the opi­oids. So when the pre­scrip­tion stopped, he started buy­ing them on the street. He felt aban­doned by the med­i­cal sys­tem, left with­out ac­cept­able op­tions to man­age his pain.

For­tu­nately, he sought help and en­rolled in a methadone pro­gram. Marc no longer needs to self-med­i­cate but, as with many Canadians, he con­tin­ues to have un­con­trolled pain. He’s on a list to see a pain spe­cial­ist but has been told it could be a year or more.

Marc and Joey’s sto­ries are not un­com­mon in Canada, where poorly-treated chronic pain and men­tal health is­sues drive both opi­oid mis­use and re­sul­tant fa­tal­i­ties. A re­cent re­view of opi­oid-re­lated deaths in On­tario showed that 66 per cent of in­di­vid­u­als vis­ited their doc­tor’s of­fice just four weeks be­fore their death. Men­tal health is­sues (no­tably anx­i­ety, de­pres­sion or sub­stance use) and per­sis­tent pain (no­tably joint or back) ac­counted for the ma­jor­ity of the vis­its.

Men­tal health is­sues ap­pear to in­crease the risk of opi­oid mis­use in­dis­crim­i­nately across age groups. In a 2012 study, youth with pre-ex­ist­ing men­tal health is­sues were al­most three times as likely to use opi­oids as their peers. Among adults, ex­ist­ing mood and anx­i­ety dis­or­ders pre­dicted high in­ci­dences of try­ing, abus­ing or be­com­ing de­pen­dent on opi­oids.

Yet spe­cific strate­gies to im­prove the treat­ment of men­tal health is­sues and chronic pain have been lack­ing in the main­stream con­ver­sa­tion about tack­ling Canada’s opi­oid cri­sis. In­ter­ven­tions to stem the opi­oid tide have largely fo­cused on ad­dress­ing sup­ply. On­tario has com­mit­ted to in­crease ac­cess to opi­oid re­place­ment ther­a­pies and Bri­tish Columbia has en­acted manda­tory opi­oid pre­scrib­ing stan­dards for physi­cians.

These ef­forts are in­valu­able — but they’re not enough.

Med­i­cal stu­dents from across the coun­try con­verged on Par­lia­ment Hill to gal­va­nize sup­port for an ap­proach to the opi­oid cri­sis that pri­or­i­tizes timely ac­cess to ef­fec­tive men­tal health and chronic pain ser­vices.

Canada can ad­dress the opi­oid epi­demic in a mean­ing­ful, ev­i­dence-based and strate­gic way. But will the solutions adopted by the fed­eral gov­ern­ment be suf­fi­ciently nu­anced to ad­dress the rea­sons un­der­ly­ing the mis­use of opi­oids? The suc­cess of any pro­posed solutions will de­pend on it.

Vi­vian Tam is a fi­nal-year med­i­cal stu­dent at McMaster Univer­sity and McMaster’s se­nior rep­re­sen­ta­tive to the na­tional Gov­ern­ment Af­fairs and Ad­vo­cacy Com­mit­tee. She is a con­trib­u­tor to Ev­i­denceNet­work.ca. Jacqueline Carverhill is a se­cond-year med­i­cal stu­dent at the Univer­sity of Saskatchewan and the chair of her Med­i­cal Stu­dents As­so­ci­a­tion’s po­lit­i­cal ad­vo­cacy branch. This ar­ti­cle was writ­ten with in­put from mul­ti­ple med­i­cal stu­dents on be­half of the Cana­dian Fed­er­a­tion of Med­i­cal Stu­dents (CFMS). Dis­trib­uted by Troy Me­dia

HAMIL­TON SPEC­TA­TOR FILE PHOTO

Fen­tanyl, above, is very dan­ger­ous. It might be in a street drug un­know­ingly and kill the user.

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