Opioids ease one pain but lead to another

Drugs that treat pain are both a blessing and a curse. Too often a prescription that brings relief leads to addiction and an overdose death.

Those drugs are classed as opioids. Oxycodone (best know under the brand name OxyContin) and fentanyl get the most attention at the moment but old standbys like Demerol, Percodan and Percocet are still in the mix.

A new study of prescription opioid use done by the Ontario Drug Policy Research Network has found that Peterborough city and county have the fourth-highest rate of opioid overdose deaths in the province.

That report surveyed all 36 Ontario public health units and was released a week before International Overdose Awareness Day. The relatively high local rate of overdose deaths and that timing makes it tempting to focus on preventing such deaths. But that’s a complex undertaking. Dr. Rosanna Salvaterra, Peterborough’s medical officer of health, is heavily involved in a province-wide campaign to reduce the harm done by prescription painkillers. As she has said, the root causes can be difficult to determine.

Over the past three years Peterborough has averaged 9.2 opioid overdose deaths per 100,000 people, nearly twice the provincial average and higher than all but three Northern Ontario regions.

Some suggest the high percentage of seniors in Peterborough is a factor. Aging brings on more long-term health issues, which result in more prescriptions, which would lead to more addiction and deaths ... or so the theory goes.

However, Cobourg and the City of Kawartha Lakes make up most of the population of a single large health unit to the south and west of Peterborough. Both have higher percentages of seniors than Peterborough does and higher rates of prescription opioid users. But the overdose death rate there is 5.4, much closer to Ontario’s norm.

Dr. Salvaterra rightly warns against jumping to easy conclusions. She also points out that a sudden cutback on opioid prescriptions would would put those who are already addicted in jeopardy.

The good news is that slow progress is being made. While 40 per cent of opioid users are still on stronger prescriptions than medical guidelines call for, overall use of the drugs fell by nearly 20 per cent last year.

That indicates that monitoring and education of doctors is having an effect. They aren’t writing fewer prescriptions but dosages are more appropriate to actual need.

The bigger opportunity for reducing opioid use get the medical community looking beyond opioids as the first alternative for pain treatment.

That requires more focus on pain management techniques in medical schools and pain clinics with specialized staff in centres like Peterborough.

Those steps would get at the root of the addiction and overdose problem.