BUSTING THE MYTH DOCTORS TO BLAME FOR OPIOID DEATHS
In 2016, everyone from the chief medical health officer to the B.C. College of Physicians and Surgeons linked the growing epidemic of drug overdoses to doctors having over-prescribed opioids.
They pointed to the United States where there were highprofile convictions in Washington, California and Florida of doctors and pharmacists who illegally diverted OxyContin to drug traffickers and addicts.
More generally, they pointed to research that suggests eight per cent of the population is at risk of some form of addiction. And there were whispers about ordinary people selling their leftover or unwanted drugs to dealers or junkies.
But there was no evidence that over-prescribing was driving the crisis then and there’s no evidence of it now.
“We certainly haven’t found to date that there is a link between doctors’ prescription and illicit deaths,” Michael Egilson said in an interview. Egilson chaired the B.C. Coroner’s death review panel that investigated 1,854 overdose deaths in B.C. between Jan. 1, 2016 and July 31, 2017.
He said panel members had all heard stories about chronic pain sufferers self-medicating by buying street drugs and dying. But there was no proof.
“To date, the B.C. experience has been primarily driven by illicit fentanyl. Some other provinces and jurisdictions have made more of a link and a narrative out of prescribing practices. But we haven’t found that’s what the issue is here.”
Illicit fentanyl was the cause of the earliest deaths the panel looked at. Now, Egilson said, the toxicology reports show fentanyl is found in 80 per cent of those who have died.
But he was careful to add the panel only looked at overdose deaths. It didn’t look at the 25 to 50 “non-fatal, near-miss events.”
Regardless, the B.C. College of Physicians acted swiftly. In 2016, it brought in prescription standards and became the first in North America to threaten to revoke doctors’ licences or fine them up to $100,000 if they didn’t comply.
With little choice, some doctors cut back on prescriptions for chronic pain sufferers, causing them to suffer withdrawal, unremitting pain and thoughts about suicide. Others “fired” patients with chronic pain and refused to take on new patients with chronic pain. Some walk-in clinics posted signs saying their doctors do not prescribe opiates.
At the time, Dr. Owen Williamson said it was causing “chaos” and “mayhem” for both doctors and their patients with lupus, arthritis, fibromyalgia, spina bifida, and pain from accidents. Williamson is the president of the B.C. Pain Medicine Specialists Association.
The College brought in the measures even though the provincial Health Ministry’s figures indicated that between 2011 and 2016, the number of British Columbians prescribed opioids had dropped by 1.8 per cent even though the population increased by one per cent and the percentage of seniors (who have the highest rates of opioid prescriptions) had increased.
Of course, in the heat of the crisis, British Columbia’s medical leaders weren’t the only ones who got it wrong.
Last month, researchers from the U.S. Centers for Disease Control and Prevention admitted it “significantly inflated” the number of deaths linked to prescription opioids in 2016.
Rather than the 32,445 overdose deaths attributed to prescription opioids in 2016, they concluded it was 17,087. The error resulted from prescription opioid-involved deaths being tallied with deaths resulting from illegally manufactured fentanyl.
The CDC is now taking a more conservative approach, the researchers said in a paper published in the American Journal of Public Health. That new approach will “better differentiate deaths involving prescription (pharmaceutically manufactured) opioids from deaths involving illicit opioids (heroin and illegally manufactured fentanyl).”
What the death panel’s report highlights is the complicated lives most overdose victims led. Eighty per cent were regular users of illicit drugs and 81 per cent were men. Two-thirds spent time in jail. Most had more than one drug in their systems when they died. Most died alone at home. More than half recently spent time in emergency. Many have tried and failed to kick their habit, which only made them more vulnerable to overdosing on opiates when they relapsed.
This is all valuable information on which to base public policy decisions about how best to deal with the ongoing crisis.
It’s also information that could have spared British Columbia’s 800,000 chronic pain sufferers from even more agony and their doctors from the stress of having to choose between treating patients the best way they knew how and complying with the College’s diktat.
Perhaps now would be a good time for the College and others in leadership positions to rebuild bridges with doctors and the one-in-five people with chronic pain by supporting their calls for a separate and serious conversation about how to meet their complex needs.