Parents of teen who died of overdose seek answers
Overprescribing, current law to blame for fatal overdose, grieving parents say
VICTORIA It only takes days for some people to become hooked on prescription opioids, says Dr. Gary Franklin.
“You can get dependent on opioids even after days to weeks of use — especially teenage brains, which are basically more susceptible to substances — to the point where it’s hard to come off,” said Franklin, a neurologist and occupational health researcher at the University of Washington.
Franklin was commenting generally after the death of 16-yearold Elliot Eurchuk of Oak Bay, who overdosed on April 20.
He had a two-year history of opioid prescriptions for sports injuries and post-operative pain.
Elliot’s parents blame his death on opioid overprescribing and a provincial law that kept them from being informed about his health issues.
Opioids are often prescribed to treat pain, but use can lead to dependence or addiction.
According to a 2017 study by the Canadian Institute for Health Information, Canada is the secondlargest per capita consumer of opioids in the world, behind the United States, with 21.5 million prescriptions dispensed in 2016.
A record number of people died of opioid overdoses in Canada last year, according to Health Canada, and most of those involved fentanyl. In B.C., a total of 1,422 overdose deaths were recorded in 2017, according to the coroners service.
About 70 per cent involved fentanyl, while 18 per cent involved other opioids such as codeine, oxycodone or morphine.
“If you don’t address inappropriate acute prescribing, you are never going to stop this,” Franklin said. He said he spotted a trend of a large spike in opioid prescribing and a rise in opioid overdose deaths within the Washington state workers’ compensation system in the 2000s.
“I reported that in 2005 and here we are 13 years later. … Why is it still such a problem? It’s ridiculous.”
If even a small number of people prescribed opioids after minor injury, surgery or dental extractions become addicted, it’s too many — especially when non-opioid medications work as well, if not better, he said.
For dental extractions, for example, non-opioids should be a first line of prescribing, whereas “right now 85 per cent of dentists in (the U.S.) use opioids first line and almost automatically give a patient 20 to 30 pills,” Franklin said.
The CIHI report found that the amount of opioids Canadians were getting in their prescriptions was dropping, while the overall number of prescriptions was going up.
“While these are very broad indicators, the fact that the overall quantity of opioids prescribed is going down and the number of prescriptions is going up is what we want to see,” said Dr. Robert Strang, chief medical officer for Nova Scotia, when the report was released.
“Opioid prescriptions for acute pain should be for a short time period only, with ongoing reassessment for repeat prescriptions.”
Rachel Staples, Elliot’s mother, is a dentist. She said she was asked to sign up for prescribing opioids 23 years ago, but declined, believing non-opioid alternatives — a combination of Tylenol and an anti-inflammatory — are sufficient for most dental surgery.
Yet, when it came to asking doctors for non-opioid alternatives for her son, who had four surgeries over 10 months and was prescribed different opioids, she was not able to convince most doctors. Over time, Elliot’s parents say, he became addicted to pain medication, supplementing with street drugs. “There has to be a different first line of approach other than opioids to manage pain, particularly in the young developing brain,” Staples said.
“Opioids should not be administered to those under 19 unless it’s an extreme situation,” she said.
“What is wrong with feeling pain? It’s a short-term problem. It’s our body telling us to stop and heal.”
Staples and her husband, Brock Eurchuk, said even when their son was known to be addicted and had to be revived from an overdose in hospital on Feb. 10, they were prevented from receiving any information about their son’s condition or treatment because the B.C. Infants Act gives minors with a doctor’s approval consent and privacy around their own medical treatment. They say they were sent home not knowing what their son had taken and without a treatment plan for him to recover.
“We, as parents of children for whom we are legally responsible, need to be able to make health and welfare decisions for our children who are under the influences of substances or who have mentalhealth concerns,” Staples said.
“It is unreasonable to expect a parent to take a child home from the hospital … and care for them without knowing the full extent of their medical history and without the ability to step in and make lifesaving decisions.”
Staples is asking the provincial government to amend the B.C. Infants Act or adopt the B.C. Liberals’ Safe Care Act to give parents the control they need to care for their children.
“This needs to be the decision of the parent alone,” Staples said, who would like to see the legal age of competency set at 19.
“We are facing a health-care crisis and more children will die if we don’t make this a priority.”
Mental Health Minister Judy Darcy has met with Staples and Eurchuk but has been largely silent on the legislation.
Darcy has said she would await the findings of an Island Health review into Elliot’s care.
Island Health aims to conclude the internal review by mid-month.
“The review involves several departments, including surgical services and child, youth and family,” said a statement from Island Health.
“Once the review is completed, our first priority will be to connect with Elliot’s family. Following that, we will share what we can.”
Doctors of B.C. president Dr. Trina Larsen Soles said we’re in a period of transition on opioid prescribing. “I think it will be slow change,” Larsen Soles said.
“It’s much easier to modify our approach for people who have never been on these medications.”
The provinces are considering the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain and how each will regulate the new rules.
The B.C. College of Physicians and Surgeons, which licenses doctors, has translated the guidelines into a practice standard for doctors, and Doctors of B.C., which represents 14,000 physicians, residents and medical students, has solicited feedback from its members.
The national and provincial guidelines — which exempt cancer and palliative pain — address how much is enough and how much is too much, risky behaviours associated with addiction and how to moderate them, Larsen Soles said.
Never prescribing opioids or weaning all people on long-term low-dose opioids for chronic pain is “ideal world,” but not real world, she said.
It’s not practical for an elderly patient on low-dose opioid for lifelong debilitating rheumatoid arthritis to take only Tylenol and Ibuprofen, for example, especially if she has an ulcer and can’t tolerate an anti-inflammatory, Larsen Soles said. “This is not someone who is going to become addicted … it just means she can knit.”
Larsen Soles said that opioid prescribing over the past 30 years has changed dramatically. “We’ve learned a lot in medicine about using less medications for everything — not just pain treatment,” she said. The current philosophy is to use the smallest dose for the shortest time possible, “whereas 10 years ago, we were being told if you don’t adequately treat your patient’s pain you are a bad doctor.”