When opioids help
Opioids are designed to help patients deal with pain
KITCHENER — Sandra Gartz is a drug user — a prescription drug user.
The 62-year-old Kitchener woman takes prescribed codeine in the form of Tylenol 3s for a decades-old workplace injury. At that time she was also diagnosed with fibromyalgia.
Starting last month, the provincial government instituted restrictions on high-dose prescriptions of opioids to people on the Ontario drug plan and Gartz worries what that will mean for people like her who rely on the potent painkillers.
“All you hear about in the news are the ones who overdose or abuse their prescriptions,” says Gartz, whose drugs are paid for by her husband’s private insurance. “You don’t hear about people like me.”
Gartz has taken codeine, a moderate opioid painkiller, for decades.
“I never got addicted to it. I have always taken it as prescribed,” says Gartz.
Opioid-related deaths have gone up threefold since the 1990s. It isn’t just recreational users who are part of that spike in numbers.
The Ontario Drug Policy Research Network found that prescriptions for high-dose opioids went up by 23 per cent between 2006 and 2011.
High-dose opioid prescriptions can also double the risk of death.
Despite that fact, strong opioids like fentanyl are still prescribed for pain.
With the removal of high-dose opioid drugs from the Ontario Drug Benefit Program’s formulary beginning Jan. 1, the government plans to curb the abuse of lethal drugs.
Examples of high dosages include 200 milligrams of oxycodone or 75 and 100 microgram fentanyl patches. In Waterloo Region, 23,695 opioid prescriptions were issued last year. It’s low compared to prescription numbers across the province, ranking 35 out of 49 regions.
This number only measures prescriptions doled out through Ontario’s drug plan. The reality is, it is much higher because a large segment of the population receive their drugs through private insurance. Provincial drug plan users are a mix of people more than age 65, low-income, those on disability, or others who need help paying for drugs.
According to the Ministry of Health and Long-Term Care, “these changes are designed to encourage the appropriate use of opioids, improve patient care and help address the growing problem of opioid addiction in Ontario.”
It won’t affect Gartz, who uses a low-dose of codeine to manage her pain and gets it through private insurance.
But what are the potent drugs prescribed for in the first place?
Chronic pain patients use them to manage their pain, says Kelly Grindrod, a pharmacist and professor at the University of Waterloo’s School of Pharmacy. People also use the medication if suffering from short-term and longterm pain.
Lower back pain, workplace injuries, car accidents and cancer are a few examples of longer-term pain.
A prescription could also be for short-term pain, like recovery from dental surgery, or pain relief for a toothache, Grindrod says.
Hip replacements can be painful so opioids are prescribed in the short-term (one to three months) while patients wait for physiotherapy.
The effectiveness of opioids has been questioned for years, but Grindrod says there isn’t much else out there for pain relief.
“We’re stuck in this world of not great drugs,” she says.
“Anybody can develop dependence.”
“It’s different from addiction because someone with a dependence (on opioids) is taking the drug to relieve pain.”
She says they can be “good drugs” because there is a portion of the population who can lead normal lives while using opioids to manage pain.
“But the people who benefit are far fewer than we think,” she added.
Gartz is one of those people. There have been times when just a few minutes standing over the sink to wash dishes would be excruciatingly painful for Gartz.
“If you’ve ever had the flu and felt achy and sore all over and just want to lay down … imagine that feeling all the time,” she says from the living room of her Kitchener home.
Her dosage hasn’t changed much over the past few decades.
“When you live with chronic pain, taking that pain pill is only part of it,” says Gartz, who is part of The Waterloo Region Chronic Pain Initiative, a new local group that raises awareness about chronic pain and pain management.
Part of her pain management includes a daily soak in her hot tub and walks using a walker. It helps keep her mind off the pain.
“You have to make a choice about how you want to live and learn how to manage it (your pain) through whatever techniques work for you,” Gartz says.
Gartz understands how addictive the drugs can be when abused, and she doesn’t want to be lumped in that category.
“The fentanyl overdoses are happening to people who use it illegally,” she says, noting she has a friend who used prescribed fentanyl patches for her pain without incident.
“Many addicts take opioids to block out their experiences or trauma … there is a difference,” Gartz says.