CANNABIS TO RE­DUCE OPI­OIDS

Dr. Lionel Marks de Chabris, a pain and ad­dic­tion spe­cial­ist in Sud­bury, sheds light on why we need to re­duce our opi­oid use and how cannabis can help re­lieve pain with­out the risks.

ZOOMER Magazine - - VITALITY -

CANA­DIAN SE­NIORS ARE BIG OPI­OID CON­SUMERS

Cana­di­ans are the world’s sec­ond largest per capita con­sumer of pre­scrip­tion opi­oids af­ter Amer­i­cans, and our opi­oid use is high­est among se­niors.

OPI­OIDS RE­LIEVE PAIN WHEN USED PROP­ERLY

Opi­oids are medicines that re­lieve acute or chronic pain by act­ing on spe­cific nerve cells in the spinal cord and brain. Ex­am­ples of opi­oids are mor­phine, oxy­codone, fen­tanyl, hy­dro­mor­phone, and OxyNEO.

THERE ARE SIG­NIF­I­CANT PROB­LEMS WITH OPI­OIDS

“Opi­oids are fan­tas­tic medicines short-term. If you break your leg, you want to have opi­oids. In the medium term, they are good for a lot of peo­ple. But in the long term, we’re start­ing to re­al­ize that opi­oids have sig­nif­i­cant is­sues, par­tic­u­larly at a high dose.” In the older pop­u­la­tion, opi­oids cause sleepi­ness, con­sti­pa­tion, re­flux, and prob­lems with the en­docrine sys­tems. They in­crease the risk of di­a­betes and re­duce testos­terone. Us­ing opi­oids long-term can lead to in­creased tol­er­ance, de­pen­dence, and with­drawal symp­toms. Opi­oids have dan­ger­ous, un­pre­dictable ef­fects, in­clud­ing ad­dic­tion, over­dose, and death.

SE­NIORS IN PAR­TIC­U­LAR ARE AT RISK

Peo­ple over age 65 have the high­est rate of hos­pi­tal­iza­tion for opi­oid poi­son­ing in Canada, ac­cord­ing to a 2016 re­port from the Cana­dian In­sti­tute for Health In­for­ma­tion and the Cana­dian Cen­tre on Sub­stance Abuse. Al­most 25% of all opi­oidrelated hos­pi­tal­iza­tions in 2014–2015 were for se­niors, yet we rep­re­sent only 16% of the pop­u­la­tion. We’re at higher risk for ad­verse drug re­ac­tions be­cause of the num­ber of drugs we take, our preva­lence of chronic con­di­tions, and age-re­lated changes in the body.

NEW GUIDELINE REC­OM­MENDS RE­DUC­ING OPI­OIDS

The 2017 Cana­dian Guideline for Opi­oids for Chronic Non-Can­cer Pain rec­om­mends restrict­ing opi­oids for new users to less than 50 mg of mor­phine equiv­a­lent a day (MED). For pa­tients who are al­ready us­ing high-dose opi­oids, the guideline sug­gests grad­u­ally ta­per­ing them to be­low 90 mg MED, po­ten­tially even dis­con­tin­u­ing them en­tirely. Un­der the pre­vi­ous 2010 guideline, the watch­ful dose was 200 mg MED.

OVER­COME THE FEAR OF WITH­DRAWAL

Ta­per­ing opi­oids, par­tic­u­larly from a high dose, should be done care­fully and slowly over a long pe­riod of time to avoid in­creased pain and with­drawal is­sues. “Un­less you’re do­ing it wrong, your pa­tient shouldn’t have a great deal of with­drawal. If you ta­per down in a rea­son­able way and you ed­u­cate and sup­port, then

Newspapers in English

Newspapers from Canada

© PressReader. All rights reserved.