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.

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