‘Bold public policy’ needed to tackle opioid crisis
Canada’s opioid crisis is worsening and health professionals and policy-makers are scrambling for a solution, a packed audience at an opioid conference in Ottawa heard Friday morning.
The invitation-only conference, chaired by Federal Health Minister Jane Philpott and her Ontario counterpart Eric Hoskins, was organized to address the increasing number of overdoses and deaths due to the use of opioids.
The conference heard that multiple doses of naloxone, the antidote administered to overdose patients, are now required when only a short time ago, just one dose was sufficient. “Breaking Bad is the reality,” paramedic Pierre Poirier told the audience during the first panel discussion of the day. “We’re not just talking about fentanyl. We’re talking about what chemists are doing. We can’t be callous about what’s happening.”
Conference attendees were asked to identify what they thought were the top three drivers of the crisis. They named prescribing practices as the top issue, followed by the easy availability of illicit opioids and inadequate addictions services.
Keynote speaker Dr. David Juurlink, chief of clinical pharmacology and toxicology at Toronto’s Sunnybrook Health Sciences Centre, said opioids are not nearly as effective for pain control as some doctors and patients believe. “We have done so much harm.”
Dr. Jason Busse of the Michael G. DeGroote National Pain Centre said strategies currently in place, such as urine screening and treatment agreements, have not prevented addiction, overdoses and deaths. Fentanyl has been found mixed with cocaine, cannabis and other drugs. “We have opened a Pandora’s box,” he said.
But Juurlink and many of the other panellists in the packed agenda had ideas for how the crisis can be addressed. The conference is to be followed by an “opioid summit” on Saturday to create a joint statement of action.
Among the possible strategies outlined Friday morning at the conference:
Naloxone should be available everywhere for free, and lay people should be trained how to use it, much in the same way ordinary people get CPR training. “It should be in gas stations,” said Juurlink. Naloxone can reverse the effects of an overdose if used promptly. Until recently, it was only available as an injectable.
In October, Philpott authorized a naloxone nasal spray for nonprescription use to help prevent overdose deaths. Federal authorities should monitor “hot spots” where overdoses are occurring in order to target interventions.
Canada is working to roll out an electronic prescribing system that will be able to track prescriptions and find patients who are acquiring multiple prescriptions through multiple doctors. The system, which will be tested in Ontario and Alberta first, will reduce the chance for fraud.
Research shows that two-thirds of people take opioids for reasons other than pain, including stress and anxiety, said Dr. Cara Tannenbaum, a researcher with the Canadian Institutes of Health Research.
“We need to address the root causes.” Tannenbaum and other presenters urged that pain be treated in a practice that incorporates treatments such as physiotherapy, psychological counselling and mindfulness training.
It might be more expensive than prescribing opioids, but it will pay off in long-term wellness and reduce costs for hospitalization.
Warnings on prescriptions for opioids should be more prominent, and it should be mandatory that health-care providers warn both patients and their families of the consequences of long-term opioid use. Tannenbaum suggested a “bold public policy.”
In Denmark, for example, patients who use drugs that cause sleepiness are not permitted to drive. She suggests the same should be true for people who consent to use opioids.
Health professionals need to recognize that sex and gender play a role, said Tannenbaum.
Women are more likely to receive prescriptions for all kinds of drugs, including opioids. More than half of women who take opioids were first exposed through a medical prescription, according to an Ontario study of 500 people with opioid user disorder at 13 rehab clinics. Only 35 per cent of the opioid users reported ongoing pain.
Meanwhile, opioids suppress testosterone levels to half their normal level in men, she said.
Harm reduction has to be a central plank in any strategy, said Dr. Thomas Kerr, co-director of a research project on addictions and urban health in B.C. Moreover, programs that enlist the peers of drug users have a much greater reach because drug users tend to avoid conventional public health programs, he said.
Kerr added there’s evidence that suggests legalizing marijuana reduces the use of opioids as users take cannabis while they seek to reduce their consumption of more powerful drugs.