Opium- based painkillers prescribed more, despite safeguards
B. C. doing better than other provinces, but still has a problem, expert says
Prescriptions for the most powerful class of painkillers continue to rise in B. C. despite strict rules to discourage their use, according to a recently released national study.
But use of high- dose opiates — considered the most dangerous because they are linked to addiction and accidental overdose — is rising slower in B. C. than most other provinces, only 8.4 per cent between 2006 and 2011. Ontario, by contrast, has the highest per capita rate of opioid prescriptions in Canada.
Opiod medications are derived from natural or synthetic opium. They include skin patches containing fentanyl and pills like Percocet, Percodan, Dilaudid and Demerol. Heroin also comes from opium, but is illegal in Canada.
Newfoundland had an 85- per- cent increase in high- dose opioid prescriptions during the study period, a situation that has officials there looking closely at the B. C. model of centralized computer tracking called PharmaNet.
Newfoundland and Labrador Health Minister Steve Kent said recently only about 40 per cent of his province’s pharmacies are linked to a computerized network, covering 60 per cent of the population.
“There is a rising rate of opioid addiction in our province and addressing that is a top priority for government,’’ he said. “We’re actively working to increase that number to get everybody connected which will definitely make a difference.’’
Analysis of B. C.’ s PharmaNet database can spot unusual prescribing patterns that could indicate abuse. The records also make it easier for a pharmacist to spot “double doctoring” — someone going to multiple physicians, often at walk- in clinics, to get multiple prescriptions.
“It’s not so easy here ( in B. C.) to double- doctor as it was in Ontario, where no such system existed until recently,” explained Benedikt Fischer, a researcher and professor at Simon Fraser University and Director of the Centre for Applied Research in Mental Health and Addictions.
“But it’s not that there’s a big problem in other provinces and B. C. is fine. I can tell you straight out that we have a substantial prescription opioid-related problem in terms of misuse, addiction and even death.”
The B. C. Coroners Service recorded between 55 and 60 accidental prescription opioid overdoses each year between 2009 and 2012.
Figures collected by PharmaNet show that pharmacists dispensed all types of opioid medications 2,906,302 times in 2013, a 55- per- cent increase since 2004.
That number is much higher than data on high- dose medications only because it includes everything from Tylenol 3 — which make up one third of the total — to oxycodone and hydromorphone, potent pain killers that made up another third.
The PharmaNet figures indicate each time a prescription is filled, not the number of patients. Changes to prescribing practises like sealed blister packs made up each week in a pharmacy can raise the number of prescriptions significantly while not indicating more drug is being made available, experts note.
Dr. Perry Kendall, B. C.’ s
It’s not so easy here ( in B. C.) to double- doctor as it was in Ontario. BENEDIKT FISCHER SFU PROFESSOR
provincial health officer, says on- the- job injuries in industries like logging, fishing and mining have left a legacy of people living with chronic pain.
“Not all of those people prescribed opioids are addicts,” he notes. “If you’re taking high blood pressure medicine and you stop, your blood pressure goes up. Does that make you an addict?”
Prescription guidelines from the B. C. College of Physicians and Surgeons written in 2012 and updated this year tell doctors to question the need for any opioid, to start with low doses and to regularly review those cases.
“There is no such thing as a ‘ painkiller’ where chronic noncancer pain is concerned,” the guidelines say. “Only a minority of patients derive modest pain relief or functional benefit from opioids; be clear about this.”
B. C.’ s Pharmacare has always restricted its coverage of the original OxyContin and its newer versions to patients in palliative care, but it can be covered by private or workplace health insurance.
Because B. C. has a historically high rate of illicit drug use, the province has been ahead of others in trying to prevent the movement of prescription medications to the street, says Bob Nakagawa, registrar of the College of Pharmacists of B. C.
The Canadian Centre on Substance Abuse says North America consumes 80 per cent of the world’s opioids. About 17 per cent of Canadians used an opioid pain killer in 2011, down from 21 per cent in 2008.