Street drugs only pain relief after MDs cut prescriptions
VANCOUVER — Desperate for relief from unbearable pain following knee surgery, Lorna Bird says she was forced to buy drugs from the Downtown Eastside streets of Vancouver when her doctor stopped prescribing an opioid in response to new standards aimed at preventing fatal overdoses.
“I started with heroin because I couldn’t stand the pain,” Bird said, recalling her fears about dying from fentanyl-laced street drugs because “everybody was croaking” and she didn’t want her grandchildren dealing with that outcome.
Bird, 60, said the prescription opioid hydromorphone, which is five times more potent than morphine, numbed the pain after her surgery in December 2014, but her doctor tapered off the dosage before stopping it despite her continuing pain.
Experts say Bird is among thousands of Canadians facing the predicament of getting painnumbing street drugs after being weaned or taken off opioids to which they’ve become addicted.
Bird said concerns about contaminated heroin had her spending $100 a day on cocaine instead, but she tries not to use it alone because she worries about overdosing if the powerful painkiller fentanyl has been added to anything she buys on a street corner.
Bird recalled a talk with her doctor: “I told him, ‘I’m shooting up powder now, cocaine, because that’s what kills the pain.’”
She said he cited standards by the College of Physicians and Surgeons of British Columbia for his decision before resuming a much lower dose of hydromorphone, along with methadose.
Bird said she continues taking both drugs, but they’re not enough to deal with her pain; so she also injects cocaine.
“Sometimes it’s hard just to get to the place where you buy your stuff,” she said through tears. “You can hardly wait to get that needle, just to get that sense of relief. It’s awful to have somebody hold you and have to walk you there. And then you’re doubled up in pain.”
Benedikt Fischer, a senior scientist at the Toronto-based Centre for Addiction and Mental Health, said between 500,000 and one million Canadians are addicted to opioids, because doctors have over-prescribed the narcotics for years.
Updated prescribing guidelines released last month by the National Pain Centre at McMaster University in Hamilton call on physicians to limit dosages of drugs such as hydromorphone, oxycodone and the fentanyl patch to the equivalent of 90 milligrams of morphine per day.
The centre also recommended physicians taper off medications or even discontinue the drugs that could lead to dependence with long-term use.
Fischer said the past decade up to 20,000 Canadians have fatally overdosed on the potent narcotics. He said while new guidelines were needed to prevent an epidemic of over-prescribing, they were not matched with systemic changes like non-pharmaceutical pain-management strategies.
“All of a sudden they’re dropping all these patients or cutting them off their opioids,” he said of doctors who prescribed excessive amounts of narcotics for chronic, non-cancer pain.