Canada is facing a major and unexpected public -health crisis: Opioid addiction. A new study published this week in the journal Addiction finds opioid overdoses killed nearly 6,000 people in Ontario between 1991 and 2010, half of them under the age of 42. A shocking one in eight deaths among young adults in the province were due to opioid abuse. And the problem is growing, with rates of opioid-related deaths tripling over the last twenty years. To put things in perspective, opioid deaths caused more years of life lost than alcoholism, pneumonia, influenza or HIV/AIDS.
A public-health crisis of this magnitude calls for a robust response from the government and public health authorities. Federal Health Minister Rona Ambrose should be applauded for indicating on Monday that she plans to set tamper-resistance standards for all opioids. It’s a good start, but the move counts as a half measure. Ottawa should be working with provincial health authorities to tighten all regulations around the drugs, including how they are prescribed and by whom.
For example, doctors in most provinces can’t easily look up a patient’s prescription history. Creating a database for physicians would help cut down on patients who seek and obtain multiple opioid prescriptions – so called “double-doctoring”.
As for the promised tamper-resistant versions of opioids, they turn to gel when crushed. So far, the evidence that they can deter abuse is thin. While these drugs may prevent hardcore addicts from crushing and injecting opioids, they won’t have any obvious impact on the majority of addicts who swallow the medication, getting high by ingesting far more than they are supposed to.
For most addicts, the issue boils down to a question of access. Doctors are prescribing more opioids than ever before, but there is little corresponding evidence that all of these drugs are being exclusively used to treat pain. The key may lie in reducing the amounts of opioids physicians dispense. While Oxycodone, morphine and codeine are probably the best known opioids, in recent years there has been a proliferation of others: hydromorphone and fentanyl, for example. It appears that these drugs are being grossly over-prescribed.
There are a number of options available to health authorities, including limiting the number of doctors able to prescribe the drugs, educating prescribers on alternatives and creating a database for prescribing physicians to better spot addicts. Requiring all opioids to be tamper-resistant is a good first step, but there is more to be done.