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Compounds descended from the opium poppy: an array of opioids from Tylenol 3 to powerhouses oxycodone and morphine at a pharmacy in Vancouver this week. (Darryl Dyck for The Globe and Mail)
Compounds descended from the opium poppy: an array of opioids from Tylenol 3 to powerhouses oxycodone and morphine at a pharmacy in Vancouver this week. (Darryl Dyck for The Globe and Mail)

Solving the painkiller crisis: It’s in the hands of doctors Add to ...

Somewhere in Canada this year, a car accident claimed the life of someone who was taking eight different kinds of potent painkillers. We don’t know the person’s name, age, gender or even where the crash took place – just that he or she is one of the nearly 2,500 such death reports sent to Health Canada’s “adverse drug reaction” database.

Some who died took their own lives, while others had used the pills to get high. But many were people who had received a prescription from their doctor: a 49-year-old man with heart problems, a 51-year-old woman who overdosed, perhaps forgetting that her dosage had gone up, a 69-year-old man simply in “pain.”

The entries are voluntary and imprecise (some deaths appear more than once), but the database is the closest the federal government comes to tracking the body count in the nation’s pitched battle with painkillers.

Doctors are supposed to “do no harm.” Yet, they now order enough opioid painkillers – compounds descended from the opium poppy – each year to give a dose to every single Canadian between ages 20 and 60.

The national consumption has risen so rapidly that Canada now ranks second per capita only to the United States, where painkillers take more lives than heroin and cocaine combined.

But the U.S. is beginning to turn the tide. This week, the prestigious American Academy of Neurology, whose members specialize in pain treatment, became the first major medical organization to oppose the long-term use of opioids for most types of chronic pain.

As well, the National Institutes of Health (NIH) – Washington’s primary medical research agency – held a two-day session where experts concluded that over-prescribing is a major threat.

The issue also was on the agenda when provincial health ministers met this week in Banff, but the Ebola outbreak in West Africa and other concerns dominated the session. Canada’s public officials have yet to grasp the full extent of the opioid crisis.

A report released last month reveals that high-dosage prescriptions – which greatly increase the risk of accidental overdose and death – rose by nearly 25 per cent between 2006 and 2011.

One expert calls the practice “quite possibly the most dangerous thing that doctors are doing in Canada right now.”

Opioids have long been used immediately after surgery, for a severe injury or in cancer patients. More recently, they have become the treatment of choice for chronic pain, the kind that may never go away, even though they are addictive and deadly. Physical dependence often takes hold within weeks, bringing with it the danger of a fatal overdose.

And despite the fact that thousands of Canadians now take opioids for chronic pain, there is little hard evidence they actually work long-term – and mounting proof they can, in fact, begin to cause pain themselves.

There are no fewer than 38 types of opioids now in use, but the notoriety surrounding OxyContin – the first of the high-powered slow-release varieties – has linked them all in the public mind with “hillbilly heroin.”

But illegal drug use is not the only reason for the rising rates, says Tara Gomes, the high-dose study author and a scientist with the Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto. “A lot of it,” she says, “is people receiving legitimate pain prescriptions.”

The nearly 20 million opioid prescriptions dispensed from Canadian pharmacies in 2013 (almost three million more than just four years earlier) were worth nearly $800-million, according to IMS Brogan, a firm that tracks pharmaceutical sales. Taxpayers picked up the tab for any covered by provincial drug plans.

Although deaths related to opioids are not being tracked, experts estimate there are as many as four a day. In 2012, the toll in Ontario – which has the highest rate of high-dose opioid prescriptions in the country – was nearly 600, or more than 11 a week, according to the provincial chief coroner’s office. A recent study in the journal Addiction found that opioids account for one in every eight deaths among Ontario young people.

“When you give somebody a drug that’s exactly the same thing as heroin, we shouldn’t be surprised that bad things ensue,” says David Juurlink, head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto.

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