In an unprecedented move, the top medical official in the United States is making a plea to every physician in the country to help turn the tide on the opioid crisis.
Canadian Health Minister Jane Philpott will be watching his efforts with interest as this country grapples with its own opioid problem. U.S. Surgeon-General Vivek Murthy will send the letters to some 2.3-million health care professionals this week – the first time he has directly sought their support to address a public health crisis. In the letters, he writes that the number of people dying from opioid overdoses has quadrupled since 1999, and while the current situation is devastating, prescribing U.S. physicians are not to blame.
"It is important to recognize that we arrived at this place on a path paved with good intention," Dr. Murthy writes. "Nearly two decades ago, we were encouraged to be more aggressive in treating pain, often without enough training and support to do so safely. This coincided with heavy marketing of opioids to doctors.
"Many of us were even taught – incorrectly – that opioids are not addictive when prescribed for legitimate pain."
A recent Globe investigation found that Ottawa and the provinces have failed to take adequate steps to stop doctors in Canada from indiscriminately prescribing highly addictive opioids to treat chronic pain. In 2015, doctors wrote 53 opioid prescriptions for every 100 people in Canada, according to figures compiled for The Globe by IMS Brogan, which tracks pharmaceutical sales.
Dr. Murthy asks physicians to make a pledge to educate themselves on treating pain safely and effectively; screen patients for misuse of opioids and connect them with treatment; and approach addiction as a chronic illness rather than a moral failing.
Dr. Philpott said the initiative has potential to be valuable and that she is keen on learning more of its details.
"[The U.S. has] had considerable success in some of [its] initiatives around addressing opioid prescribing practices," she said in an interview on Thursday.
"I think one of the keys to success in this challenge that we're all facing is making sure that all the appropriate players have an appropriate say in these kinds of decisions. I'd be curious to know, for instance, how much he's worked with prescribers and other education bodies to be sure that there's been engagement on behalf of prescribers. But certainly, it's a very interesting concept."
More than 14,000 Americans died of overdoses involving prescription opioids in 2014, according to the U.S. Centers for Disease Control and Prevention. Canada has no national-level data for prescription-opioid related deaths, but the figure is estimated to be about 2,000.
Canada is the world's second-largest per capita consumer of opioids, behind the United States – a distinction Dr. Philpott calls "extremely concerning."
The minister has taken several actions in recent months to address Canada's opioid crisis and related surge in overdose deaths, including expressing support for harm-reduction sites and making naloxone, a drug that reverses the effects of an opioid overdose, available without a prescription.
Her office has also released a five-point plan of action on opioid misuse that includes a proposal to require a prescription for low-dose codeine products, mandatory risk management plans for certain opioids and promotion of prescription monitoring programs that would track how many prescriptions are written and how many are filled. An opioid summit is also planned for the fall, although a date has not yet been set.
Asked if she, like Dr. Murthy, had a message to deliver to all Canadian physicians, Dr. Philpott underscored the need to be partners in addressing the crisis.
"This is about all of us realizing that, for a variety of reasons, prescribing opioids has escalated," she said. "First of all, we need to understand better why it happened, and then find what part each of us has to play to improve it. The message to physicians and other prescribers is that they need to be supported so that they have the tools that they need to practice excellence as they all want to do."