Canada's Minister of Health, Rona Ambrose, is on a crusade to bring doctors to heel on the overprescription of opioid painkillers. She says doctors are too quick to treat patients' chronic pain with the powerful drugs, which are cousins to heroin and share a lot of its downsides.
She's right. Something needs to be done, and starting on the front lines with the doctors who prescribe the painkillers makes sense. But Ms. Ambrose also needs to point the finger at the department she runs, which has been slow to respond to a crisis that was foreshadowed in the United States, and which has not offered alternatives to a drug group that is a lifesaver for many people suffering from chronic pain.
Canadian pharmacies dispensed 20 million opioid prescriptions in 2013, three million more than in 2009. The number of high-dosage prescriptions rose 25 per cent between 2006 and 2011. As many as four people die every day from opioid-related deaths. The numbers of prescriptions and deaths have been rising steadily, following a similar pattern already well-established in the U.S., where one researcher found that half of patients who take opioids for three months are still on them five years later.
And yet, in the past five years, Health Canada has approved two dozen new versions of opioid painkillers, including in 2013 a generic version of oxycodone that was banned in the U.S. because it was too easy to crush and then inhale or inject.
Yes, doctors need to prescribe fewer opioids. Many of them agree with Ms. Ambrose, including the CEO of the Royal College of Physicians and Surgeons of Canada. But doctors can't just stop treating a patient's chronic pain. They need alternatives. Long-term pain management without opioids requires education, counselling, lifestyle changes and repeat visits to the doctor. Hospitals need to be able to offer surgery more quickly to patients in pain, and they need to develop more modern, less invasive surgical procedures.
All these things take money. It's easy to ask doctors to prescribe fewer pills, but as a solution to a serious problem it's as simplistic as using opioids to kill a backache in the first place. The takeaway for Ms. Ambrose is that there are no magic-pill solutions.