Opioid prescriptions on the rise despite health risks, report finds
Doctors continue to recommend drugs for long-term pain relief despite risks of addiction and overdose.
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Donna May craved OxyContin. She had abruptly stopped taking the drug and the spinal pain that led doctors to prescribe it in the first place had flooded back.
May watched the toll OxyContin addiction was taking on her daughter, Jac, and she didn’t want the same to happen to her.
After Jac’s prescription for the powerful pain-relieving narcotic was abruptly ended, she sank into a life of illegal drug use, disease and, eventually, death by overdose in 2012.
In the years since May and her daughter began taking OxyContin, physicians, politicians and the public have come to better understand the risks posed by opioid drugs like oxycodone, hydromorphone, codeine and fentanyl.
But a new report by Health Quality Ontario has found the number of opioid prescriptions, and the number of patients filling those prescriptions, continues to rise.
“You hear a lot about foreign-imported fentanyl, or fabricated street drugs, but one of the key takeaways from this (report) is that a huge source of opioids into our society is actually through the prescription pad,” said Dr. Joshua Tepper, president and CEO of Health Quality Ontario.
More than 1.9 million Ontarians filled a prescription for opioids in the fiscal year 2015-16.
That’s about 10,000 more than filled prescriptions in 2013-14, the report said.
Meanwhile, the number of prescriptions filled in Ontario rose from 8.7 million to more than 9.1 million.
These figures do not include prescriptions filled in hospitals or prisons, or as part of addiction treatment.
“It doesn’t really make sense that (nearly) 2 million people in the province would need an opioid each year,” said public health researcher Dr. Pamela Leece in the report. “Perhaps more could be done to offer other treatments for pain.”
For years, opioids have played an important role in alleviating pain for cancer patients, people in palliative care, and those with acute injuries like cuts, burns or broken bones.
Medical researchers have not reliably established whether opioids are effective when used for more than 12 weeks, the report said.
But the National Pain Centre at McMaster University has estimated that between 500,000 and a million Canadian adults are currently on long-term opioid treatment for chronic pain.
The risk with ongoing opioid use “is that we take what should be a short short-term injury and we create a long-term dependency,” said Tepper.
“When someone has been prescribed opioids regularly, they often say that it really surprised them how hard it was to stop taking the opioids,” Leece told the report’s authors. People don’t truly appreciate how physically dependent a patient can become, she added.
The Star has reported that 734 people died in Ontario of opioid-related causes in 2015 — the equivalent of about two people per day.
There are several pain-relieving alternatives, such as physiotherapy, occupational therapy, surgery, local injections or non-opioid medication, that do not pose a risk of dependency, doctors say.
Earlier this month, the National Pain Centre released opioid guidelines encouraging doctors to consider non-pharmaceutical — or at least non-opioid — relief for chronic pain not related to cancer.
Many patients are never offered those options.
“Things like muscle pain or lower back pain or headaches are extremely difficult to diagnose and understand,” said Benedikt Fischer, a senior scientist at the Centre for Addiction and Mental Health
“Most physicians don’t have time for that, nor the interest in investing all that time. What’s a lot easier is to pull out the prescription pad and give them something that, at least for a while, will make them feel good.”
May, who has become an advocate for safe injection sites and other drug reform measures since her daughter’s death, said opioids were the only solution recommended when she first sought pain relief.
“At the time I was prescribed Oxy, and with my daughter too, I don’t think any other measures were (considered),” she said.
After stopping her OxyContin prescription, May managed her pain mainly through meditation and changes to her lifestyle. About four years later, she was approved for surgery to treat her degenerative spinal condition. She is now pain-free.
In more remote or rural parts of the province, however, resources like surgery or even physiotherapy may be less available, said Dr. David Marsh, an associate dean at the Northern Ontario School of Medicine, a joint initiative by Lakehead and Laurentian universities.
Data in the Health Quality report found that central Toronto had the lowest rate of patients who filled opioid prescriptions in 2015-16. The regions around Chatham-Kent and from Sudbury up to James Bay had the highest rates of prescription in the province.
“Over the past 15 years, there was a culture change to start prescribing more opiates for chronic, long-term, non-cancer pain,” Marsh said.
“Now we have to have another culture change in the medical profession to get people to stop prescribing these high doses for longer periods of time,” he added.
“It’s a shared responsibility between governments, public health officials, teaching hospitals, anyone that touches on the quality of health care.”