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Once again, it’s the less than 10 per cent of the population who abuse prescription drugs who seem to be getting all the attention. One only needs to read Ontario Health Minister Deb Matthews’ comments last Friday or the accompanying news release regarding the government’s plans to introduce legislation to curb “the growing abuse of prescription narcotics” to see how accurate this is.
Matthews said last Friday she would introduce legislation this fall that will allow the province to expand its drug database to track prescription drugs as they’re dispensed under both public and private drug plans. The current system only tracks drugs prescribed under the Ontario Drug Benefit plan, which funds medications for seniors and those on social assistance. “We know that there is a serious narcotics abuse issue facing many Ontarians and their families throughout our province. We are taking a range of steps that reflect the severity of the issue,” she said.
The release points out the number of oxycodone–related deaths in Ontario “has nearly doubled since 2004,” yet ministry officials were not immediately able to provide specific numbers. The release continues, “To combat this growing problem, the province intends to introduce legislation this fall that would, if passed, help address the abuse of prescription narcotics, while ensuring access to pain medication for those who need it most.” As part of the Quick Facts part of the release, it points out that since 1991, prescriptions for oxycodone–containing medications rose by 900 per cent and that narcotics abuse–related admissions to publicly funded treatment and addiction services in Ontario doubled from 2004–08.
Not to be outdone, some news reports on Matthews’ press conference also added to the hyped rhetoric. A London Free Press article states, “Many become addicted after being prescribed narcotics, especially for chronic pain.” The comment is not attributed and this columnist is inclined to believe Matthews did not make the allegation, although she has often spoke of the woman she met who was prescribed OxyContin because of an injury to her back and got addicted and is now a prostitute to fuel her addiction.
There is no doubt that use of and crimes related to prescription narcotics is a growing problem in some areas of the province, including London’s east end (which includes Matthews’ constituency) and Ottawa, so one can understand the government’s concern. There’s also no doubt that elements of the government’s planned narcotics strategy are welcome.
Yet, while the government says it wants to ensure chronic pain patients have access to pain medication, their rhetoric could have the opposite effect. There are already a fair percentage of physicians who are conservative when it comes to prescribing pain medication because some fear a College of Physicians and Surgeons investigation and others who, due to a lack of education on pain and addiction, truly believe patients will become addicted if prescribed pain medication. St. Catharines resident Helen Small, who is the executive director of the charity Promoting Awareness of RSD/CRPS in Canada, has heard about the problem first hand through the charity’s help line. Small has received a number of calls from patients with RSD (Reflex Sympathetic Dystrophy) and CRPS (Complex Regional Pain Syndrome), a neurological disorder that results in severe burning pain, who report either their doctor not prescribing opioids because they believe the patient could get addicted or from ones who are under–prescribed, again because of the fear of addiction. Dr. Roman Jovey, program director for CPM Centres and a physician at Mississauga’s Credit Valley Hospital in the Addiction and Concurrent Disorder Centre, has said that sadly this “happens fairly often, particularly in a society that is opiate–phobic.”
And statements such as the one in the London Free Press only serve to heighten that paranoia. Yet, Jovey points out a 2008 study found the risk of someone with no previous history of addiction become addicted to opioids was 0.6 per cent. In the case of those with a previous history of addiction, the risk of becoming addicted to a prescription opioid is as high as 18 per cent.
As for the ministry’s purported doubling of the number of oxycodone–related deaths since 2004, let’s look at the numbers more closely. A study published in the Canadian Medical Association Journal in December found that the numbers of deaths from opioid pain medications increased between 1991 and 2004. After reviewing nearly 7,000 files at the Office of the Chief Coroner of Ontario, they found there were 13.7 deaths per million in 1991 that increased to 27.2 per million in 2004. They were unable to get accurate numbers post 2004 as the coroner’s data was incomplete. They also found other prescription medication, such as sleeping pills, or alcohol, contributed to a large percentage of these deaths. The coroner’s office has reported that between 1999 and 2003 there were a total of 291 deaths where the victim was found to have oxycodone in their bloodstream. In 60 per cent of those cases, the victim also had high levels of alcohol and other prescription drugs in their system. Their 2009 release featured a slightly higher number of overdoses from oxycodone but it was unclear what percentage was strictly related to oxycodone. If—and that’s a big IF—the government’s statement is true, there were 54.4 deaths per million in 2009, which equates to about half a percentage of the population. Boy, you talk about a “growing” problem. The percentage of the population who abuse prescription drugs is about 8.3 per cent, according to a 2006 U.S. National Institute on Drug Abuse study and are primarily between 16 and 25. Numbers in Canada are about the same.
Despite the misleading numbers and statements, there is merit to what Matthews is proposing. Jovey welcomes the monitoring system. “I welcome any strategies to limit misuse in the small percentage of the population as long as this does not adversely affect appropriate pain management for those suffering from treatable chronic pain.” Matthews said the key to the narcotics strategy is identifying and educating doctors and pharmacists who are over–prescribing and dispensing pain medications and identifying patients who are addicted. “We will not turn blind eyes to problems that are significant. It’s a problem we take very seriously.”
Jovey, who spends countless hours a year educating physicians about pain management, welcomes the education, but believes more could be achieved if the curriculum in medical school provided more hours on pain management education. A 2007 study found medical students only received an average of 16 hours on pain. By comparison, veterinary students received five times as much teaching on pain. The CMA Journal study suggested doctors tend to rely on the pharmaceutical companies’ marketing campaigns when it comes to which drugs to prescribe.
Whether pain patients will indeed continue to have access to the drugs they need once the strategy is rolled out will largely depend upon Matthews’ ministry. But one hopes the experiences in the U.S., where pain patients found their prescriptions being reduced or cut because the Department of Health thought they were being prescribed too many, is not repeated here. V
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