Last week I attended the 7th International Conference on Addictive Disorders, Addiction Medicine and Pharmaceuticals in San Diego, California, USA. Considering the Opiate Crisis occurring in both USA and Canada, this conference should have been turning people away, nevertheless, everyone who attended this symposium left with new information and insight on how we might all be able to make a difference in the fight against opiate deaths and addiction.
The Crisis is Real!! Nearly 4000 Canadians died from apparent opioid overdoses in 2017, up from nearly 3,000 in 2016. These numbers are alarming but per capita, second only to the USA with a documented 72,000 overdose deaths in 2017 from opiates.
Fentanyl or fentanyl analogs were involved in nearly three-quarters of deaths earlier this year — an increase again from 2017 and 2016 — and victims were most often men. About 94 percent of all deaths were considered accidental, or unintentional overdoses, with the largest concentration in the 30- to 39-year-old age group. These are not drug addicts either. Death is occurring in first-time users, and those living in chronic pain.
Fast forward to 2018. The latest national report tracking deaths linked to the painkilling drugs shows there were 1,036 apparent opioid-related deaths in Canada (primarily in BC, Ontario, and Alberta) from January through March 2018. This figure marks an increase of five percent from the same period in 2017, and a 44 percent jump from the first three months of 2016, which makes me wonder, how did we get to this place?
In 1990, a study was published stating that health care providers were doing a very poor job of treating pain, and suddenly pain assessments became a vital sign, in much the same way as blood pressure, and temperature is recorded in your chart. The belief that opiates were not addictive, and the expectation that the patient should have “zero pain” rather than “some discomfort” became the standards of prescribing practices. It was not unusual for patients to be prescribed a thirty-day supply of opioids whether they needed it or not, and taking opiates for more than seven days increased the potential for addiction.
Fast forward to 2018. We are making some progress, but there is still much to be done:
1. Health Canada – has asked more than 100 pharmaceutical companies to stop any and all of their opioid marketing to health care professionals in Canada until the government considers introducing new regulations. Here are the companies who have agreed to comply: Ethyparm, Mint Pharmaceuticals, Paladin Labs, Pro Doc Ltee, Purdue Pharma and Teligent.
New regulations could include new limits on visits by drug companies’ sales representatives to doctors’ offices, conferences and educational courses sponsored by opioid makers and opioid ads in scientific journals.
2. British Columbia named Purdue Pharma, Paladin Labs, and Pro Doc, among others, in its recently launched lawsuit to reclaim costs association with the ongoing opioid crisis. The provincial government alleges the companies contributed to that crisis by downplaying the risks of their opioid products, particularly their addictive potential when advertising them to physicians.
3. Best practice techniques that reduce potential addiction to prescribed opioids are being implemented in some healthcare sites. They include:
a. No more than three to five days of medication prescribed for non-metastatic pain
b. Removal of opiates from standardized order sets in hospital
c. Implementing shared decision making into daily care of patients, including education about the expectation that the patient should be comfortable, but not pain-free.
4. Enhanced Recovery after Surgery Projects that focus on methods to decrease opioid use both pre- and post-op are producing great results, including reducing the length of stay in the hospital.
5. Abuse Deterrent Formulations have been developed by Pharmaceutical Companies like Egalet Corporation, and if adopted in the tablet formulation of opioids could render these drugs resistant to manipulation.
6. Physicians, surgeons, and health care providers are having important conversations with their patients about the addictiveness of opiates. Pain clinics are helping chronic pain patients manage their symptoms while reducing their consumption of opiates.
7. Safe injection sites are providing users with clean needles, and important information about recovery from addiction. Access to Naloxone without a prescription has prevented countless drug overdose deaths.
Here is what we can personally do to prevent this crisis from growing:
1. If you have any opioids in your home, take them to your local pharmacy for safe disposal.
2. Discuss the addictive risks, and potential-for-death caused by even one-time use of these drugs, and keep the conversation going. Our children deserve to know that taking a pill at a party could be the last thing they ever do, and if it doesn’t kill them, it may just become an addiction requiring stronger drugs and doses (like heroin), increasing the risk of potential death from overdose substantially.
3. If you are scheduled for surgery or a procedure that may cause pain, explore ways to treat that pain without opioids, if possible. If opioids are required, limit their use to no more than 3 to 5 days. Speak with your physician and pharmacist about your pain management plan and expect to be a bit uncomfortable. The expectation that there will be no pain is unrealistic.
The loss of even one life to an opiate overdose is too many. This crisis continues to devastate the health and lives of our communities and their families. Let’s focus on solutions. The little things we do collectively will make a big impact.