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Alan Cassels: Tackling the causes of Canada’s opioid epidemic

By all accounts, we are in the midst of a deadly drug epidemic so severe and widespread that few people in North America will remain untouched by it.

By all accounts, we are in the midst of a deadly drug epidemic so severe and widespread that few people in North America will remain untouched by it. In case you think I’m exaggerating, right now we have probably the highest rates of narcotic abuse and deaths in modern history.

Critics have begun pointing the finger at the medical system and its prescribers — well-meaning doctors who have been giving too many patients excessively powerful opioid medications to deal with modest pain. But we can dig deeper and look at the relationship between medical education and pharmaceutical-company influence as a significant contributing factor.

Typically, the suggestion of an epidemic is hyperbolic, but it doesn’t seem so in this case. Last month, provincial health officer Dr. Perry Kendall said B.C. has a bona fide “public-health emergency” on its hands, mostly due to the alarming number of overdose deaths linked to prescription opioids.

Opioids include prescription narcotics such as Oxycontin, hydromorph Contin and fentanyl (which some say is 100 times stronger than morphine). Kendall said there were more than 200 opioid-related overdose deaths so far this year in B.C., and that there could be 800 by the end of the year.

What’s happening in B.C. is a microcosm of what is happening across Canada, where we have some of the highest rates of prescription-opioid consumption in the world. From 2006 to 2011, use of opioids in Canada rose by 32 per cent and that rise has continued unabated, despite efforts to slow it down.

The U.S. is also in damage-control mode, trying to stem the incredible numbers of deaths due to opioids. In 2012, 259 million prescriptions were written for opioids — enough to give every American adult their own bottle of pills. Since 2000, the overdose death rate in the U.S. has risen by 200 per cent; nearly 19,000 opioid-related overdose deaths occurred in 2014.

Two weeks ago, I sat in a room while Dr. Vivek Murthy, the new U.S. surgeon general, told the assembled crowd that he was driven to make the opioid epidemic a top priority in his administration due to the devastation he’s seen in communities all across the country.

He told us the U.S. experiences an overdose death every 24 minutes, and the life expectancy of white, male, middle-class Americans is dropping.

The problems, as well as potential solutions, are incredibly complicated, but I agree with Murthy when he says that curbing society’s exposure to opioids — particularly those that come from a prescription pad in a doctor’s office — is absolutely vital. As he said: “Physicians need to be retrained to think twice — or three or four times — before writing that first opioid prescription.”

It’s important to recognize that liberal prescribing of opioids is a recent problem and, since the mid-1990s, can be linked to the message-crafting activities of the pharmaceutical industry that helped shape both patient perceptions of pain and influence how doctors thought about the safety of these drugs. Doctors were increasingly encouraged — sometimes through industry-funded educational activities or by using textbooks on pain management paid for by the makers of opioids — to prescribe the drugs for a much wider population of patients.

If revising the messaging around opioids was a business-oriented strategy of the opioid makers, we cannot place the blame solely upon them. Some of that blame has to do with the co-dependent relationship between physician education and the drug industry, which funds a substantial portion of physician education in Canada.

Is this epidemic not dire enough to finally build the absolute firewall we need between physician education and the pharmaceutical industry?

We need unbiased, safety-oriented messages about the appropriate use of opioids and knowledge of their wicked addiction potential. We also need to remind ourselves, both patients and prescribers, that any incredibly powerful and effective drug can also be incredibly dangerous and destructive.

The focus to tackle the addiction problem has to be serious, multi-faceted source control. We need greater access to addiction-treatment facilities and methods to rescue people from the depths of addiction, certainly. But we also need to curb society’s underlying dependence upon drug-company money for doctor training.

Alan Cassels is a pharmaceutical policy researcher at the University of Victoria and author of The Cochrane Collaboration: Medicine’s Best Kept Secret.

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