Trevor Hancock: National inquiry is needed on opioid crisis

We are in the midst of an opioid drug crisis. This year, deaths from illicit drug overdoses in B.C. exceeded 600 to the end of October, and will likely approach 800 by year’s end.

This is more than double the number of deaths from last year, and close to triple the 300 deaths from motor-vehicle crashes in B.C. in 2015. This has led B.C. to declare a public-health emergency, and to calls for a similar declaration nationally.

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There is no consistent approach to monitoring and reporting overdose deaths across Canada, but a rough tally for 2016 by Global News suggests we might be looking at 2,500 to 3,000 deaths from opioid drug overdoses in Canada in 2016. That would put it close to the top 10 causes of death in Canada; in 2012, the 10th largest cause of death, at 3,327, was kidney disease.

But we should not lose sight of an important fact: “This crisis has its roots in the health-care system,” as an October 2016 report from Toronto’s Centre for Addictions and Mental Health bluntly puts it, describing the health-care system as “the vector in this epidemic.”

A large part of the reason this is happening is that doctors have been overprescribing opioids, using them as first-line painkillers and creating addicts. The CAMH report notes that “across the country, consumption of prescription opioids increased by 50 per cent between 2000 and 2004 and 70 per cent between 2004 and 2011.” As a result, “Canada and the United States now have the highest rates of prescription opioid use in the world.” And these high rates, claims the report, “correlate strongly with harm.”

The CAMH report traces the blame to several sources. First, it notes that physicians get little training in pain management. Astonishingly, while pain management is a mandatory part of the curriculum in all the veterinary programs in Canada, this is the case in only one-third of medical schools. Moreover, medical students get only one-fifth as much time in pain management training as do veterinary students.

Second, the report states that there has been a lack of investment in pain management. But third, the report says that “in the 1990s, pharmaceutical companies in North America developed and promoted a number of opioid formulations as low-risk, non-addictive, effective treatments for moderate pain.”

In a 2009 article in the American Journal of Public Health, Dr. Art VanZee described the marketing campaign in the U.S. after the introduction in 1996 of perhaps the most notorious of these drugs, Purdue Pharma’s OxyContin, as unprecedented and aggressive. He noted: “From 1996 through July 2002, Purdue funded more than 20,000 pain-related educational programs … that had enormous influence on physicians’ prescribing throughout the country.”

In a 2011 article, Canadian drug-policy researchers noted that the same held true in Canada, and that in both countries the widespread use and misuse of OxyContin — and by implication, other opioids — was due to “the inadequate control over the promotion of the drug by the regulatory authorities.”

Another factor to consider is the role of the Colleges of Physicians and Surgeons across Canada. The role of these colleges, which license and regulate physicians, is to protect the public. For example, the B.C. College states:

“The college’s overriding interest is the protection and safety of patients … Regulation of the medical profession is based on the foundation that the college must act first and foremost in the interest of the public.”

So where was the college when physicians were being inadequately trained, were the recipients of aggressive marketing and were over-prescribing opioids and contributing to this epidemic?

Here are four questions that a national inquiry into the opioid crisis needs to investigate:

• What went wrong with the training of physicians?

• What role did the pharmaceutical industry play in normalizing the prescribing of opioids?

• What went wrong in Health Canada’s regulatory process?

• Where were Canada’s Colleges of Physicians and Surgeons when all this was happening?

We need to understand what happened, we need to assign responsibility and hold people and organizations accountable, and we need to make changes to ensure this does not happen again.

Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

thancock@uvic.ca

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