Calling the Ontario government’s answer to the growing concern of painkiller addiction and overdose problems a “knee-jerk move,” one Western researcher said it’s likely to create more problems than the provincial solution hopes to solve.
As of Jan. 31, the province de-listed all opioids that exceed the equivalent of 200 milligrams (mg) of morphine a day, from its Ontario Drug Benefits Program, which pays the cost of many prescription drugs for those over the age of 65, as well as individuals receiving social assistance. The goal is to maintain a prescription level of 90mg per day.
“It’s a response to what it referred to as the ‘opioid crisis,’” said School of Physical Therapy professor Dave Walton. But the response might do more harm than good, he added, noting while it may prevent overdose deaths down the road, it could also cause suffering to millions of Canadians.
Addiction problems are a serious concern, Walton noted, adding he doesn’t want to undercut the seriousness of the issue. In 2014, more than 700 people died in Ontario from opioid-related causes, a 266 per cent increase since 2002. In British Columbia, last year alone, there were 914 overdose deaths from illicit opioid use, with another estimated 50 to 80 overdose deaths from prescription opioid use.
“The solution of tightening down prescription guidelines might affect five per cent of (those who take opioid medications), if that,” Walton said. “Lost in all of this narrative is the voice of the people who need it. If you live with constant suffering that’s not controlled, you have relatively few options. You either turn to the black market and hope you can find stuff that can work – and how many people are really comfortable with doing that – or suicide, as the other option.”
Walton said thoughts of suicide are much higher in those suffering chronic pain issues than the general population.
To help fight what it calls the “growing problem of opioid addiction in Ontario,” the province’s Ministry of Health and Long-Term Care has indicated chronic non-cancer pain can be managed more effectively in most patients, recommending some cutting doses as much as 75 per cent for some individuals, and that any consideration of a higher dosage requires careful reassessment of the pain.
The ministry website notes 24- and 30-milligram capsules of hydromorphone, transdermal patches that deliver 75 and 100 micrograms of fentanyl an hour, and 50 mg tablets of Meperidine, also known as Demerol, are now delisted from the benefits program.
Walton, whose research focuses around the measurement, prognosis and understanding of the development of chronic pain, said the majority of people taking opioids – even at the above amounts – are taking them legitimately and need them to maintain a reasonable level of wellness and quality of life.
The most liberal estimates, he added, state addiction occurs in 8-12 per cent of patients, which means 90 per cent of people taking opioids legitimately need them. The strong narrative of the opioid crisis has added to the stigma of patients being seen as “addicts,” Walton stressed.
“These are the same people that have lived a life, or several years, of unwanted stigma because of their chromic pain, which is usually invisible,” he said. “They have had to endure sideways glances from employers, colleagues, even family and friends. Are you really in that much pain?”
With one in every five adult Canadians living with chronic pain, that means millions of people are suffering, Walton said. Lowering the prescribed dosage of opioids is going to affect thousands. When doctors start to taper their medications down, especially without alternatives, it will cause undue suffering to many, he added.
Walton is neither pro- or anti-opioid, but rather pro-patient, he said. He feels a more nuanced approach is needed to prescribing opioids.
“I don’t know of any example in the past where a one size fits all approach works for any chronic issue. This is not cookie cutter,” he said. “I’m afraid we’re going to trade one public health crisis for another – uncontrolled chronic pain, needless suffering, more hospitalization, more accessing the black market and an uptake in suicide. I just hope this doesn’t happen. I really hope I’m wrong.”