National strategy blueprint for tackling prescription drug abuse crisis in Canada

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TORONTO - A national strategy to deal with the abuse and misuse of opioids and other potentially harmful prescription drugs is being unveiled in Ottawa today, a 10-year plan to tackle what's being called a public health crisis of epidemic proportions.

The plan, drafted by the Canadian Centre on Substance Abuse (CCSA), the National Advisory Council on Prescription Drug Misuse and other key organizations, aims to reduce the potential harms of such medications as opioids, stimulants and sedatives.

Canada is neck and neck with the United States as the country with the highest per capita use of opiates, the potent pain killers that include oxycodone, hydromorphone and fentanyl.

The national strategy, entitled First Do No Harm, is said to contain numerous recommendations on how to deal with Canada’s prescription drug problem. That could include stricter prescription monitoring and tighter supply chain control of high-potency opioids, for instance.

"I think it's great really that the CCSA has finally taken this on, and hopefully the federal government and the provincial governments ... and others who have a role to play will listen to many of the recommendations," said Dr. Irfan Dhalla, a member of the National Advisory Council, who declined to discuss specifics of the report.

"It's a great title because it illustrates that at the root of this problem, unlike most of the other substance misuse problems — alcohol, cocaine, tobacco — the root of this problem is a physician with a prescription pad.

"I think the report makes that quite clear, that if physicians prescribe these drugs more carefully, we will likely have fewer cases of addiction and overdose death," said Dhalla, an internist and researcher at Toronto's St. Michael's Hospital who has long spoken out against indiscriminate prescribing of opioids like oxycodone.

More than 1,000 Canadians will die this year as a result of taking opioids, often from overdoses, said Dr. David Juurlink, a physician and addiction researcher at Sunnybrook Health Sciences Centre in Toronto. "Sometimes they're abusing them, sometimes they're not.

"And for every person who dies, perhaps 10 seek treatment for drug addiction. And perhaps more than 100 — and no one really knows for sure — have a problem with misuse or addiction involving opioids," he said.

"So it's not hyperbole to say that this is the biggest drug safety problem our society faces today."

If the problem is going to be solved, added Juurlink, doctors need to write fewer prescriptions and have patients on these powerfully addictive drugs for shorter periods of time.

And when the drugs don't appear to be working to relieve a patient's pain, physicians "absolutely must not escalate them to the stratospheric doses that we've seen used so often over the last decade."

Juurlink said doctors, dentists, pharmacists and other health professionals have been given inaccurate and misleading information about the effects of certain prescription opioids, in some cases by the pharmaceutical companies that produce the drugs.

"And that has left us in a difficult position," he said. "We feel compelled to use these drugs and we feel compelled to prescribe them at high dosages, and patients have to a certain extent developed a sense of entitlement to these drugs."

As well, when it comes to writing a medication script for pain relief, doctors must rely on what patients tell them about their level of suffering, added Dhalla.

"Our bias is to trust the patient, that's what we're taught to do. And the fact of the matter is that some patients who suffer from addiction will sometimes lie to get an opioid so they can sell it to someone else."

Still, Dhalla said physicians alone can't solve the complex problem of prescription drug abuse.

"We need help from governments, regulatory authorities, pharmaceutical companies," he said.

"I hope that the various groups involved with developing the report and the groups to whom the recommendations are made take it forward ... I hope this is the turning point."

Organizations: CCSA, Canadian Centre on Substance Abuse, National Advisory Council on Prescription Drug Misuse St. Michael's Hospital Sunnybrook Health Sciences Centre

Geographic location: Canada, TORONTO, Ottawa United States

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