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Canada's Opioid Guidelines Let Her Die Without Dignity

Our response to overdose deaths is to target pain patients and their doctors, when most know that this is not the source of the problem.
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The last six months of her life before she passed away last week were spent in misery thanks to the new opioid-prescribing policies being forced in Canada. Catherine, as she was known on the Roy Green Show, died last week. She was a frequent guest on Green's show talking about how the new Canadian opioid-prescribing guidelines have impacted her. I've been writing about this here for quite some time.

Catherine first became ill in 2010 with a blood disorder that resulted in her body retaining iron. It caused her terrible constant pain and effected her liver, her stomach lining and her heart. Her family doctor treated her pain with a combination of long term opioids supplemented with short-acting opiods for breakthrough pain. She described to Roy that her pain level was kept to a three or four out of 10, and she was able to maintain a reasonable quality of life and to work.

Martin Barraud

When the 2017 guidelines for opioid use in non-cancer pain were introduced, her doctor was ordered by his regulatory agency to reduce her medications by 50 to 60 per cent and her pain level shot up to a seven or nine. She was no longer able to work or to function. She had been on a wait list for a pain clinic for two years and was told it would be another year before she could see someone. Before her unfortunate death, she was struggling greatly with pain which her doctor was prevented from ameliorating as he had done in the past.

The guidelines do not tell doctors to force patients off opioids, but that is what is happening. Jason Busse, the chair of the guideline committee who is an associate professor of anaesthesia (a chiropractor not an MD) and researcher at McMaster University, assured Green that the guidelines do not mandate that and he said that it was dangerous to do so. However, he did admit that doctors are under pressure to reduce opioid use amongst their patients.

His colleague on the guidelines committee, Dr. David Juurlink from the University of Toronto, agreed that we will not fix the addiction problem in Canada by cutting people off opioids — instead, he insisted cutting them off will make things worse for them.

So, why are we doing exactly that?

Our response to overdose deaths is to target pain patients and their doctors, when most know that this is not the source of the problem.

The main reason seems to be the false belief that doctors prescribing opioids to patients are the cause of the large increase in addictions and overdose deaths. As I've pointed out before, this is not the case. In his interview linked above, Dr. Busse estimates that maybe five per cent of people prescribed opioids become addicted, while Dr. Juurlink thinks it is maybe 10 per cent. I've argued that it is much lower than that. Dr. Busse suggested that only about five per cent of prescribed opioids are diverted to illegal use.

A recent report shows that Hamilton has one of the highest death rates for opioids in Ontario, but one of the lowest prescription rates for opioids. The deaths are caused by illicit drugs. And Dr. Busse told Roy Green that experts have no idea how many of these deaths resulted from drugs prescribed to people, those that are diverted from legitimate prescriptions or drugs from illicit sources.

Dr. Thomas Kline recently wrote that the idea that prescription drugs cause addiction is nothing but a myth and that opioids are the only drugs that ease pain. Journalist Nick Bilton — who wrote American Kingpin about the founder of the Silk Road, a drug-selling website on the deep dark web — points out much of the deaths are attributable to purchases on the web. The chart on page 315 showing the enormous increase in deaths from synthetic drugs correlates with the revenues from that website. Both took off at about the same time. Bilton noted that 20 per cent of respondents who were asked where they got their drugs claimed they got them off the internet in the first year that website started up. It is likely much higher now.

Our response to overdose deaths is to target pain patients and their doctors, when most know that this is not the source of the problem. People have pain, we have the resources to deal reasonably well with that pain and it is inhumane to do what is being done. For politicians, it is a seemingly simple (but wrong) solution to demonstrate that they are doing something.

Getty Images/iStockphoto

There may, however, be another reason amongst some doctors which was explained by Dr. Juurlink and it comes down to a bias against opioids, for whatever reason. Juurlink explained to Green that there are a lot of people on opioids who think they are doing well but really aren't. "They are being harmed in ways that they do not appreciate," he said.

When my doctor gives me medicine, I know if it works. If it has side-effects, I assume they are known. For the pain patient, opioids take most or all of the pain away and you have no or few ill effects. But Juurlink thinks that is because you do not know what is really happening to you. I suspect that he is talking about a condition called opioid-induced hyperalgesia. For some people, taking high doses sensitizes you and you get more pain rather than less. Fine — maybe for some, but if you are taking the meds and your pain keeps getting worse, then you go to the doctor and tell him/her. It could be hyperalgesia or it could be tolerance requiring a higher dose. Regardless, the entire concept is highly controversial and some question the validity of the studies

In my opinion, Dr. Juurlink's comments reflect a considerable arrogance — "You may not know it is not good for you, but I'm a doctor and I know better." This attitude has no place in modern medicine. What we are seeing, again in my opinion, is a horrible experiment playing with people's lives. Maybe overdose deaths will decline if we attack legitimate pain patients. Let's see.

People are suffering with this opioid experiment and dying without any dignity. It is time to end it.

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