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Painkiller Deaths Double In Ontario

Source The Globe and Mail
December 8th, 2009
ANNA MEHLER PAPERNY

Painkillers are causing twice the number of overdose deaths they were two decades ago, a new study has revealed. And most of those who died obtained the medications through a doctor’s prescription and had seen a physician within the last month of their life.

The increase mirrors a dramatic rise in prescriptions for oxycodone. The potent opiate, found in OxyContin and Percocet, has proliferated in an epidemic of chronic pain turning Canadians into a nation of pill-poppers – using more prescription opioids per capita than any country but the United States and Belgium.

It’s an indication that many doctors have underestimated the power and complexity of prescription opioids, and their ability to harm as well as help, said Irfan Dhalla, a doctor at St. Michael’s Hospital in Toronto and the report’s primary author.

Dr. Dhalla is one of many physicians and researchers who argue that prescribing physicians – from general practitioners to gynecologists – need to reconsider the treatment of patients suffering from chronic pain and addiction.

“Physicians will be very surprised to learn just how many deaths occur from prescription opioids each year,” Dr. Dhalla said.

This new information comes as the Ontario government changes the way it regulates prescription opioids – placing limits on how many pills it will pay for per prescription, and possibly adding more addiction-treatment options for patients. Helen Stevenson, head of the province’s public drug program, says this urgent action is necessary because of a slew of evidence about Ontarians becoming hooked on these drugs.

One case brought to light by the study involved a patient who “walked out of the pharmacy with more than 2,000 pills” – all obtained through an apparently legitimate prescription.

“That, in itself, shocked us,” Ms. Stevenson said. “When we then saw this bigger picture of our data, we realized the urgency of starting to implement measures.

The study, published today in the Canadian Medical Association Journal, found that between 1991 and 2007, opioid-related deaths doubled in Ontario – to 27.2 per million people from 13.7 per million. During that period, prescriptions of oxycodone – added in 2000 to the list of drugs Ontario’s drug plan covers – shot up 850 per cent, and the number of oxycodone-related deaths quintupled.

More tellingly, about two-thirds of people dying of prescription opioid overdoses had seen a doctor in the preceding month; more than half had filled an opioid prescription in that time. The typical patient had seen a doctor 15 times in the year before he or she died.

Those overdosing on oxycodone are predominantly people with family doctors or, at the very least, easy access to a walk-in clinic. They aren’t buying their drugs on the street – or, if they are, it’s to supplement prescriptions.

Although there have been studies of opioid-related deaths in the United States and elsewhere, this is the first study examining trends in prescription-opioid deaths in Canada – and the first in the world to examine whether people dying of prescription-opioid overdoses are within the health system.

“If people are seeing physicians and getting prescriptions and going to pharmacies, that would certainly suggest a missed opportunity for prevention,” Dr. Dhalla said. “If you’re seeing your doctor 15 times in the year before you die, that means there are 15 visits where the fact that a person might be on multiple drugs that interact with each other could be addressed, psychological problems could be addressed, alternative strategies for dealing with chronic pain could be considered”

The study found prescription opioids kill, on average, 300 people in Ontario each year. HIV/AIDS kills 100 people annually; H1N1 has killed 100 people in Ontario so far. Other illicit drugs cause few overdose deaths by comparison.

“The perception, if you watch the movies, is that people inject heroin and die,” Dr. Dhalla said. “In Ontario there are far more deaths from prescription opioids than heroin. Deaths from illicit drug use without prescription opioids are relatively rare.”

It’s a case of a potent drug – as much as twice as powerful as morphine, which is far less easily available – not getting “the respect it deserves,” says David Juurlink, a doctor at Sunnybrook Health Sciences in Toronto and one of the report’s authors.

“It’s a very, very common medication, and familiarity breeds contempt,” he said.

A set of guidelines on opioid prescriptions, pain and addiction treatment drawn up by a team of experts from across the country is in the final stages of feedback, and will be released early next year.

Before the end of the month, Ontario plans to impose limits on the number of opioid pills it will cover, per prescription. And in January, the province will decide whether to fund buprenorphine – a less-addictive alternative to methadone that costs more per pill but would make addiction treatment available to more people.

“We don’t really have the authority to dictate what a doctor can prescribe,” Ms. Stevenson said. “Where we have the authority is around what we’re prepared to pay for.”

But while addiction doctors say it’s high time to add buprenorphine to the provincial formulary, they’re worried that limiting access to drugs is too blunt a tool, and will deprive patients suffering from pain of the treatment they may need.

“[Limits] might also actually reduce the availability of oxycodone and other prescribed opioids for patients who legitimately benefit from it,” said Curtis Handford, a doctor at the Centre for Addiction and Mental Health in Toronto. “Physicians still need to be able to access medications if they feel they’re warranted.”

7 comments to Painkiller Deaths Double In Ontario

  • This dovetails nicely with a January 2009 article in the Journal of the American Board of Family Medicine, which documented a “massive increase in costs for medical management of chronic back pain, while no significant increases in patient outcomes or disability rates had been observed”, and also noted massive increases in post-intervention complications (including death). The statistics were terrible to behold:

    a 423% increase in expenditures for opioids for pain in just an 8 year period.

    Read more here:

    Medicine and the Overtreatment of Back Pain

  • A few years ago, the ontario government decided that they would no longer pay for chiropractic services.

    Did the Ontario government really save any money?

  • RI Chiropractor,

    That is a great question, but the bigger question would be “did they make anyone healthier and get them off of more pills” I would say the answer to that would probably be a stong NO. Then I often wonder, chiropractic in Ontario did not go away, so are people paying Out Of Pocket, and taking more responsibility now for their health?

  • I wonder if the rabid anti-chiro people up in Canada (the usual suspects who love to testify at all the trials) would care to chime in about this? Or that Kissinger guy…the anesthesiologist from Oklahoma. Got anything to say about this?

  • Frank, I think you misread my response. I was responding to the post above that said that the Ontario Government stopped paying for Chiropractic care. I responded that the decision to stop Chiropractic care in Ontario did not make the people of Ontario any healthier,get them off of pain pills, and other useless meds. That was my point, that by trying to stop Chiropractors who are drug free providers and health educators, that the Government did not serve the public well.

    RESPONSE:

    Thanks for the clarification Dr. Garber!

    It always surprises me what the bean counters choose to target. When recent large studies demonstrate decreases of 60.2% in-hospital admissions, 59.0% less hospital days, 62.0% less outpatient surgeries and procedures when chiropratic care is provided as an option in managed care, it boggles the mind that Ontario chooses to discontinue coverage. I guess they just didn’t read or believe the 2 Manga Reports.

  • Somewhere along the line you would think that they look at the bottom line? The bottom line is saving utilizing chiropractic care. There has to be other forces working that we are not aware of to stop the progression of Chiropractic care. It boggles my mind.

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