The Circuitous Treadmill

"It's sad to say that most pharmacists have come to accept this as an occupational hazard. As a gatekeeper for medication, they know there is always a risk ... that at one point they're going to be looking down the barrel of a gun or at the point of a knife."
"[Weapons can be varied; an aerosol-can/lighter combination turns into a] flame thrower; [dousing a pharmacist with gasoline with the threat to light up his life works well] "That's all it took. The strategies that are being applied, there's no end to them."
Allan Malek, senior vice-president, Ontario Pharmacists' Association

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Theft and similar losses represent a vital source of Canada's drug-abuse problem, fuelling the thriving street trade in illicit/prescription drug handovers. Health Canada requires by law that pharmacies, distributors and wholesalers report to them thefts, robberies, pilfering by employees, losses in transit, "unexplained" losses and any other noted absences of 'controlled' substances; prescription drugs whose use can result in abuse and harm.

Attention has turned to those opioid painkillers so increasingly popular that they have served to identify Canada second only to the United States in per capita consumption. The addiction and overdose death rate has mounted in lock-step with the rise in use of these potent medications. Both among people prescribed the drugs by a physician and those people who make their purchases clandestinely at street level.

Health Canada registers losses ramped up sharply from pharmacies in 2011 among four of the most popular opioids -- oxycodone, morphine, hydromorphone and codeine, with 415,000 tablets disappearing in 2011. Theft and losses from "licensed dealers"; distributors and wholesalers up the supply chain, spiked in 2010, decreased the following year and have climbed since 2011.

The medications are hugely popular. People don't like to feel down, depressed, restless and unhappy with the way their lives are unfolding. They don't want to accept that sometimes experiences in life aren't of the joyful variety, that in everyone's life there are times when sadness and depression prevails, and then, for the most part, for most of us, that time passes and we get on with life. People are impatient, eager to lift themselves immediately out of a funk.

"We're not always happy, and there are often good reasons for unhappiness. But there's this idea that we should all have high self-esteem, fantastic relationships and tremendous jobs.
"It's like cosmetic psychopharmacology: If you don't like the way you look, you go to a plastic surgeon and get it fixed. If you're not happy enough, go to a doctor and go on anti-depressants."
Dr. Joel Paris, professor, past chair, department of Psychiatry, McGill University, Montreal.

Canadians rank among the highest users of antidepressants in the world, reporting the third highest level of consumption among 23 member nations surveyed by the Organization for Economic Co-operation and Development. OECD figures show Canadians consumed 86 daily doses of antidepressants for every one thousand people per day in 2011, greater numbers than the UK (71 doses per day), Spain (64) and Norway (58).

Iceland, at 106 doses per 1,000 people per day, and Australia, with 89 doses were higher in antidepressant use than Canada. Retail drugstores in 2012 filled 42.6-million prescriptions for antidepressants, according to figures released by prescription-drug tracking firm IMS Brogan. And while Dr. Paris stresses that antidepressants are essential in cases of severe, debilitating, life-threatening depression, these figures reflect a far larger societal problem.

Pills like Prozac and its ilk are being swallowed daily by millions of Canadians who may not be aware and may be equally disinterested in knowing that studies suggest that in instances of mild depression, where, to quote Dr. Paris "you're still working, you're still functioning", the drugs don't often work, or they may produce a temporary placebo effect.

"And then you get onto this thing, where you try another one, and you try a third one, and then you add some other type of drug entirely. It's a whole treadmill of pharmacology people get caught up in. The fear of relapse has driven doctors to keep people on them for years", commented Dr. Paris.

These are not innocuous drugs; a decade ago pharmaceutical companies were ordered to add a warning that use of the drugs place people at increased risk of suicidal thoughts and behaviour in the class of antidepressants known as SSRIs; selective serotonin reuptake inhibitors. And they can be addictive. Some people stay on them for years, because they're generally well tolerated.

"Part of the problem is that they're not toxic enough to make people want to stop them" Dr. Paris remarked.

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