Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Wednesday, August 26, 2015

Physicians Prescribing Pain-Killing Death

"What I frequently see is undisciplined, unstructured and arbitrary use of these medications [most often by] a well-intentioned, but weak-willed and under-informed physician who has lost control of the patient-doctor relationship."
"We don't think that there are malignant, bad doctors knowingly feeding this problem If there are, they are few."
"Quite frankly, patients show up expecting pain treatment and expecting to be pain free."
Dr. Douglas Grant, CEO, registrar, College of Physicians and Surgeons of Nova Scotia

"There is no doubt that we are in the midst of an epidemic of opioid-related deaths."
"Whether it's an overdose, or whether you just had too much drug in your system and you had a couple of glasses of beer and went to sleep, that's enough to do it."
Dr. David Juurlink, head clinical pharmacology and toxicology, Sunnybrook Health Sciences Centre, Toronto

"[There is] massive ignorance [of the complexity of addiction and pain treatment]. The solution is to get better care for pain, and better care for addiction, not to demonize a drug or a class of drugs and try and identify simplistic solutions like increasing the regulation of those drugs."
Dr. Mary Lynch, professor of anesthesia, psychiatry and pharmacology, Dalhousie University, Halifax

In 2014, a greater number of people in the United States died of opioid-related deaths than from car accidents. And that statistic is little different in Canada where the prescription of opioids ruining lives "is a problem of enormous magnitude that is killing people", according to Dr. (Gus) Grant, speaking before delegates at the Canadian Medical Association's annual general council meeting. Doctors prescribing powerful narcotic painkillers like oxycodone, he contended, don't adequately understand the drugs.

Another doctor speaking at the meeting stated that in Canada too, "We kill more people now than cars do." And the simple fact has emerged that Canadian doctors present among the highest prescribers of opioids in the world. Some family physicians practising in the Province of Ontario alone, are responsible for prescribing 55 times the quantity of opioids to their patients, as do other doctors in catering to the health needs of people in their care far more responsibly.

"If we were doing that with something like blood pressure medications or cholesterol meds I think there would be hell to pay, but somehow it's OK because it's only narcotics", commented Dr. Christopher Milburn of Cape Breton. Safe medical practise does not condone the free prescribing of opioids in extremely high dosages. Yet it happens and one woman in British Columbia with multiple identities obtained and filled over 250 prescriptions for a variety of narcotics from various doctors and pharmacies in a six-year period.

Regulators released a report stemming from a two-year investigation which was critical of 46 doctors whom they held responsible for "deficient prescribing practices" related to that rather spectacular fraud case. Across the country police have been intensifying warning about fentanyl, a drug that is so powerful, it can be 50 to 100 times more morbidly toxic than morphine. And even as fentanyl circulates as the street drug of choice, deaths reflecting tainted street formulations of fentanyl have been steadily increasing.

The Canadian Community Epidemiology Network on Drug Use recently released a report pointing out that between 2009-14, fentanyl was identified as the cause or contributing cause of at least 655 deaths. Since OxyContin was reformulated with a "tamper-resistant" version, the drug that was the single most common drug safety problem, helped increase opioid abuse. According to a recently published study, patients prescribed high-dose opioids-- 200 mg or more of morphine per day become 24 times likelier to die from the drugs.

Dr. Juurlink frequently sees patients on 500 mg to 1,000 mg of morphine daily. The result is the occurrence of death, not just from someone "gobbling down a bunch of pills in self-harm". Dr. Grant emphasized that doctors have become "casual", "blase", about prescribing these drugs, and in the process less concerned about safety linked to drug use. As a result, opioids continue to be prescribed at rates and volumes hitting a new high.

The only word of caution, and plea for doctors to be more concerned with the legitimate needs of patients suffering chronic pain was from Dr. Lynch, who spoke of a reality where some patients struggle to be prescribed opioids for legitimate pain control; those with rheumatoid arthritis, for example, or chronic inflammatory bowel disease.

Purdue Pharma executives pleaded guilty to misbranding OxyContin pills, but the marketing message became well-established, says a family doctor who laments the widespread usage of high-dose painkillers.
Purdue Pharma executives pleaded guilty to misbranding OxyContin pills, but the marketing message became well-established, says a family doctor who laments the widespread usage of high-dose painkillers. (Toby Talbot/Associated Press)

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