The Opioid Dilemma

Opioids include prescription painkillers such as oxycodone, fentanyl and morphine, as well as illegal street drugs like heroin. Canada's health ministers are meeting Friday in Ottawa to discuss the crisis. (Toby Talbot/Associated Press)

"If governments are claiming that doctors prescribing opioids for pain are the cause of the current opioid crisis, then surely we should be at the table discussing solutions that will reduce the harms of opioids but will not punish our patients with pain."
"It's a stacked agenda. How can you have a reasonable solution without doctors who treat pain and pain patients? No one will talk about the possibility that opiates may possibly be helpful." 
"The idea is that opioids are evil substances that shouldn't be used by anybody. They're just a tool, but they're an important tool."
"I'm all for safety and reducing risk. But let's not make people suffering from chronic pain the collateral damage."
Dr. Roman Jovey, medical director, CPM Centres for Pain Management, Mississauga, Ontario

"We have limited seating at the Opioid Conference, and unfortunately cannot accommodate all organizations that are interested in attending."
"I would like to assure you that several representatives will be in attendance from pain and palliative care networks. In addition, the conference will be available through webcast."
Health Canada official email

"I think the entire emphasis has been on the addictions side. The concern is that the conference is one-sided and does not reflect the best interests of all patients. We think we have a lot to offer, and we want to be part of the process."
"A lot of patients are doing well on opioids. They have jobs; they have families. The vast majority of people on opioid medications don't sell them on the streets. If you look at addictions some come from [prescription] diversions. But much of the fentanyl comes illegally from China."

Dr. Chris Giorshev, head, Ontario Medical Association, section on chronic pain

"I wanted an opportunity to buttonhole someone and show them a person who has been in pain every day."
"The politicians want to do something about the horrible scourge of addictions. The easiest, fastest thing to do is remove access. But there are legitimate users who will have no access."
Marisa Robertson, 54, chronic pain injury as teen competitive gymnast, Ottawa

Federal Minister of Health Jane Philpott, left, and Ontario Health Minister Eric Hoskins discussed Canada's growing opioid epidemic Friday after a two-day summit in Ottawa, as calls grow for Health Canada to declare a public health emergency. (Christopher Katsarov/Canadian Press)

According to Dr. Giorshev, who in his practise considers doctors to be in a unique position to advise authorities concerned over the proliferation of illegal drugs on the blackmarket and consequential deaths arising from them, the lack of presence of prescribing physicians at this major conference bodes ill. It is prescribing physicians whose patients present with pain that must be managed to enable them to have some quality of life, who have the expertise backed by experience in the safe use and effective prescribing of opioids who should have a advisory presence, he feels strongly.

In his own Barrie, Ontario practise, he treats patients suffering from chronic pain and patients who are addicted to drugs. A substantial enough number of the Canadian population, he emphasizes, suffers from moderate or chronic pain - between fifteen to twenty percent. When Dr. Jovey, another physician wanting to help confront the social dilemma of overdose-and-death at the major Opioid Conference taking place in Ottawa asked colleagues whether they would be attending the conference he discovered none had been invited.

Even chronic pain sufferers themselves who had heard about this summit on pain management and the runaway phenomenon of overdose deaths who hoped to be able to attend the conference to possibly give a first-person anecdotal account of what they know and what they experience with respect to constant pain in their lives and the working solutions to gain better lives through managing that pain, were terribly let down to discover that attendance was strictly limited, and they were out of luck.

There was one notable physician who had been invited to the conference, but to listen, not to speak. Dr. Viona Campbell, president-elect of the Canadian Pain Society stated that one of the commitments the Canadian Pain Society plans on is to make certain that out of this summit will also come an assurance that any strategy they support will also contain measures ensuring that opioid analgesics "remain available to those patients who require them for appropriate medical use, and that these individuals are treated compassionately".

"The likelihood to get a deliverable that is deliverable [sic!] is inversely proportionate to the number of people there [at the conference]", explained Dr. Campbell, an anesthesiologist at Toronto's Hospital for Sick Children, speaking of the presence of the guest groupings at the conference, which to her knowledge includes two pain-suffering patients. While there is logic in the government's wish to tackle the social problem of wasted lives due to drug overdoses, it is understandable that pain patients visualize steps being taken to tighten the availability of legitimate drugs prescribed for their use.

The conference theme is to take direct aim at pathways to reducing public harm relative to the availability of opioids. The following "opioid summit" after the conference concludes is meant to produce an agreed-upon joint plan of action. In six weeks' time the government of Ontario will put a halt to paying for some higher-strength, long-acting opioidsl little wonder pain patients are concerned for their future pain management. In Ontario alone in 2014, 685 overdose deaths occurred.

Governments are desperately searching for some way to reduce those tragic deaths. And legitimate pain patients foresee themselves as becoming victimized by the fallout of governments' attempts to restrict availability of those deadly drugs to users addicted to painkillers. Any such attempts will be destined to have a limited viability, given the brisk trade of cheap lab-produced opioids coming in from China to satisfy the North American demand. The United States is facing a similar dilemma.

A national conference on the opioid overdose crisis, held in Ottawa on Nov. 18, had a visible reminder of the death tolld, photos of some of the many ordinary Canadians killed by the powerful anesthetic that drug dealers are using to cut street drugs such as cocaine. Peter O'Neil / PNG