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

Saturday, July 01, 2017

The Savage Myth of Opioid Non-Addiction

"The new guidelines are basically an attempt to turn around a huge freighter ship that's moving in one direction, and now we're doing a 80-degree turn."
"All of a sudden they're [prescribing doctors] dropping all these patients or cutting them off their opoids."
"I see more people dying."
"What really most urgently needs to happen in our system, Canada-wide, is system-management."
Benedikt Fischer, senior scientist, Centre for Addiction and Mental Health, Toronto

"I started with heroin because I couldn't stand the pain. Everybody was croaking [people dying of fentanyl-laced street drugs]."
"I told him [her doctor], 'I'm shooting up powder now, cocaine, because that's what kills the pain."
"Sometimes it's hard just to get to the place where you buy your stuff. You can hardly wait to get that needle, just to get that sense of relief."
"It's awful to have somebody hold you and have to walk you there. And then you're doubled up in pain."
Lorna Bird, 60-year-old grandmother, Vancouver
A man walks past a mural by street artist Smokey D. about the fentanyl and opioid overdose crisis in the Downtown Eastside. DARRYL DYCK / THE CANADIAN PRESS

A 60-year-old drug addict? What would her grandchildren think? She's thought about that. Thought about what it might be like for her grandchildren to discover that their grandmother was one of those addicts that the infamous Downtown Eastside streets of Vancouver -- home to people with mental problems, the homeless and the addicted; petty criminals who commit crime to pay for their next fix -- is known for.

She faced a dilemma when her doctor decided he would stop prescribing an opioid; his personal response to new standards and guidelines among medical professionals reacting to the epidemic of overdoses caused by the deadly opioid fentanyl and its even deadlier cousin carfentanil being used by unscrupulous and profit-driven drug dealers to cut more common street drugs with, to substantially increase their profit margin.

Lorna Bird had surgery in December of 2014, when the prescription opioid hydromorphone (five times more potent than morphine) had been prescribed to numb the intolerable pain she suffered with. However, despite the ongoing pain her doctor began by decreasing her prescription and then finally stopping it altogether. Presumably in an effort to wean her off dependence on the pain \-relieving effects of the opioid, but delivering her straight into the hands of street drug dealers, to cope on her own with the Russian roulette of fentanyl overdosing.

She, according to experts in the field, ranks among thousands of other Canadians with their predicament involving the acquisition of pain-numbing street drugs in the face of having become addicted to the opioids they were originally prescribed for their pain. Lorna Bird was spending $100 daily on cocaine, hoping that she wouldn't be acquiring contaminated heroin instead. Because of her concerns of overdosing should fentanyl be added, she has someone with her when she takes it.

Her doctor had responded to his patient's plea by referring to the College of Physicians and Surgeons of British Columbia having issued new standards as his primary motivation to alter his prescription methods. He finally agreed to allow her to resume a lower dose of hydromorphone, along with methadone. Yet she finds this insufficient to adequately dull her incessant pain, so she continues with both drugs while also injecting cocaine.

The recently updated guideline for prescribing opioids released by the National Pain Centre at McMaster University in Hamilton urges doctors to limit dosages of drugs like hydromorphone, oxycodone and the fentanyl patch to no more than 90 milligrams of morphine daily. They recommend as well that physicians taper medications, even discontinue prescribing the drugs that have led, with long-term use, to dependence in their patients.

According to the Public Health Agency of Canada, close to 2,500 people have lost their lives to opioid overdoses last year. Approximately 20,000 Canadians, according to Dr. Fischer, have overdosed fatally on the potent narcotics being prescribed for them. He urges non-pharmaceutical pain-management strategies be implemented as  systemic changes to prevent the over-prescribing epidemic of opioids.

A public health emergency was declared in British Columbia in reflection of the fatal-overdose crisis that has taken more than 1,400 lives there, between January of 2015 and March of 2017.

The number of overdose calls Vancouver firefighters deal with on a daily basis can be overwhelming, but are becoming routine. Pictured are firefighters and B.C. Ambulance paramedics taking a woman who suffered a fentanyl and heroin overdose to the hospital. Jason Payne / PNG

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