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Opioids are killing with abandon while politicians wait to act

May 2, 2016

If politicians really wanted to get widespread bipartisan support on an issue, they’d do more about opioid addiction.

The statistics are staggering:  nearly 100 Americans die every day from opioid abuse. It is believed that 4,000 people across Canada died from opioid-related causes in 2017.

And the main source of opioids, drugs like oxycodone, hydrocodone, morphine, codeine? Your family doctor.

Opioids are prescribed by real doctors for real pain: debilitating back pain, to help recover from surgery, to help alleviate agony so severe a person cannot get out of bed, let alone take care of themselves, their families or go to work.

The problem is, once the high of a pain-free existence wears off, the thought of going back to the pain is too much. The pain itself, even if it’s not as severe as it was before, is overwhelming. And since pain reporting is subjective — on a scale of 0-10, how much pain are you in today?— how can a doctor really know whether a person is suffering from “real” agony or just looking to keep feeling nothing?

Healer or enabler?

Dr. Eugene Gosy, a pain specialist in the Buffalo area, has become something of a flashpoint in the ongoing battle over opioid addiction. His patients believe he’s a godsend, the only one who can help them, and that his current federal drug charges are a witch hunt for which he’s a scapegoat and easy fall guy.

But for others, Gosy is emblematic of the problem: A doctor who would give anyone anything, creating an entire population of addicts who use drugs as a crutch and aren’t in need of actual help so much as their next high.

He’s been indicted on 166 charges, including the deaths of six people under his care and contributing to the deaths of others. The indictment, released in November, accuses him of “handing out prescriptions for opioids including fentanyl, oxycodone, morphine and hydrocodone without a medical basis to patients who were clearly abusing the medications that have fueled a national crisis.”

Drug overdoses are now the number one cause of death for Americans under the age of 50.

In Canada, the highest percentage of opioid-related deaths, 28%, happen in people between the ages of 30 and 39, with men at greater risk than women (74%). And those who died from opioid-related overdoses are often found to involve one or more non-opioid drugs as well (82%).

What’s worse, the beneficial effects of opioids, which can be life-saving and perfectly useful and safe in certain settings, decrease over time if used in excess.

On Geeks & Beats Season 5 Episode 25, ‘Too Soon,’ Dr. Vincent Lam, medical director of the Coderix Medical Clinic in Toronto, says there’s substantial evidence that sustained use of opioids to treat chronic pain not only causes a person to develop a tolerance, which means the medicine doesn’t work as well as it used to, but it can result in “opioid-induced hyperalgesia. The body becomes more sensitive to pain over time with exposure to opioids. At the end of the day, you don’t end up with great pain control in most cases over the long haul.”

What’s being done?

In the US, the Trump administration has pledged to take a hard position on opioids. In October, the president declared a public health emergency pertaining to opioid abuse and addiction, talking publicly about his brother, Fred, an alcoholic who died in his 40s. It’s not something Trump talks about often.

“We are currently dealing with the worst drug crisis in American history,” he said at the time. “It’s just been so long in the making. Addressing it will require all of our effort…. We can be the generation that ends the opioid epidemic.”

Trump first spoke seriously about fighting opioids last August, indicating he would declare an “epidemic.” But as NPR points out, “public health emergencies expire after 90 days, although the administration says they can be easily renewed. The designation gives the administration access to the Public Health Emergency Fund, but that fund is nearly empty.”

The administration had particular areas of focus: expanding access to telemedicine services; speeding the hiring process for professional working on opioids, and allowing funds originally designated for dislocated workers and those fighting HIV/AIDS to be used to treat addictions.

The sad truth is, if the Trump administration rolled out anything concrete with any kind of real, longstanding vision of how to fight opioids with real treatment, real metrics and real care, it would easily be embraced by Democrats and Republicans alike, in addition to Americans eager to find a reason to stand together.

Instead, nothing’s been done. It’s all talk and no action.

Canada making strides

Moving north, Health Canada says there were 2,861 opioid-related deaths in 2016, a death rate of 7.9 people per 100,000. Between January and June 2017, there were nearly half that many, 1,460 deaths.

British Columbia holds the distinction of the highest number of deaths per population: 985 deaths, or 20.7 per 100,000 people, in 2016 and 798 between January and June 2017. In Ontario, there were 867 deaths, or 6.2 per 100,000 people, for all of 2017, with 214 opioid-related deaths reported in the first half of 2017.

More than 700 doctors called on Ontario Premiere Kathleen Wynne to declare a public health emergency in October 2017, urging her to following in the footsteps of British Columbia. That declaration would allow more funding to be allocated to harm-reduction workers, increase overdose prevention sites and would boost opioid programs.

In October, the Canadian Nurses Association released a statement calling on the government to “lead efforts for a more coordinated approach between all levels of government and to also work with stakeholder groups to take concrete steps to stem the national opioid crisis. Equitable access to health and social services is at the heart of this public health epidemic.”

Canada is leading the way in some efforts – efforts that are available in some U.S. cities but not on a national level.

There are at least a dozen supervised injection sites across the country. A small number, yes, but it’s a place where addicts can use in a place where they’re safe, they have access to clean needles (to avoid further health problems like HIV transmission, infections and exposure to diseases like hepatitis) and they’re in the presence of medical professionals who can spot and immediately address overdoses.

Last year the Canadian government passed legislation making it easier for such clinics to open. Expect to see more in the coming years. And they work – the nation’s first location, in operation in Vancouver for 14 years, sees about 500 injections daily but has never had a fatal overdose.

The government also is working to create and enforce labeling requirements on all prescription opioids and to disseminate literature to people getting such prescriptions, warning them about the long-term consequences and risk of addiction. That legislation is expected to be final with publication in the Canada Gazette this summer.

Something doesn’t add up

There’s one other thing to consider.

The situation is dire in North America, but this is a crisis not shared by the rest of the world.

Dr. Lam tells Geeks & Beats that the U.S. and Canada don’t have the same rates as comparable countries, including Australia or nations in Europe.

“Canada and the U.S., we are by far the number one prescribers of opiates,” he says. “There’s something we’re doing differently in terms of our culture, in terms of our medical systems. Australia doesn’t have anything near the scale of opioids, the mortality we have. That’s a first-world country with similar expectations in a lot of ways.”

The difference? “We are programmed by our expectations of the last few decades to think opioids are the solution,” Dr. Lam says. It doesn’t play out with practices around the world. We just have to take a step back first and question whether opioids are really essential in all the situations we have come to assume they are essential.”

 

There’s no time to wait. It’s time to act.

In my family, we’ve watched as my ex-brother-in-law, my niece’s father, has struggled with addiction for years. He had chronic back pain requiring at least two surgeries. He watched his father die from alcoholism and wanted to avoid the same fate. He’s now underweight, looks like a zombie, can’t hold a job and, last I knew, still lives in denial that he’s got a problem. He’s lost his wife and his child and it still wasn’t enough. For the sake of my niece, we’re all hoping he can pull it together. But we know the deck is stacked against him.

Everybody knows it’s a problem. It’s obvious more has to be done. We all know people are dying. And yes, treatment is costly and painful and scary, both for the person afflicted and their loved ones. But wringing our hands just isn’t going to cut it anymore. It’s time for governments to put their money and policies where their mouths are and start doing the hard work.

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