Opioid crisis in Canada

Canada has the highest rate of opioid use in the world. Vancouver, one of the most populous cities in Canada, experienced nine deaths from fentanyl overdose in a single night. About 622 unintentional overdose deaths were seen in the first 10 months of 2016 in Vancouver, and 338 deaths from overdose in Alberta. Carfentanil, an opioid that is 10, 000 times more potent than morphine, was recently found on streets in Ontario. There has been 40% increase in street drug use in Canada in 2016 compared to the previous year. These statistics are  concerning. For any wise Prime Minister of Canada, this issue would top the priority list, far surpassing other issues such as climate change, immigration, and childcare benefits.

Do Canadians experience more pain than people elsewhere in the world? If so, is it physical or mental pain, or both? Are they more depressed and lonely than others? Are good drug plans to be blamed for the unprecedented opioid addiction rates? Who are at-risk populations for opioid misuse? Do Canadian doctors receive adequate training in prescribing narcotics? Are Pharmacists well-trained in recognizing opioid addictions? Do law enforcement officials receive appropriate training to identify opioid overdose cases? Is the public well-informed about the risks associated with opioid overuse? Is the government taking the necessary steps to resolve this crisis?

As a Pharmacy Assistant, I frequently come across prescriptions that ask for 100+ narcotic tablets at once. Although I empathize with patients who experience chronic pain, I firmly believe that doctors should only prescribe narcotics for a short time frame (e.g., a month supply), should prescribe more medications, if required, as refills, and should regularly follow-up with their patients on narcotics. Prescribing small amount of narcotics at a time ensures safety of the patient as well as of those in their surroundings. For example, if a 50-year-old working man with 100% drug coverage plans is given 360 tablets of Lenoltec at once at a cost of $0.00, how do we know that he is closely following the usage instructions? How do we know that his 32-year-old son is not taking his medications?

I recognize that there are circumstances when exceptions for patients should be made to ensure that they do not suffer without their medications. For example, if a patient is going on a vacation for a couple months and need his/her pain medications. However, the high frequency at which I see more than 100 narcotic tablets (sometimes 150 tablets, even 360 tablets) being dispensed at pharmacies makes me question the prescribing and dispensing behaviours of such medications.

The good news is that pharmacotherapy (e.g., methadone and suboxone)  is available for effective treatment and management of opioid abuse. However, are there opportunities for those with opioid dependence to participate in self-help community support groups when seeking treatments? A simple Google search showed that these opportunities are not readily available when compared to highly accessible alcohol dependence self-help groups. Investing in these services could have profound positive results.

In conclusion, Canada is experiencing unprecedented rates of opioid overdose. A significant number of deaths and injuries have been linked to opioid addiction. This crisis must be taken seriously be everyone, including the government, law enforcement officials, medical professionals, and the public. An urgent action is necessary.

References:

Selby, P. Nov 2016. Dealing with Canada’s opioid crisis. http://www.camh.ca/en/hospital/about_camh/newsroom/news_releases_media_advisories_and_backgrounders/current_year/Pages/Dealing-with-Canada’s-opioid-crisis.aspx

Fentanyl overdoses killed hundreds of Canadians this year, experts say 2017 could be deadlier

Featured image from Google Images

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