Doctor fears narcotic use in N.B. will lead to more fentanyl deaths

A Moncton doctor is warning that New Brunswick physicians are writing too many "inappropriate" prescriptions for narcotics and that is paving the way for more overdoses from fentanyl.

Dr. Tom Evans, an anaesthesiologist and the lead physician at the pain clinic in Moncton, says most people who try fentanyl have already tried many other prescription drugs.

"You don't get to fentanyl without passing through codeine, OxyContin, MS Contin, Tramacet — you don't get there without being exposed to the narcotics first — you have to have the gateway drug," Evans told Information Morning Moncton.

"And we've got a problem in this province with inappropriate prescribing of the gateway drug."

A CBC news investigation into drug overdoses in the Martimes has found fentanyl was involved in at least 32 deaths since 2008.

• Fentanyl involved in at least 32 Maritime drug deaths

"Unfortunately the root cause of all of this … is prescription opiates. The opiates that are out there primarily have been prescribed to people," Evans said.

Evans has been studying chronic pain since 2001 and has collected comprehensive data on about 700 patients that shows when they arrived at the pain clinic nearly half of them were already taking a prescribed narcotic.

"That reflects the practice of 256 physicians from around New Brunswick so it's not the prescribing pattern of a couple of doctors," he said.

The New Brunswick College of Physicians and Surgeons is hoping a new prescription monitoring program, launching in 2017, will be part of the solution to the growing problem of narcotics addiction.

Worries dealers won't stop at fentanyl

Up until the 1990s it was considered taboo to prescribe narcotics for non-cancer patients, but Evans said that changed when an aggressive marketing campaign convinced many doctors to write more narcotics prescriptions for all kinds of chronic pain.

"It's taken us from the mid-1990s until the last few years to recognize the downside of this, which is inadvertent addiction … and high rates of inadvertent opiate-related deaths even prior to fentanyl coming on the scene."

Evans believes opiates have a role in controlling pain but advises that all non-narcotic options should be tried first and all patients should be screened for risk factors before a narcotic trial.

"That's not happening," he said.

"What we're seeing in the data is no screening," he said. "Tylenol 3s — doesn't work, Percocet — doesn't work.

"We get into all sorts of combinations of narcotics and people just carry on and then they're exposed and then they're at risk for a fentanyl event."

Evans worries that drug dealers won't stop with fentanyl, which is 50 to 100 times stronger than morphine.

"There are other ones beyond fentanyl that we use ... that are cousins of it which are even more potent," he said.

"I think once they get the handle on fentanyl these guys will start to make the other one which is sufentanyl which is even more potent."