Doctors must help remedy opioid crisis in Canada, CMA meeting hears

Canada's opioid epidemic isn't a single crisis but a complex set of overlapping crises that will take multiple strategies to solve, a panel of experts told the annual meeting of the Canadian Medical Association.

"This is a crisis for Canada and every community is going to have to deal with it," Dr. David Milne, a Calgary-based anesthetist told about 1,200 delegates attending the CMA meeting in Quebec City on Tuesday. 

"As a profession, we must accept responsibility for this and help to remedy it," said Milne, referring to the long history of
physicians overprescribing opioids to manage patients with chronic pain.

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Dr. David Juurlink, head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto, said the medical community was misled in the 1990s by drug makers about the potential harms of opioids, including U.S.-based Purdue Pharma, which claimed its slow-release drug OxyContin posed little danger of addiction, even with long-term use.

From a prescribing perspective, "we have to do things differently," said Juurlink. "We have an entire generation of docs
who've just come to view opioids as our go-to drugs for patients with pain," despite a paucity of scientific evidence supporting their effectiveness and with growing awareness of their potential harms.

"We need to prescribe these drugs much less readily for both acute and chronic pain than we have," he stressed.

But it isn't only pain patients taking the powerful medications that are at risk. Illicit opioids such as fentanyl have been flooding into Canada over the last two years, putting anyone who uses illicit drugs at risk of a fatal overdose.

"There has never been a more dangerous time to purchase drugs on the street because of the profusion of fentanyl and several dozen [opiate] analogues of various potencies," Juurlink said.

'People die less when you bring them inside'

In B.C. alone, 967 people died of an opioid-related overdose last year and the province is on track for more than 1,500 such deaths in 2017, said Dr. Christy Sutherland, a family physician who treats patients in Vancouver's Downtown Eastside.

"My patients don't want to die and they live in daily fear of death," she said. "When you use, each time because of the contaminated market of drugs in B.C., you're worried that you're going to die."

While the ultimate goal may be to help those addicted to opioids to get off the drugs through treatment with the replacement medications methadone or Suboxone, Sutherland said the immediate focus is on preventing people dying of an overdose after unwittingly taking a street drug laced with fentanyl.

"So my job is to keep them safe," said Sutherland, who is involved with several harm-reduction programs, including Vancouver's supervised-consumption site INSITE.

"You want drug users to feel welcome whatever program you are creating and then you want to target marginalized populations who are not engaged with the health-care system and for whom treatment is not an immediate realistic option," she said.

"People die less when you bring them inside and when you attach them to medical care. …That's the outcome that we should be concerned about as physicians — not what it looks like to the public."

Milne said all the opioid-related deaths that have occurred represent an "extraordinary loss" on their own, but each one also represents "many more Canadians that use, misuse and abuse opiates on a regular basis or even an episodic basis."

"And we should never lose track of the fact that people involved in this epidemic are our family, our friends and our neighbours," he said. "And they all require the same respect and empathy to deal with this, as it is a significant health problem."