Are new Canadian guidelines for opioid prescribing sensible — or cruel?
Canada’s new guidelines for prescribing opioid pain medication were released earlier in the week and many questions still require answers. However, first the questions must be asked. Unfortunately, I’ve heard little of real substance.
Today, Dr. Jason Busse, of McMaster University and main editor of the guidelines, joins me in hour 1. Then, Dr. Rob Tanguay, psychiatrist and addiction specialist at the University of Calgary.
Chronic non-cancer pain can be so debilitating it may lead to suicide. Dr. Fiona Campbell, incoming president of the Canadian Pain Society and anesthetist at Sick Kids Hospital in Toronto, shared with us recently that for those chronic pain patients who end their lives, the sequence is pain-social isolation-depression-suicide.
Callers dealing with chronic pain have spoken on air about suicide being on their minds daily.
This is the extreme end of the chronic pain spectrum but should not be ignored.
I don’t doubt the professional skills and care delivered by the medical professionals engaged in creating the guidelines, but I’m quite sure that prior to the guidelines being written, the “opioids are bad” message was constant.
There are questions about the recommendations within the guidelines. One such recommendation is that an entire team of medical professionals be assigned to chronic pain sufferers in order to wean them from opioids and deliver non-opioid alternatives. The teams would consist of “several health professionals whom physicians can access according to their availability (possibilities include, but are not limited to, a primary care physician, nurse, pharmacist, physical therapist, chiropractor, addiction specialist, psychiatrist and psychologist [among others]).”
Seriously? In Canada, more than 10 per cent of the population has no access to a family doctor. Now, suddenly this myriad of specialists will be available to individual patients? Of course, the guideline covers that base somewhat with the words “according to their availability.” And if none are available? If the patient has no primary care physician (more than 1 of 10 Canadians), then what? A public health clinic? A hospital E.R.? Please!
The guidelines also include “the use of opioids for chronic non-cancer pain is accompanied by significant risks. In Ontario, annual admissions to publicly funded treatment programs for opioid-related problems doubled between 2004 and 2013, from 8,799 to 18,232.” My question: are these all chronic pain patients prescribed opioids, or do the numbers include drug addicts who have no chronic-pain issue but seek out and abuse opioids?
Another quote from the guidelines: “Overall 1 of every 550 patients started on opioid therapy in Ontario died of opioid-related causes a median 2.6 years from his or her first opioid prescription.” That means 549 of 550 did not die of opioid-related causes in that median time frame.
Perhaps I’m misreading and/or misunderstanding material contained in the guidelines. What I do know is that I’m not misunderstanding the horror of chronic pain. My wife suffered from such massive and quality-of -life-shattering pain prior to her cancer battle. The pain was caused by a serious back injury. Doctors were even then (more than 10 years ago) leery of providing her with opioid pain relief, even though she herself was a medical professional. I would see tears, but not a complaint. She would simply lie down and suffer.
If a medication is available to a patient and that medication makes life bearable, then in my view and in the view of chronic pain sufferers I’ve spoken with, let the patient decide what she or he requires. There are likely many, many thousands of Canadians whose lives are made bearable through opioid use. As for addiction? Where the sole outcome of opioid use is quality of life improvement, should we really care if they “need” their meds?
There are stories of children dying of cancer for whom physicians are reluctant to prescribe morphine, Oxycodone and other available opioids. Why? They fear the children will become addicted.
When you have a moment, visit U.S. radio talk show host Dennis Prager’s website and read his blog post about the suicide of his stepson’s father. It will break your heart.
Roy Green is the host of The Roy Green Show and a commentator for Global News.
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