The Alberta College of Physicians and Surgeons published a letter about the opioid crisis on Thursday, putting some of the responsibility on doctors.
The college said doctors helped create the crisis and now need to help solve it.
“Over-prescribing of opioid painkillers contributed to the crisis, in part because physicians were told to treat pain more aggressively, and that opioids were a safe way to do it,” the open letter reads.
“Doctors didn’t set out to do harm but we helped create the crisis, and now we need to help solve it.”
Dr. Scott McLeod, the college’s registrar, said the medical community’s understanding of opioids has changed over the years.
“Going through medical school and training, we were taught at that time that opioids were very safe and if used appropriately, you could increase the dosages. Like everything in medicine, knowledge changes over time. We learn more and more. It’s been recognized now that perhaps there are better ways of prescribing opioids.”
Scroll down to read the letter, posted in two Alberta newspapers on Thursday, or click here to read it on the college’s website.
Canada has the second-highest prescription opioid use per capita in the world, with Alberta higher than any other province.
“The onus goes on everybody in the health care system, really, but physicians are a key player in the system,” McLeod said. “We can’t ignore this problem. We have to be a part of the solution.
“Does it put a bit of pressure on physicians? It probably does, but I think it’s still important for us to have some ownership of this to try and help our patients.”
Doctors have been making changes. Between September 2016 and September 2017, opioid prescriptions dropped by seven per cent.
“These numbers demonstrate that there may potentially be a turn for the good, but we still have a long way to go,” McLeod said. “We still can’t just focus on numbers. We have to continue with that partnered approach.”
Despite the drop, there are still concerns, especially about lowering an opioid-dependent patient’s dose too fast.
“When we look at numbers about prescribing, yeah, the numbers are getting better, but at the same time, the deaths are getting worse,” Virani said.
“The harm that’s happening from opioids in total continues to rise in spite of the fact that the prescription supply is decreasing and in some ways, because the prescription supply is decreasing. It’s not to say that we shouldn’t be smarter about prescribing, but it can’t be done in isolation.”
“The college was one of the first organizations that identified prescription opioid use as a significant problem, going back over 10 years,” said Dr. Hakique Virani, a public health and addiction medicine specialist at the University of Alberta.
“Unfortunately, it didn’t pick up the amount of steam, in terms of a public health response, that it ought to have. [We] might have prevented this situation that we’re in today if we heeded their calls at the beginning.”
In the letter, the college advocates expanding access to treatment, harm reduction and overdose prevention.
“The reduction in prescribing is good but it brings risks of its own,” the letter reads. “We want physicians to prescribe based on the latest evidence and guidelines, not to stop prescribing opioids altogether, or make sudden changes in the care of individual patients to meet any numerical target.”
“The college is not saying chase numbers; the college is saying be thoughtful, be good doctors, measure risk, assess it and mitigate it,” Virani added.
He said the interventions that might have worked 10 years ago are different from ones being proposed today. He said toxic drugs are the easiest ones to traffic and thus, decriminalization and reducing stigma must be major parts of the discussion.
“[Interventions] need to be done very much in tandem with a global public health response — optimizing harm reduction, improving access to treatment, and a bigger policy issue of decriminalizing drug use, which I think is the most important intervention that we need to have done quickly.”
“We’ve done our part in creating this huge demand for opioids in the population, and now that demand is being met not so much by prescription opioids but by the elicit bootlegged fentanyls that are causing untold numbers of deaths,” Virani explained.
“We need to get rid of those incentives for the black market to make things more toxic, and that requires us not to just have a conversation about decriminalization, but really push forward with smarter drug policy quickly.”
According to an Angus Reid survey, nearly 20 per cent of Canadians say they have been prescribed opioids in the last five years.
The same survey found 67 per cent of Canadians are in favour of supervised injection sites and more than 85 per cent support compulsory treatment programs for those who overdose.
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