This isn’t the first slew of suggestions on how to tackle Canada’s “crisis” in prescription opioid misuse. But many hope it’ll be the last.
A report released Wednesday by the Canadian Centre for Substance Abuse culminates a year-long mind-meld of people representing almost every group in the country with a stake in stopping painkillers from creating addicts, drug dealers and deaths.
The dozens of suggestions and sub-clauses include:
- Changing labels on prescription opioids – this might make prescribers more cautious but would also restrict how pharmaceutical companies can market them.
- Adding a layer of scrutiny when physicians prescribe these drugs – for private insurers as well as public ones.
- Making more medications harder to crush and abuse.
- Making it easier for addicts to get treatment: Across the country, methadone programs are full or simply inaccessible to people outside big cities.
- Requiring researchers and drug companies to publish all data from clinical trials.
Crucially, the report notes, everyone involved – governments, doctors, pharmacists, police – needs a better sense of what’s going on. It goes as far as suggesting loosening Canada’s privacy legislation to allow more information to be shared.
Canada used to have a national drug monitoring system, but it was dismantled in the mid-1990s. Some provinces collect some information, but not in a comprehensive or standardized way.
“Health Canada’s ability to detect and prevent the diversion of prescription drugs needs to be strengthened,” the report reads.
The wide range of recommendations was designed to “truly scrub through this entire problem,” says Michel Perron, head of the Centre for Substance Abuse. “It’s long overdue, in terms of a national strategy.”
They were also designed to gain the endorsement of everyone involved. And, of course, none of these is binding. “There’s a moral suasion argument here,” Perron says.
That makes some skeptical. “I’m all for constraints,” says David Juurlink, a doctor at Toronto’s Sunnybrook Health Sciences Centre. “I just think that people are going to scream bloody murder if that’s what is recommended. He predicts provinces “would balk” if asked to add an extra step for anyone who wanted to prescribe powerful painkillers. “It would be highly unpopular.”
At Wednesday’s announcement in Ottawa, Health Minister Leona Aglukkaq said prescription drug abuse is “an issue we all have a responsibility to address. No one group can solve this issue.” She said she’s looking at the recommendations, but wouldn’t say whether she’ll implement any.
Aglukkaq has come under fire from some in the medical community for not taking more proactive steps to curb the growing issue of opioid addiction, especially when Health Canada approved the sale of generic OxyContin last fall.
“I cannot make decisions on whether a product should be on the market or not based on what’s happening on the street,” Aglukkaq said Wednesday. She added that Health Canada is “doing work around” warnings and adverse effects on drug labels.
Pharmaceutical companies aren’t allowed to advertise their drugs for off-label uses, so narrowing directives on labels (to only include palliative or cancer pain, for example) would mean they couldn’t market them for any other use.
Some argue that policy of non-interference doesn’t hold.
“I don’t get the whole, ‘Our hands are tied’ argument, ’cause that’s what the whole point is,” Dhalla said. “I think most people who’ve thought about this carefully think the regulatory regime has failed.”
In 2009, a working group based out of McMaster University’s National Pain Centre came out with national guidelines for opioid prescribing; in 2011, the civilian jury at an inquest into two overdose deaths in Brockville, Ont. came out with dozens of recommendations. Neither produced the sea change addiction experts are hoping for; overdose deaths and overall prescription rates continued to climb.
But Perron insists this latest set of recommendations is different.
“This is about keeping people’s feet to the fire, making sure we’re all working on the same page and learning the various lessons so we don’t have another Brockville in, say, Winnipeg.”