Pubdate: Tue, 19 Apr 2016
Source: Globe and Mail (Canada)
Page: A1
Copyright: 2016 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Authors: Karen Howlett & Grant Robertson

HEALTH CANADA TO EXPLORE NATIONAL PLAN TO DEAL WITH OPIOID ABUSE

Health Minister Jane Philpott has asked her staff to work on a range 
of options to address Canada's epidemic of opioid abuse, including 
setting up a national surveillance system to monitor drug overdoses.

"There's an exponential growth in the number of opioid overdose 
deaths," Dr. Philpott told The Globe and Mail. "It's one of the most 
stark examples of why we have got to find a new way forward and we 
have got to address this."

Dr. Philpott spoke to The Globe ahead of this week's special session 
of the United Nations General Assembly on the world drug problem. She 
will lead the Canadian delegation on Wednesday, when she plans to 
signal to the international community that drug policies under the 
federal Liberals will be built on a foundation of public health 
rather than law enforcement.

Dr. Philpott said she has asked bureaucrats at Health Canada to 
address gaps in the system that make it difficult for front-line 
workers to respond to the opioid crisis. This involves asking them to 
take into consideration "all possible options," including looking at 
updating guidelines for prescribing the drugs. The guidelines have 
not been updated since 2010, which puts Canada out of step with the 
United States.

A Globe investigation found that neither Ottawa nor the provinces are 
taking adequate steps to stop doctors from indiscriminately 
prescribing highly addictive opioids to treat chronic pain. And 
addiction-treatment programs are few and far between - a legacy of 
the former Conservative government's tough-on-crime policies.

The minister has not yet given Health Canada bureaucrats a timeline. 
She has asked them to examine whether British Columbia's response to 
a surge of overdoses from fentanyl and other drugs in that province 
can be adopted elsewhere.

B.C. declared a public health emergency last week - a move that 
allows officials to collect real-time data on overdoses.

Illicit fentanyl is rapidly moving east from B.C. and Alberta, where 
overdoses linked to the drug claimed 418 lives in 2015. The illegal 
form is largely a product of organized crime. The crisis has its 
roots in Canada's epidemic of prescription painkiller abuse.

Policy makers are scrambling to find a replacement for opioids to 
reduce the problem. At a conference in New York on Monday before the 
UN summit, doctors and researchers debated the merits of substituting 
other drugs that could be used as painkillers, such as medical marijuana.

Rosalie Pacula, vice-president of the International Society for the 
Study of Drug Policy, told the gathering that in U.S. jurisdictions 
where cannabis has been legalized for medical use, hospitals have 
seen a significant reduction in patients showing up in emergency 
rooms after overdosing on opioids.

"It's about a 40-per-cent decline in treatment admissions, which is 
really, really large, and something that we were confused by," said 
Ms. Pacula, who presented the new research. "Why such a big effect? 
We have to assume ... that people are substituting marijuana for 
opioids, and in doing that they are becoming less addicted to 
opioids, so there are fewer treatment admissions."

Cannabis use does not result in the respiratory deaths that opioid 
overdoses are causing because the section of the brain that controls 
respiratory function does not have cannabinoid receptors, said Susan 
Weiss, associate director of scientific affairs at the U.S. 
government's National Institute on Drug Abuse.

However, that does not mean marijuana is without its own risks and 
problems. Better data are needed to study the issue, researchers say, 
since switching one drug for another could lead to a different 
addiction, along with other unforeseen health problems, since 
marijuana is often used recreationally in conjunction with alcohol and tobacco.

Brian Emerson, a medical consultant for the British Columbia Ministry 
of Health, praised Ms. Pacula's research as "tantalizing evidence" 
that marijuana could be a safer option than opioids to treat pain. 
However, he said more work must be done from a public-health 
perspective to determine what risks are associated with increased cannabis use.

The problem with medical marijuana, the meeting heard, is the lack of 
research on the drug to indicate how it can be used. Cannabis has for 
decades been treated as an illicit substance, so the type of clinical 
trials common for pharma drugs have not been performed on it.

"We need to understand a lot more about the utility and efficacy of 
marijuana for pain. It works for some kinds of pain, but not for 
others, it works or some people, not for others," said Benedikt 
Fischer, senior scientist at Toronto's Centre for Addiction and Mental Health.

Dr. Fischer said the U.S. research is promising, but Canada needs 
more data on its own situation. 
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