Pubdate: Mon, 09 Jan 2017
Source: Vancouver Sun (CN BC)
Copyright: 2017 Postmedia Network Inc.
Contact:  http://www.canada.com/vancouversun/
Details: http://www.mapinc.org/media/477
Author: Daphne Bramham
Page: A4

THE UNINTENDED CONSEQUENCE OF B.C.'S ATTEMPT TO STEM ILLICIT DRUG OVERDOSES

Doctors may reduce opiate dosage for patients suffering chronic pain

"Funny story," the email begins. What follows is anything but.

Recounted are five years of pain, suffering and a gradually increasing
prescription drug dependency, which even now is barely enough for the
storyteller to make it through the day looking after two kids.

The storyteller has a spinal injury. Surgeons initially refused to
operate; a couple of years later they determined it had been operable, but
now it was too late. The storyteller now has chronic pain that includes
tingling and burning down one arm and into the thumb and pointer finger.

Over the years, the dosage of opiates needed to control the pain has been
increased.

That leads to the punchline: Soon, the dosage may be substantially reduced
and the storyteller (who asked not to be named) forced into chemical
withdrawal.

It's not because the drug no longer works. It's because in mid 2016 the
College of Physicians and Surgeons of B.C. became the first in North
America to attempt to curb what it calls a North American crisis in
physicians' over-prescription of opioids by making its standards legally
enforceable.

The college made the change after Perry Kendall, B.C.'s medical health
officer, declared a public health emergency in April due to rising numbers
of overdose deaths from illicit fentanyl.

The college then began sending letters to physicians whose prescriptions
exceeded the enforceable standards. Deputy registrar Ailve McNestry has
said that the letters are meant to be educational, not disciplinary.

But that's not how the message has been received. It's not surprising,
since physicians can now lose their licences or be fined up to $100,000 if
they don't comply.

It's caused "mayhem" and "confusion" for both patients and physicians,
says Owen Williamson, president of the B.C. Pain Medicine Specialist
Association.

Bear in mind, an estimated 800,000 British Columbians suffer from chronic
pain due to conditions like arthritis, fibromyalgia and lupus or from
injuries. Many, like the storyteller, are dependent on opioids (in
increasingly high doses due to increased tolerance to the drugs over time)
to be able to go to work and lead relatively normal lives.

Williamson emphasized his concern for people dying in the streets of
fentanyl overdoses. But he said, "The timely access to care of one in five
British Columbians who suffer from chronic pain is now being compromised
by the college's enforceable standards."

Pain BC's executive director Maria Hudspith put it another way: "The
college has succeeded in creating a climate of fear."

And, tragically, that may actually exacerbate the fentanyl crisis because
some chronic pain sufferers may end up buying their drugs on the street.

Why? Because physicians concerned about losing their licences are reducing
patients' dosages and forcing them into chemical withdrawal. The college
has warned doctors that they can't set patients adrift or suddenly cut off
their medications, but some physicians have urged opioid-dependent
patients to find another doctor because they will no longer be prescribing
the drugs at all.

Meantime, an increasing number of physicians refuse to take new patients
who are opioid dependent, and many walk-in clinics have posted signs at
the entrance saying that their doctors cannot prescribe opiates.

All of this because the college, provincial health officer Perry Kendall,
Doctors of B.C. president Alan Ruddiman and others link the
over-prescription of opioids to overdose deaths from illicit street drugs.

But they have scant evidence of that.

They point to the United States, where physicians have been charged, fined
or jailed for knowingly over-prescribing opioids that ended up being
illicitly re-sold. But nothing similar has happened in Canada, where
opioid prescription rates are second highest in the world after the U.S.

They point to the generally agreed estimate that eight per cent of the
population is at risk of some form of addiction, but it could be an
addiction to anything from drugs, alcohol and gambling, to nicotine or
pornography.

Medical researcher Kate Smolina, who found that the long-term opioid use
in B.C. rose two per cent (about 100,000 people) between 2005 and 2012,
told Canadian Press in December that "invariably some will turn to (the
street)."

Where's the proof? Smolina responded in an email: "The quotes are
unfortunate as I didn't realize I would be cited verbatum (sic)."

"Regarding transition from filling a first opioid prescription to becoming
a chronic user to then seeking drugs through illicit means - it's a
million dollar question," she wrote.

"There is very little information available at the moment to quantify and
exactly describe that pathway."

There may well be an over-prescription problem in B.C. and Canada, but
absent any evidence that it is a factor in the illicit fentanyl overdoses
here, it raises a troubling question: Why have the one-in-five British
Columbians - from grannies to injured labourers with chronic pain - become
collateral damage or even potential victims in the illicit overdose
emergency?

This is not a funny story. Still, there is a chance of a happy ending if
the college's fear mongering leads to a separate and serious conversation
about how British Columbia fails to meet the complex needs of those with
chronic pain.

More about that in another column.
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