Pubdate: Fri, 03 Mar 2017
Source: Edmonton Journal (CN AB)
Copyright: 2017 The Edmonton Journal
Author: Hazel Magnussen
Page: A12


Complex problems call for multi-faceted solutions, Hazel Magnussen

Canada faces a major public health crisis as people continue to die
from opioid overdoses. Measures to save lives present new challenges
and divert attention from preventive measures to tackle the problem's
root causes.

According to Dr. David Jurlink, head of clinical pharmacology and
toxicology at Sunnybrook Health Sciences Centre in Toronto, increased
prescriptions for narcotic pain killers contributed to the crisis.
Once prescribed only for acute pain, narcotic pain killers were being
used for chronic pain until "the culture of prescribing opioids began
to shift." Patients who become addicted to prescription medications
may resort to illicit street drugs. (CBC News, Dec. 24, 2016).

In British Columbia, fentanyl, a deadly synthetic opioid caused 914
overdose deaths last year, almost 80 per cent higher than those
recorded in 2015 (Globe and Mail, Feb. 2, 2017). Fentanyl and its more
potent form, carfentanil, which may be laced with other drugs, can be
ordered online from suppliers in China. In Alberta, according to the
Opioids and Substances Misuse Alberta Report, in 2016, 343 individuals
died from an apparent drug overdose related to fentanyl (including 22
cases where carfentanil was involved). From Jan. 1, 2014 to Dec. 31
2016, quarterly opioid dispensations from community pharmacies
increased by 23 per cent.

The issue of opioid abuse warrants in-depth analysis and a coordinated
response that includes better access to other forms of pain
management, to opioid addiction treatment, and public education
regarding the risks associated with opioids and illicit drugs. For
example, a tiny amount of the more potent carfentanil, a tranquillizer
for large animals, can be lethal. Persons attending to overdose
victims are at risk if they have contact with the powder.

A national conference bringing together government officials, medical
experts and concerned citizens in November 2016 recommended a national
strategy to address the growing crisis. Health Minister Jane Philpott
committed support for more supervised safe injection sites. Political
leaders from British Columbia called for crackdowns on fentanyl
exports from China and requested more resources for the RCMP and
Canada Border Agency.

Preventive measures have been overshadowed by an emphasis on naloxone,
an antidote for opioid overdoses, which is being administered by
paramedics, police officers, family members or others encountering an
overdose victim. While naloxone saves lives, overdose survivors
receiving naloxone may be left with brain damage.

B.C. paramedics, physicians and neuroscientists are drawing attention
to these possible adverse consequences of administering naloxone. Even
when breathing is restored, brain damage may have already occurred if
the brain was without oxygen for more than four minutes.

Paramedic Jon Deakin points out the emphasis on naloxone does not
acknowledge the need for CPR to prevent brain damage. Dr. Del
Dorscheid, ICU physician at St. Paul's Hospital in Vancouver, reported
that he is seeing more cases of hypoxic brain injury linked to drug
overdoses (Times Colonist, Dec. 31, 2016).

In a CBC opinion column on January 29, Dr. Judy Iles and Dr. Julie
Robillard, University of British Columbia professors in neurology and
neuroethics, note that efforts to fix the fentanyl crisis with
naloxone alone will not help address the root cause of the crisis.
They warn that the arrival of carfentanil will increase the problem.
Naloxone can increase withdrawal symptoms, lead to repeated drug use,
perpetuate the cycle, and reduce the person's contact with
professional support services. Iles and Robillard recommend proactive
preventive approaches to match reactive responses with naloxone. They
also call for greater accountability for, and tracking of the naloxone
use and monitoring its impact.

Complex problems require multi-faceted solutions. Further data are
needed to fully grasp the magnitude of the opioid problem, understand
the implications of current approaches to the crisis and effectively
plan for its ongoing management.

The situation calls for greater public awareness, community support,
professional leadership and political will in addressing the many
layers of a challenge that has crept up and seemingly caught our
nation by surprise.

Hazel Magnussen is a retired nurse and author of The Moral Work of Nursing.
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