Pubdate: Mon, 26 Jun 2017
Source: Globe and Mail (Canada)
Copyright: 2017 The Globe and Mail Company
Author: Camille Bains
Page: S2


Desperate for relief from unbearable pain following knee surgery,
Lorna Bird says she was forced to buy drugs from the Downtown Eastside
streets of Vancouver when her doctor stopped prescribing an opioid in
response to new standards aimed at preventing fatal overdoses.

"I started with heroin because I couldn't stand the pain," Ms. Bird
said, recalling her fears about dying from fentanyl-laced street drugs
because "everybody was croaking" and she didn't want her grandchildren
dealing with that outcome.

Ms. Bird, 60, said the prescription opioid hydromorphone, which is
five times more potent than morphine, numbed the pain after her
surgery in December, 2014, but her doctor tapered off the dosage
before stopping it despite her continuing pain.

Experts say Ms. Bird is among thousands of Canadians facing the
predicament of getting pain-numbing street drugs after being weaned or
taken off opioids to which they've become addicted.

Ms. Bird said concerns about contaminated heroin had her spending $100
a day on cocaine instead, but she tries not to use it alone because
she worries about overdosing if the powerful painkiller fentanyl has
been added to anything she buys on a street corner.

Ms. Bird recalled a conversation with her doctor: "I told him, 'I'm
shooting up powder now, cocaine, because that's what kills the pain.'

She said he cited standards by the College of Physicians and Surgeons
of British Columbia for his decision before resuming a much lower dose
of hydromorphone, along with methadose.

Ms. Bird said she continues taking both drugs but they're not enough
to deal with her pain, so she also injects cocaine.

Benedikt Fischer, a senior scientist at the Toronto-based Centre for
Addiction and Mental Health, said between 500,000 and one million
Canadians are addicted to opioids because doctors have overprescribed
the narcotics for years.

Updated prescribing guidelines released last month by the National
Pain Centre at McMaster University in Hamilton call on physicians to
limit dosages of drugs such as hydromorphone, oxycodone and the
fentanyl patch to the equivalent of 90 milligrams of morphine a day.

The centre also recommended physicians taper off medications or even
discontinue the drugs that could lead to dependence with long-term

"The new guidelines are basically an attempt to turn around a huge
freighter ship that's moving in one direction, and now we're doing a
180-degree turn," Dr. Fischer said, adding a "catastrophic" number of
deaths could result if more patients resort to taking street drugs.

"All of a sudden they're dropping all these patients or cutting them
off their opioids," he said of doctors who prescribed excessive
amounts of narcotics for chronic, non-cancer pain.

"I see more people dying," he said.

Evan Wood, director of the BC Centre on Substance Use, said the opioid
crisis demands a two-pronged approach - one to deal with patients
who've become dependent on the narcotics and another for people who
have never been prescribed the narcotics but need pain management.
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