Pubdate: Sun, 09 Jul 2017
Source: Victoria Times-Colonist (CN BC)
Copyright: 2017 Times Colonist
Page: A10


A new window has opened on the epidemic of overdose deaths engulfing
our province. It is being alleged in the U.S. that some manufacturers
of opioid drugs misled physicians about the addictive power of these
medications. Several states, including Ohio, are suing pharmaceutical
firms on that basis. They claim physicians were told that later
generations of opioids such as oxycontin - a powerful painkiller -
were much less addictive than earlier versions. In 2012 alone,
pharmacies in Ohio dispensed 790 million opioid pills.

There have also been allegations in the U.S. that drug distribution
companies knowingly sold opioids to shady pharmacies that dispensed
medications without proper precautions.

These developments are important for two reasons. First, opioids such
as oxycontin are highly addictive, assurances to the contrary
notwithstanding. Second, there is substantial evidence that patients
who become addicted to oxycontin and other potent painkillers
sometimes move on to illicit fentanyl.

We tend to think of overdose victims as street users with long-term
drug habits. But research published by the B.C. Centre for Disease
Control shows that about half of all overdoses, provincewide, occur in
private residences.

That led provincial health officer Dr. Perry Kendall to note that many
of those dying at home are not stereotypical drug users, but
professionals and parents. It's a reasonable presumption that at least
some of these victims began their addiction after receiving an opioid
prescription from a GP.

That's why those lawsuits south of the border are so concerning. They
point to a concerted effort by big pharma to mislead physicians into
prescribing more of their product.

So has this happened in Canada? Apparently, it has. Published research
suggests that one of the companies sued by Ohio sponsored
pain-management lectures at the University of Toronto's medical
school, where the addictive qualities of medications were repeatedly

What about B.C.? There are mixed opinions within our medical community
as to the extent of misleading marketing here. Certainly, we have
tougher rules than some American states as to the tactics that are

However, some authorities believe it's likely that corporate sales
techniques have played a part in boosting opioid use here. And our
prescribing rates might back that up. In 2015 - the most recent
figures - opioids were the second most commonly used class of drug in
the province.

According to the Canadian Institute for Health Information, a stunning
452,718 patients received an opioid prescription that year. That's one
in 10 British Columbians.

It's impossible to say with precision how many doses this amounts to.
Some patients might be on the drug for only a few days. Others might
be on it all year.

However, we are likely talking about tens of millions of doses, some
of which inevitably leak onto the street.

To be fair, the oversight body for doctors in B.C., the College of
Physicians and Surgeons, is aware of the risks. Tough guidelines have
been issued, backed up by fines as high as $100,000 for doctors who
don't comply. That has likely reduced the volumes being prescribed.

But the question remains: Has enough been done to persuade physicians
that they should change their approach to managing chronic pain?

With an epidemic of opioid deaths sweeping B.C. (and North America
generally), the answer appears to be no.
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