Pubdate: Tue, 07 Nov 2017
Source: Toronto Star (CN ON)
Copyright: 2017 The Toronto Star
Authors: Cara Vaccarino and Joe Manget
Page: A13


Canada's response to the opioid crisis has been fragmented and
marginally effective at best. We deserve a better approach, and the
answers are out there. Other countries are effectively dealing with
the issue and Canada should be more open to learning from them. There
are several key steps we can take to ensure Canadians with addiction
can lead healthier, happier and more productive lives.

First, we need to recognize this is actually a crisis. Do you remember
SARS and how it impacted every Canadian with a focused response from
our public health teams? Forty-four Canadians died from SARS. How
about AIDS at its peak in 1995? We all were aware of the crisis and as
Canadians we worked together diligently to help. That year about 1,400
people died from AIDS. Compare this to over 2,400 Canadians dying from
opioid overdoses in 2016 and the number likely to double in 2017.

Why are we not treating this as a crisis? Is the life of an opioid
addict worth less? Our governments have taken some steps to recognize
the seriousness of the issue but we have a long way to go. In the
meantime, thousands more of your neighbours, co-workers and family
members will die.

Second, we need to accept that addiction is a chronic disease, not a
moral failure. Diabetes is also a chronic disease, often brought on by
poor choices of diet and lack of exercise as well as genetics. We
provide diabetics with the right health care services and education to
effectively treat this chronic disease, and we have programs to
prevent or postpone the onset of diabetes.

Why is addiction treated differently? Ten per cent of our population
has an addictive tendency, 1 per cent of which will become seriously
addicted to drugs or alcohol. The good news is that by recognizing
that addiction is a chronic disease, we can effectively treat the vast
majority of addicts.

Third, we need a concerted and unified effort to effectively treat
addicts with a long-term goal of abstinence. We must recognize that to
effect change, we need to engage addicts to accept their chronic
disease and make the right lifestyle and social choices to live drug
or alcohol free. It can be done and abstinence is a very achievable
and worthwhile goal.

Our experience suggests that well over 90 per cent of addicts can be
abstinent over time, with a mix of outpatient psychological
interventions such as cognitive behavioural therapy and in-patient
treatment. There are multiple Canadianmade digital tools such as Wagon
( to help these addicts stay abstinent.

Safe injection sites are an admirable effort, but they do not address
the longer-term addiction issues. Notably, countries such as Portugal
(held up as a world leader in addiction treatment) do not use
supervised injection sites, as they prefer to deal with the core
issues of addiction. Portugal seamlessly balances harm reduction and
abstinence to achieve wellness for all patients and as a result has
one of the lowest societal costs of addiction in the world.

Fourth, we need to understand the root cause of the crisis. The recent
spike in deaths is widely attributed to the increased availability of
fentanyl, which is up to 100 times more potent than heroin and is
increasingly mixed with a variety of street drugs. We have programs
underway to deal with the importers and distributors of this deadly
compound, but that is not enough.

Most health-care experts agree that the root cause of most opioid
addiction is over-prescription of pain management drugs. For example,
in June one of the authors had a cycling accident and suffered a
fractured pelvis. He was in some pain but thought it manageable.
Without even asking, the attending emergency room physician prescribed
a highly addictive opioid.

Think about this happening tens of thousands of times each day,
knowing that10 per cent of us have the tendency to become addicts.
Unnecessary exposure to these opioids can lead to addiction and the
seeking of higher and higher "highs," ultimately leading to heroin and

To break this cycle is simple - we enforce strict prescription
guidelines for any opioid. There is at least one Canadian company that
has developed clinical decision support software that can prevent
improper prescribing of opioids.

Canada has a terrific health care system and our political leaders all
want to do the right thing. With focus on the right areas, we can
prevent thousands of deaths.

Isn't it worth the effort?

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Cara Vaccarino is chief operating officer of Edgewood Health Network. 
Joe Manget is chairman and CEO of Edgewood Health Network.
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MAP posted-by: Matt