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Prescription painkiller deaths continue to rise

Toronto researchers and doctors propose solutions

Toronto, August 24, 2011

Dr. Irfan Dhalla Dr. Irfan Dhalla

By Leslie Shepherd

Fatal overdoses from prescription opioids are increasing in many countries, especially the United States and Canada. This increase has occurred at the same time as a dramatic increase in opioid prescribing for chronic non-cancer pain, say researchers and doctors at the Institute for Clinical Evaluative Sciences (ICES) and St. Michael’s Hospital.

“We believe physicians and regulatory authorities should take a multifaceted approach to reduce opioid-related harm, and do so in a way that will not compromise access to prescription opioids for people who do stand to benefit,” says Dr. Irfan Dhalla, lead researcher.

In a peer-reviewed article in the British Medical Journal, the researchers say the evidence supporting the use of opioids in chronic non-cancer pain is weak. There are no randomized controlled studies supporting the use of long-term treatment with opioids and large observational studies suggest that opioids are associated with more harm than non-opioid alternatives.

In the US, deaths involving opioid painkillers increased from 4,041 in 1999 to 14,459 in 2007 and are now more common than deaths from skin cancer, HIV and alcoholic liver disease. In Ontario, more than 300 people die each year from opioid overdoses.

The researchers suggest a multifaceted approach to tackle the crisis here in Canada:

  • Changes to the way opioids are marketed. Health Canada should review all promotional material before it is disseminated. Fines should be large enough to deter inappropriate marketing. Bonuses for pharmaceutical sales representatives should be prohibited for potentially addictive medications.
  • High-dose opioid formulations should be withdrawn, as per the recommendations from the recent Coroner’s inquest in Brockville.
  • Physician organizations and governments should develop educational material independently of the pharmaceutical industry. This material should include information about non-opioid alternatives as well as information about how opioids can be prescribed safely.
  • Real time electronic databases, such as the one that has been proposed in Ontario, should be implemented as soon as possible. It should become the norm for physicians and pharmacists to check these databases before prescribing and dispensing opioids respectively.
  • Physicians should be asked to register with their provincial college or an alternative authority when prescribing opioids in doses that exceed the recommendations of clinical practice guidelines.
  • Health Canada should require pharmaceutical companies to conduct long-term clinical trials to determine where the risk: benefit ratio is favourable and where it is not.