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Posts Tagged "opioids"

17Oct

Fewer B.C. residents were prescribed opioids last year: report

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Fewer people in B.C., Saskatchewan and Ontario were prescribed opioids last year compared with 2013 and the number of patients who began treatment on the pain medication decreased by nearly 10 per cent, the Canadian Institute for Health Information says.

The institute said in a report released Thursday that eight-per-cent fewer patients, or about 220,000 people, in those provinces are taking prescription opioids while about 175,000 fewer people were started on the drugs.

Patients who began taking opioids were prescribed smaller doses for shorter duration and when it came to long-term opioid therapy, fewer people were prescribed the medication for a period of 90 days or longer before sometimes being switched to other types of drugs to manage pain, the agency said.

It said initiatives including national prescribing guidelines introduced in 2017, along with prescription-monitoring programs to help reduce harms related to the overdose crisis, likely influenced prescribing trends.

“Despite overall decreasing trends in the prescribing of opioids, opioid-related harms and deaths have continued to rise across the country in recent years,” the report says.

Michael Gaucher, director of pharmaceuticals for the agency, said only the three provinces provided complete data for opioid prescribing for the six years covered in the report but they represent a large portion of Canada’s population.

Some chronic-pain patients have been concerned about being cut off opioids they need, and Gaucher said that is a valid issue to consider because opioids are an effective treatment.

“The concern with prescription opioids goes deeper than the person (taking them) and there can be others in the household that can access them,” he said.

Dr. Norman Buckley, scientific director of the Michael G. DeGroote Institute for Pain Research and Care at McMaster University in Hamilton, said “it’s unfortunate” that data for Quebec and Alberta, for example, couldn’t be included in the report.

He said doctors in Quebec generally prescribe fewer opioids than other provinces and are known for getting a substantial amount of education on pain management while physicians in Alberta and B.C. have access to real-time prescription monitoring systems for patients.

“You could make the argument that having a concerted pain strategy actually also leads to less reliance on opioids,” he said from Hamilton.

Buckley, who often treats pain patients referred to him by other doctors, said it’s important for patients to know they need to be tapered off opioids slowly.

“It’s about correct prescribing or optimal prescribing rather than trying to drive the dose down. What you need to be looking at are things like measures of function, and those typically don’t come through on large-scale administrative health data,” he said. “You can’t tell, if people’s doses came down, did they stop going to work, for example, or did they start relying on more assistance for home care?”

Buckley said one of his patients, a man in his late 50s, had been prescribed opioids for 10 years due to a variety of workplace injuries but decided to taper off due to his concerns about long-term use. His dosage was gradually reduced over a year-and-a-half, Buckley said, adding his pain wasn’t any better but his “mental energy” improved somewhat.

“He also finds he’s edgier than he was so his wife has been in once or twice to say, ’Look, he gets grumpy a lot more than he used to but he’s probably a bit more mentally active.’ ”

The patient also received physical therapy, one of the ways the national guidelines advise doctors to treat pain beyond opioids, but many provinces don’t cover such costs, Buckley said.

“A lot of people don’t have that. This is one of the push-pull parts (of the issue). Optimal pain management includes more than medications. It includes education, sometimes cognitive behavioural therapy and exercise,” Buckley said. “But a significant portion of the country can’t access those through their provincial health-care systems.”

Buckley suggested all provinces provide complete opioid prescribing data to the Canadian Institute for Health Information so a fuller picture of what’s happening across the country is available.

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27Jun

Thousands of tabs of addictive opioids stolen from VGH last year

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Over 2,000 doses of opiates were stolen from Vancouver General Hospital by staff last year, according to documents obtained through a freedom of information request.

Over 1,600 tabs and 853 millilitres of hydromorphone were reported stolen from the hospital in two unrelated incidents last January.

“The diversion or misuse of narcotics is rare,” spokesperson Matt Kieltyka explained in an email to Postmedia. “Vancouver Coastal Health takes this issue seriously and has several systems in place to ensure narcotics are dispensed and accounted for as prescribed.”

Kieltyka said staff were involved in both instances, but he was not able to give details on what disciplinary measures were taken.

Such theft, known as “drug diversion,” has been a rising concern in recent years.

Data from Health Canada shows 13,221 doses of opioids were reported stolen from medical facilities in 2018.

Over 3,200 of those were in B.C., which is more than any other province except Ontario, where over 9,700 were taken.

Theft of hydromorphone, which is sometimes sold under the name Dilaudid, jumped sharply in B.C. between 2017 and 2018, according to Health Canada data, with 3,211 units stolen in 2018 compared to just 12 the year before.

Mark Fan, a researcher at North York General Hospital who studies drug diversion, said data on stolen drugs is likely incomplete and that rates of diversion as “probably underestimated.”

“At any point in the medication use process, it’s possible for it to be transferred away from legitimate use,” said Fan.

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He said diversion usually occurs when a staff member manipulates documentation or falsifies prescriptions to over-order medication. They also may physically steal the substances.

In such cases, the theft may not be discovered until an audit is conducted.

Drug diversion made headlines in 2015 after a VGH aide overdosed on stolen opiates. Since then, Vancouver Coastal Health and the Provincial Health Services Authority have adopted measures that Kieltyka said include “dispensing machines, vaults, locked cabinets and security cameras.”

The authority says they have also piloted use of “containers that contain a solution that renders the drugs unusable” at two units within Vancouver Coastal Health and may implement them province-wide.

Const. Steve Addision with the Vancouver Police Department says hydromorphone is fairly common in the city’s illicit drug market, and that a 2-mg pill usually sells for around $10.

But the major driver of diversion is addiction.

Dr. Shimi Kang, an addictions psychiatrist who has worked with hospital staff involved in drug diversion, said workplace stress and access to potent opioids creates a “perfect storm” for substance use.

“We have to recognize that healthcare practitioners are human too,” she said.

She said nurses often face high levels of stress and violence in the workplace and that adequate sleep, time off and support are the best ways to prevent addiction.

“We get so caught up in being the healer that we forget to heal ourselves,” said Kang.

Dr. Mark Haden, a professor at the UBC School of Population and Public Health and a supervisor with the B.C. Centre on Substance Use, said it shows the indiscriminate nature of addiction.

“Being employed by the system does not protect one from addiction,” he said.

Hydromorphone is sometimes used in opiate-replacement therapy as a substitute for stronger street-level drugs. Last month, Canada became the first country in the world to approve use of injectable hydromorphone in treating opioid use disorder.

Haden said making the drug legally accessible could prevent thefts — and deaths.

“If hospital staff who are also addicted to opiates had (open) access to them, they wouldn’t steal them,” he said. “I think the solution to the fentanyl crisis and people stealing from hospitals is the same.”

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1May

Daphne Bramham: Alcohol, not opioids, is Canada’s biggest drug problem

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Alcohol is so much a part of our culture that 80 per cent of Canadians drink. But each year, nearly 15,000 people die from alcohol related harms.


Canadian governments are addicted to the revenue from alcohol


DALE DE LA REY / AFP/Getty Images

With so much focus on illicit drugs and overdose deaths, it might seem that opioids are the biggest addictions problem. Far from it.

Alcohol kills many more people each year (14,800 in 2014), results in more hospitalizations annually than heart attacks and is one of the most expensive and intractable health problems.

While cannabis was legalized a year ago and B.C.’s chief medical health officer is pushing hard for decriminalization and ultimately legalization of all illicit drugs, two Canadian addictions research centres want tougher regulations to mitigate the costs and harms of alcohol use and addiction.

The Victoria-based Canadian Institute for Substance Use Research and the Toronto-based Centre for Addiction and Mental Health want a minimum price of $3.50 for a standard drink in a bar or restaurant and $1.75 for off-premise sales. They also want a national minimum drinking age of 19, which is a year higher than national minimum for cannabis. Those are just two of the recommendations in reports they released last month that look at federal, provincial and territorial alcohol policies.

The reports also calling for stricter guidelines for advertising, restrictions on manufacturers’ and retailers’ promotions on digital and social media platforms, and a federal excise tax based on alcohol content that would replace the GST.

Over the past decades, the researchers found an erosion of effective policies and regulations.

“Overall, alcohol policy in Canada has been largely neglected relative to emerging initiatives addressing tobacco control, responses to the opioid overdose crisis, and restrictions imposed on the new legal cannabis market,” their report on the provinces and territories says. In several jurisdictions — Ontario is the worst example — “customer convenience and choice are being given priority over health and safety concerns … the responsibility of governments to warn citizens of potential risks is largely absent.”

British Columbia got a bare pass at 50 per cent based on its potential to reduce alcohol-related harm, which is not good. But it’s still better than the national average of 43 per cent.

Alcohol-related harm was estimated at $14.6 billion in 2014, according the Canadian Centre on Substance Use. Productivity loss due to illness and premature death accounts for $7.1 billion. Direct health care costs add another $3.3 billion and $3.1 billion is spent on enforcement costs for this legal drug.

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Tobacco was second at $12 billion followed by opioids at $3.5 billion and cannabis at $2.8 billion. But the data predate the opioid overdose crisis and cannabis legalization.

Alcohol’s costs and harms reflect the fact that 80 per cent of Canadians drink. It’s not surprising. Culturally, we associate drinking with celebrations and good times. It’s We’re bombarded with images in movies, TV and ads of beautiful people drinking and having fun.

Scarcely a week goes by that there isn’t a “good news” story about research showing that a glass of red wine might be good for your heart or that yet another populist politician is campaigning on a promise to slash the price of beer.

Yet less was made of University of Washington’s Global Burden of Diseases Study last summer that found alcohol was the leading factor in 2.8 million premature deaths in 2016 and is so harmful that governments ought to be advising people to abstain completely.

One problem is that Canadian governments are addicted to the revenue from alcohol. Liquor sales and taxes provided $12.15 billion to federal and provincial governments in 2017/18 — $1.6 billion more than five years earlier, according to Statistics Canada.

Last year, liquor consumption rose in British Columbia, which already had the highest drinking rates in Canada. There were also record sales, which meant that in addition to tax revenue, the Liquor Distribution Branch provided $1.12 billion in earned revenue, up from $1.03 billion two years earlier.

Good for taxpayers? Not really. The reports by the substance-abuse centres recommends B.C. “reconsider the treatment of alcohol as an ordinary commodity: Alcohol should not be sold alongside food and other grocery items as this leads to greater harm.”

It’s based on research done last year by Tim Stockwell of the Canadian Institute for Substance Use Research. He and his researchers found that when access to alcohol is easier, more people die.

Between 2003 and 2008, “a conservative estimate is that the rates of alcohol-related deaths increased by 3.25 per cent for each 20 per cent increase in stores density.”

Estimates have to be conservative because alcoholics’ fatalities are mistakenly counted as death from one of more than 200 other kinds of alcohol-related fatalities including car accidents, suicide, liver diseases, cancers, tuberculosis and heart disease.

What’s surprising is that more than a century after legalization, there are no federal or provincial policies aimed specifically at mitigating alcohol’s harms and costs.

The opioid crisis has been the catalyst for governments to finally think about addictions and drug-use policies and, it’s now impossible to ignore the slower moving crisis caused by alcohol abuse and addiction.

In the coming months, the B.C. health officer also plans to release an alcohol addictions report. The B.C. Centre on Substance Use recently developed guidelines for best practices in treating alcohol addiction, but the provincial government has yet to approve or release those.

Prohibition proved a failure. Yet, legalization and regulation are not panaceas either. Because even with more than 100 years of experience, there is still no jurisdiction in Canada or anywhere else that seems to have got it right.

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Twitter: @bramham_daphne


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