TORONTO, November 7, 2016 - We like to boast when Canada is declared number one in the world at anything. This is not one of those times.
Canada has the highest rate of opioid use on earth. In Ontario, where opioid use is highest, the rate of prescription dispensing is five times what it is in the United Kingdom. There is no suggestion that Canadians suffer from five times as much pain, so how did we get to this?
As the just-released CAMH Prescription Opioid Policy Framework states, it is a made-in-Canada crisis.
“Opioids are being prescribed too frequently, at overly high doses and quantities, for longer periods of time than medically necessary, and in contexts that are not supported by evidence,” the CAMH Prescription Opioid Policy Framework states. But reducing the rate of opioid prescriptions, while vital, is only part of the solution.
Equally vital is a robust commitment to increased addiction treatment and scaled-up harm reduction strategies to keep people dependent on prescription opioids from turning to more powerful and dangerous street drugs like heroin and fentanyl. Otherwise, “the risk is that well-intentioned opioid policy can actually increase opioid-related harm.”
Recommendations from the CAMH opioid framework include:
- Implementing best practices for pain treatment and opioid prescribing. This includes improving access to non-opioid pain management options and ensuring that prescribers are using updated opioid prescription guidelines for chronic pain.
- Continuing modernizing Ontario’s addiction treatment system. The full range of evidence-based therapies should be available across the province, and addiction treatment should be integrated into primary care and community settings.
- Scaling up harm reduction services. In addition to continued government support for naloxone, needle exchange services and supervised consumption sites, the federal government should pass “Good Samaritan” legislation and reinstate harm reduction as a pillar of the Canada’s drug strategy. Under the previous government, oversight of the drug strategy was transferred from Health Canada to the Justice Department, and 70 per cent of its budget was spent on law enforcement. Health Canada should once again take the lead re-commit to an approach to substance use that treats it as a health issue, not a criminal one.
Dr. Peter Selby, CAMH’s Director of Medical Education, contributed his expertise to the CAMH opioid framework. He believes that just as public policy decisions in Canada over the past two decades have precipitated this crisis, sound and sensible policy decisions can help reverse the damage.
Doing a better job of educating doctors in all aspects of pain management is a key part of that.
“The problem is that even if you train them in pain management but you don’t train them in addiction, they won’t recognize when things are going off,” says Dr. Selby. “We need a continuing education program.”