'Breaking Bad is the reality': Canada’s opioid crisis is worsening, conference hears

[guest]

Canada’s opioid crisis is worsening and health professionals and policymakers are scrambling for a solution, a packed audience at an opioid conference in Ottawa heard Friday morning.

The invitation-only conference, chaired by Federal Health Minister Jane Philpott and her Ontario counterpart Eric Hoskins, was organized to address the increasing number of overdoses and deaths due to the use of opioids.

The conference heard that multiple doses of naloxone, the antidote administered to overdose patients, are now required when only a short time ago, just one dose was sufficient.

“Breaking Bad is the reality,” paramedic Pierre Poirier told the audience during the first panel discussion of the day. “We’re not just talking about fentanyl. We’re talking about what chemists are doing. We can’t be callous about what’s happening.”

Keynote speaker Dr. David Juurlink, chief of clinical pharmacology and toxicology at Toronto’s Sunnybrook Health Sciences Centre, said opioids are not nearly as effective for pain control as some doctors and patients believe. “We have done so much harm.”

Dr. Jason Busse of the Michael G. DeGroote National Pain Centre said strategies currently in place, such as urine screening and treatment agreements, have not prevented addiction, overdoses and deaths.

Fentanyl has been found mixed with cocaine, cannabis and other drugs.

“We have opened a Pandora’s box,” he said. “You can almost feel the pace of this quickening.”

But Juurlink and many of the other panellists in the packed agenda had ideas for how the crisis can be addressed. The conference is to be followed by an “opioid summit” on Saturday to create a joint statement of action.

Among the possible strategies outlined Friday morning at the conference:

• Naloxone should be available everywhere for free, and lay people should be trained how to use it, much in the same way ordinary people get CPR training. “It should be in gas stations,” said Juurlink. Naloxone can reverse the effects of an overdose if used promptly. Until recently, it was only available as an injectable. In October, Philpott authorized a naloxone nasal spray for non-prescription use to help prevent overdose deaths.
• Federal authorities should monitor “hotspots” where overdoses are occurring in order to target interventions.
• Canada is working to roll out an electronic prescribing system that will be able to track prescriptions and find patients who are acquiring multiple prescriptions through multiple doctors. The system, which will be tested in Ontario and Alberta first, will reduce the chance for fraud.
• Research shows that two-thirds of people take opioids for reasons other than pain, including stress and anxiety, said Dr. Cara Tannenbaum, a researcher with the Canadian Institutes of Health Research. “We need to address the root causes.” Tannenbaum and other presenters urged that pain be treated in a practice that incorporate treatments such as physiotherapy, psychological counselling and mindfulness training. It might be more expensive than prescribing opioids, but it will pay off in long-term wellness and reduce costs for hospitalization.
• Warnings on prescriptions for opioids should be more prominent, and it should be mandatory that health-care providers warn both patients and their families of the consequences of long-term opioid use.
• Tannenbaum suggested a “bold public policy.” In Denmark, for example, patients who use drugs that cause sleepiness are not permitted to drive. She suggests the same should be true for people who consent to use opioids.

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