If you think the USA, Canada and Germany are overusing the medications known as opioids, there may be other countries you could add to the list. But these seem to be the top three, and there is concern – as always – about medication abuse.
This is a big topic of discussion, and it comes up again as specialists in Canada recommend new guidelines for doctors who are prescribing medications such as morphine, codeine and OxyContin.
I think most would agree on this point – we need to get the medications to the people that can benefit, and not prescribe it to patients that won’t benefit. But just how to go about this isn’t easy. People with chronic pain often complain that they’re mistaken for abusers, and even in the medical world there’s a lot of debate over just what "addiction" even is. It’s been suggested more than once that some of these medications are not as addictive as they’re sometimes thought to be.
But there is concern in Canada because of the rapid increase in opioid consumption, and also deaths related to the drug.
But of course a big concern is overdose deaths, so we’re not talking about deaths from prescriptions. And a study in the USA sponsored by SAMHSA (Substance Abuse and Mental Health Services Administration) suggested that over half of those who used painkillers for non-medical purposes got them from friends for free. A challenging problem to deal with.
There’s also the issue of taking more than one medication, which can make statistics difficult (all right, so this many people died taking an opioid, but was it really due to the drug or a combination of factors?).
So in both Canada and the USA (I imagine Germany faces similar issues, though I haven’t researched the situation there as much) there are guidelines and agencies to try to regulate these things and make recommendations to doctors. But in both countries, the situation remains complex and we’re far from having answers.
The fear is, of course, that tighter guidelines will raise costs for those who would benefit, and make it harder for them to get the medications they need, opioid or otherwise.
The new Canadian recommendations are mostly common-sense, however. For example, know your patient’s medical history, monitor to see if the opioids are really helping, start with a trial, and so on.
But will the guidelines help? I suspect that it will still come down to the attitude of the doctor. Somehow, good information needs to get into her hands – how to deal with different types of pain, which drugs help and how, what the risks are, and how to listen to patients and understand what the need really is.
But that information too often gets lost in politics, prejudice and power-plays. Hopefully we can all do our part to work with our doctors to find the right treatment.
What do you think? How can these countries get the best treatment to the right people, while keeping drugs away from people who will be harmed by them?
If you’re in Canada and want to go more in-depth, you can read the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain here.