Germany, the USA and Canada – Overusing Opioids?

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.

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2 comments… add one
  • Emily May 7, 2010

    There is a difference between physical addiction (which causes withdrawal health issues when the medication is discontinued) and addictive behaviour/drug abuse.

    Development of drugs which counter the “high” associated with addictive behavior/drug abuse of narcotics would be beneficial (I thought there were a couple in the process of approval??).

    Physical addiction to certain drugs is a given, but addicitive behavior is an individual trait (one pill is good, twelve pills at once must be even better) that is difficult to predict. Drug seekers often hit different emergency departments in a few days feigning problems that people with legitmate illnesses receive pain killers for, which makes it that much harder for those of us with specific problems to receive proper treatment. This is one reason pain management specialists often make you sign a contract stating you will only get your pain medication from them.

    I feared being treated as a drug seeker since at one time I spent a lot of time in ER’s due to untreated excruciating headache pain, but actually my vital signs such as heart rate, respiration, and blood pressure showed I was in very bad pain and I never had any problems getting emergency treatment.

  • James May 11, 2010

    Thanks Emily – your point is well taken. That is one fear, that sometimes even health professionals don’t understand what addiction is, and when patients can really benefit from “painkillers”.

    However, I do think this is changing – slowly, but I think information is getting out there to doctors about how to know if someone has an addiction problem, or is really dealing with pain and could be helped by certain medications. You experience in ER is an encouraging sign, I think.

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