Opioid Refugees: Fentanyl crisis is leaving patients in pain

Opioid refugees: How the fentanyl crisis led to a backlash against doctors that’s leaving people in pain | Georgia Straight Vancouver’s News & Entertainment Weekly – by Travis Lupick on March 17th, 2018

David Reid’s body has taken a few blows over its 68 years. In 1992, he was in a bad car accident that left him with a severe concussion. This affected his balance and led to a couple falls down stairs

“And I do drywall for a living,” Reid said. “I still do it because there’s not enough in a pension to really allow you to survive,” he continued. “As long as I have the oxycodone, I can get by. It allows me to work.”  

Reid told the Georgia Straight he was never on a high dose of the semisynthetic opioid. He was given 10-milligram pills of the prescription painkiller and told to take no more than three a day. That was usually enough. Then, last December, Reid’s long-time doctor retired. His new doctor had concerns about the medication and cut him off.

“He bluntly told me: ‘I don’t write prescriptions for oxycodone or for any other opioids,’ ” Reid recounted.

I question the professionalism of any doctor who selectively chooses not to prescribe medications that are used to treat the most common form of human suffering.

Since losing his prescription, Reid has worked his way through the phone book, calling one clinic after another looking for a doctor who will prescribe him the pain medication he says he needs to work.

“Every doctor I went to said, ‘No, I can’t prescribe any.’ ”

North of the border, many people believe that the opioid crisis is playing out the same as in the U.S. That’s because Canadians watchCNN and read Americannewspapers, and the effect has been for important regional variations in the crisis to be glossed over and confused

In response to media reports that focus on the U.S., Canadian doctors have received increasingly intense criticism and pressure to scale back opioid prescriptions.

When a foreign country, Canada, bases its policies on the preposterous junk the media in the US is peddling, they are in trouble.

This has left patients like Reid—people with real pain who just want to get through a hard day’s work—with nowhere to turn for the medicine they need, except maybe to the streets.

This patient profile has become so common that in the United States that it has a name: “opioid refugee”.

Unintended consequences

province’s chief coroner, Lisa Lapointe told the Straight that although the overdose epidemic in the United States is driven by a combination of prescription opioids like OxyContin plus heroin, and, more recently, fentanyl, B.C’s opioid crisis is largely the result of just one drug: fentanyl.

Lapointe said her coroners are on the ground, interviewing the families of drug-overdose victims, and what they’re hearing is that a majority of deaths in B.C. involve people who struggled with addictions to illicit drugs for some time.

This is just as true of the US, but no one here is willing to step up and react to it. Instead, we the tired old and wrong refrain about prescriptions opioids causing overdoses.

Dr. Patricia Daly is chief medical health officer and vice president of public health for Vancouver Coastal Health

she emphasized the same point as the coroner: “There is not a causal link between prescription opioids and the opioid crisis here,” Daly said.

She expressed concern for a false perception that unfairly paints B.C. doctors as reckless.

“Most of our crisis here concerns people who have a long-term heroin addiction and the contamination of the heroin supply.”

In both countries, prescribing practices have begun to change.

From 2012 to 2016, the rate of prescribed-opioid daily doses declined 8.9 percent.

Lapointe warned that this is where a relationship between prescription opioids and illicit fentanyl could emerge.

“Anecdotally, we’re hearing from people whose doctor stopped prescribing,” she said. “If doctors aren’t able to prescribe opioids, and folks are then turning to illicit drugs in a market that’s increasingly dangerous, the policy is actually leading us down a worse path.”

“In the midst of an overdose crisis, to cut off people who are receiving prescription opioids could put them at great risk, because they could turn to the illegal market,” she explained. “If you have patients right now that are dependent on prescription opioids, reducing their dose or cutting them off may put them at risk of overdose death.

Revised guidelines

How doctors decide when to prescribe opioids for pain is officially outlined in a document issued by the College of Physicians and Surgeons of B.C. (CPSBC). The college published a new set of these guidelines in June 2016 which call attention to concerns for addiction

“There was a belief and a hope that we could really improve the lives of people with chronic, persistent pain with opioids,” Wilson said. “But the emerging science more recently has said that it’s only a small number of carefully selected patients that benefit.”

I’m not sure what a “small number” is and how it compares to the “larger number” of people being prescribed opioids that supposedly don’t need them.

Untreated pain

Maria Hudspith is the executive director of Pain B.C., a patient-advocacy group. She acknowledged that overprescribing had become an issue in Canada—though not to the extent that it did in the United States. But Hudspith said that although action was required to reduce the numbers of presriptions, she believes that B.C. has now gone too far in the opposite direction.

“There has been a pendulum swing around opioids,” she said. “And now there are definitely people who live with chronic pain who are reliant on opioids for pain relief who can no longer access them.”

Hudspith suggested that the blowback against doctors in the U.S. combined with deaths in B.C. attributed to illicit fentanyl has led many people to confuse the two issues and associate doctors here with overdoses that are actually the result of street drugs.

How sad to see Canda following the US’s idiotic and pointless prescriptions opioid restrictions.

Author: Travis Lupick is a journalist based in Vancouver. His first book, Fighting for Space: How a Group of Drug Users Transformed One City’s Struggle with Addiction, was published in November 2017. You can follow him on Twitter, Facebook, and Instagram.

Original article: Opioid refugees: How the fentanyl crisis led to a backlash against doctors that’s leaving people in pain