Prescription painkiller deaths continue to rise

23/08/2011

Fatal overdoses from prescription opioids are increasing in many countries, especially the United States and Canada. This increase has occurred at the same time as a dramatic increase in opioid prescribing for chronic non-cancer pain, say researchers and doctors at the Institute for Clinical Evaluative Sciences (ICES), St. Michael’s Hospital and the University of Toronto Faculty of Medicine.

“We believe physicians and regulatory authorities should take a multifaceted approach to reduce opioid-related harm, and do so in a way that will not compromise access to prescription opioids for people who do stand to benefit,” says Dr. Irfan Dhalla, lead researcher.

In a peer-reviewed article in the British Medical Journal, the researchers say the evidence supporting the use of opioids in chronic non-cancer pain is weak. There are no randomized controlled studies supporting the use of long-term treatment with opioids and large observational studies suggest that opioids are associated with more harm than non-opioid alternatives.

In the US, deaths involving opioid painkillers increased from 4,041 in 1999 to 14,459 in 2007 and are now more common than deaths from skin cancer, HIV and alcoholic liver disease. In Ontario, more than 300 people die each year from opioid overdoses.

The researchers suggest a multifaceted approach to tackle the crisis here in Canada:

Changes to the way opioids are marketed. Health Canada should review all promotional material before it is disseminated. Fines should be large enough to deter inappropriate marketing. Bonuses for pharmaceutical sales representatives should be prohibited for potentially addictive medications.
High-dose opioid formulations should be withdrawn, as per the recommendations from the recent Coroner’s inquest in Brockville.
Physician organizations and governments should develop educational material independently of the pharmaceutical industry. This material should include information about non-opioid alternatives as well as information about how opioids can be prescribed safely.
Real time electronic databases, such as the one that has been proposed in Ontario, should be implemented as soon as possible. It should become the norm for physicians and pharmacists to check these database before prescribing and dispensing opioids respectively.
Physicians should be asked to register with their provincial college or an alternative authority when prescribing opioids in doses that exceed the recommendations of clinical practice guidelines.
Health Canada should require pharmaceutical companies to conduct long-term clinical trials to determine where the risk/benefit ratio is favourable and where it is not.

URL for readers to click on once embargo lifted: http://www.bmj.com/cgi/doi/10.1136/bmj.d5142

The article “Facing up to the prescription opioid crisis,” is online at BMJ.com on August 23, 2011.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

St. Michael’s Hospital provides compassionate care to all who enter its doors. The Hospital also provides outstanding medical education to future healthcare professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing Knowledge Institute, research at St. Michael’s Hospital is recognized and put into practice around the world. Founded in 1892, the Hospital is fully affiliated with the University of Toronto.