How Are Prescriptions Affecting the Opioid Crisis?

The impact of prescription opioids are marginal compared that of illicit drugs, but it's not one that should be ignored.

February 13, 2019

By Ayesha Habib / Photo: Terry Gibson

When we think of the opioid crisis, we think of the vast network of illicit drugs circulating the streets and, more recently, the influx of fatal overdoses caused by drugs laced with fentanyl—1,156 fentanyl-related fatal overdoses were reported in British Columbia in 2017, a 73 percent increase from the previous year.

Opioids are a pressing concern for Canadians. A study on opioid-related fatalities in Canada found that rates of apparent opioid-related deaths and hospitalization were highest in B.C. and Alberta in 2016, compared to the rest of the country. But opioids are not solely a Canadian concern: since the ’90s, prescription opioid abuse and fatalities have been steadily rising globally. Coincidentally, this growth in opioid-related harm occurred at the same time OxyContin, a prescription painkiller of oxycodone, was heavily marketed by its makers Purdue Pharma to doctors in the U.S. The influence of the OxyContin’s popularity was even felt up north: the number of oxycodone prescriptions increased 850 percent from 1991 to 2007 in Canada.

Only a few weeks ago, Purdue Pharma was caught up in a pretty incriminating lawsuit, which held the pharmaceutical company responsible for accumulating more than $4 billion USD from opioid profits. The Sackler family behind Purdue Pharma is accused of pushing opioids, namely OxyContin, onto doctors whilst knowing the drug was highly addictive and could lead to fatalities.

The plight of Purdue Pharma offers a fitting time to look at the opioid crisis beyond the role of illicit drugs and into where prescription opioids come into the picture. A study on 2,833 opioid-related deaths in Ottawa between 2013 and 2016 found that one-third of victims had an active opioid prescription at the time of death, and three-quarters had an opioid dispensed to them in the three years prior to death.

A recent report released by Ottawa-based healthcare tech company Reformulary Group delved into the role prescription drugs have in Canada’s opioid crisis. The impact of prescription opioids are marginal, to be sure, compared that of illicit drugs, but it’s not one that should be ignored, urges the report.

Canadians are being prescribed higher-than-recommended dosages of opioids and for longer periods.

The report, which analyzed datasets for public and private prescription claimants from 2013 to 2017, found that one in five Canadians took an opioid in each year. It also found that doctors were prescribing doses “significantly above the maximum dose recommended in the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain.” Due to potential tolerance developments, the report revealed that higher dosages of opioids were linked to increasing opioid therapy lengths.

So, Canadians are being prescribed higher-than-recommended dosages of opioids and for longer periods. Considering that opioids have been proven to be no more effective at targeting pain than ibuprofen, this is a little concerning. Why are narcotics still being prescribed in such high doses? Are pharmaceutical companies, like Purdue Pharma, aggravating the issue here in Canada?

BC attorney general David Eby certainly thought so in August 2018 when he filed a lawsuit against over 40 pharmaceutical companies (including Purdue Pharma) for downplaying the real harm of their drugs to doctors—a move that was heavily criticized by opponents for being likely to “drag out over decades.” And while direct-to-consumer marketing for prescription drugs is banned in Canada, there is very little enforcement by the government on both ad agencies and pharmaceutical companies.

Are pharmaceutical companies to blame for the opioid crisis?

Helen Stevenson, CEO of Reformulary Group, told VanMag that pharmaceutical companies do have a role to play in the opioid crisis in Canada. “When pharmaceutical companies are talking to doctors, they’re not highlighting the harms or potential harm of higher doses,” she says. But to place the blame solely unto the pharmaceutical industry would be reductive. “It’s hard to isolate specific root causes.”

A complicated problem won’t have a simple solution, but Stevenson urges Canadians to take steps towards being better informed about prescription opioids. “We need to ask questions when we’re given prescriptions,” she says. “‘Are there alternatives? Is this a high dose? Would a lower dose be more appropriate? Are there other treatments I could try?’”

With the recent legalization of cannabis, and its medical history of relieving pain, Stevenson asks whether looking into medical marijuana as an alternative to opioids could be a positive option. There is little scientific evidence on the matter, but Stevenson notes that there is anecdotal evidence that opioid use can be reduced by marijuana. With such a pressing need for active solutions to address the multi-faceted opioid crisis, these types of questions must certainly be encouraged.

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