Post-surgery meds leading to addiction

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David Kawai / Postmedia News archives Codeine was the most common opioid prescribed early to patients after surgery. (CNS DAVID KAWAI)

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   • Mass withdrawal of painkiller feared

With Canada facing what has been called a crisis of prescription painkiller addiction, new Canadian research shows patients prescribed opioids after minor surgery are significantly more likely to become chronic users within a year.

The study of nearly 400,000 Ontario patients suggests some surgery patients are being prescribed heavy-hitting narcotics out of proportion to their pain, setting them on a path to potential addiction to a drug they may never have needed to begin with.

Toronto researchers analyzed data for 391,139 patients, aged 66 and older, undergoing minor surgery from April 1997 through December 2008. All were "opioid-naive" before surgery, meaning they had not been prescribed an opioid within the previous year.

The team looked to see how many patients were dispensed an opioid within seven days of "low-pain, short-stay" surgery for cataracts, gallbladder removal, prostate tissue removal or varicose vein surgery.

About seven per cent of patients were prescribed opioids within seven days of leaving hospital, and more than 10 per cent of them continued to use the medications one year later.

Overall, "if you filled a prescription for an opioid, you were more than 44 per cent more likely to be a user at a year," said senior researcher Dr. Chaim Bell.

The Toronto doctor said he was surprised at how relatively common it is for patients to be given a prescription for an opioid even after cataract surgery. The entire cataract procedure takes about 15 minutes and is performed using anesthetic eye drops.

"Patients are often in their street clothes. This is about as outpatient as you can get as a type of surgery," said Bell, an associate professor of medicine and health policy at the University of Toronto and a staff physician at St. Michael's Hospital.

Codeine -- Tylenol 3, for example -- was the most common opioid prescribed early, followed by oxycodone, the active ingredient in OxyContin and its successor, OxyNeo.

But many patients initially prescribed codeine moved to more potent opioids, such as oxycodone and fentanyl patches, within one year of the surgery, Bell's team writes -- even though the study focused solely on procedures that aren't generally associated with long-term, post-operative pain.

"Some of this might be due to treating all surgeries the same," said Bell, an adjunct scientist at the Institute for Clinical Evaluative Sciences in Toronto. "We're always focused on treating a patient's pain and making sure that we provide proper pain relief, which is a fantastic approach," he said.

But in many cases, patients are given a standard dose based on the expectation of pain, he said, rather than tailoring it to the individual surgery or individual patient. "We don't necessarily need to treat all post-operative pain with the strongest medications in our arsenal."

The team found surgery patients were more likely to get an opioid than an NSAID, or non-steroidal anti-inflammatory drug. "Usually you would do it the other way -- you should be seeing more people getting NSAIDs after surgery," Bell said.

Opioids can cause sedation and respiratory depression. Some people who use them describe the effect as being like moving in slow motion. The drugs can be fatal in overdose and long-term use can lead to tolerance and addiction.

Canadians are among the highest users of prescription opioids in the world. In the past decade alone, our opioid consumption has more than doubled. In a move to reduce diversion and abuse, most provinces have announced plans to restrict access to OxyNeo.

-- Postmedia News

Required reporting of drug shortages urged

TORONTO -- The Canadian Cancer Society wants federal Health Minister Leona Aglukkaq to do more to address the urgent issue of drug shortages in the country and says a mandatory reporting system for looming shortages is an important first step.

"Getting a cancer diagnosis or diagnosis of another significant illness is already stressful enough. To read in the newspapers that the drugs you need may not be available or to hear from your doctor that your treatment is being delayed, you really deserve the information," Dan Demers, the society's director of national public issues, said in an interview.

Demers and others from the cancer society met with members of Parliament on Monday to discuss their concerns over the drug shortages. The issue was to be the subject of an emergency debate in the House of Commons Monday evening.

The problem of drug shortages has been increasing over the last year, both in Canada and elsewhere. But the problem hit a crisis point recently when Sandoz Canada had to temporarily shut down its plant at Boucherville, Que., to make upgrades in response to complaints about the plant from the U.S. Food and Drug Administration.

The plant, which makes 90 per cent of the injectable drugs used in Canada, experienced a fire during the upgrade process. The plant is expected to resume production in the near future.

-- The Canadian Press

Republished from the Winnipeg Free Press print edition March 13, 2012 C11