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Track prescription-drug use, experts say

Canada second in world rankings of pharmaceutical-narcotics use

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When it comes to fighting prescription-drug abuse in the country, government officials, health-care providers and law enforcement officers agree that without a national strategy, their efforts are doomed to fail.

Canadians have become the second-largest consumers of prescription narcotics and other controlled substances per capita in the world, according to the International Narcotics Control Board.

Yet Canada lacks a national tracking system that would monitor cases of addiction and related deaths.

"We haven't developed a co-ordinated approach that makes sense in Canada that allows each province to have a bit of a framework to guide their own direction," says Dr. Susan Ulan, co-chair of the Alberta-based Coalition on Prescription Drug Misuse.

Some provinces, including Saskatchewan, Alberta, British Columbia and Nova Scotia, have had extensive monitoring programs in place for more than a decade, says Ulan, while others are just getting started.

In a bid to streamline those efforts, the Canadian Centre on Substance Abuse has recruited a group of about 30 health experts to develop a national strategy to track drug misuse and overdose rates.

They expect to have a monitoring system in place before the end of the year, but observers say the country has a long road ahead of it when it comes to combating the problem.

The strategy would take a five-pronged approach focusing on prescription-drug abuse education, prevention, treatment, enforcement and monitoring of at-risk patients and physicians.

Ontario Health Minister Deb Matthews agrees a strong national strategy "is absolutely the way to go."

Canada's biggest province registered about 400 deaths due to abuse of opioids -- painkillers such as morphine, codeine and oxycodone. That's nearly double the number of deaths in motor-vehicle accidents.

The high rate of addiction to OxyContin, a drug up to twice as strong as morphine, has prompted First Nations leaders in some northern Ontario communities to declare a state of emergency.

In February, it was reported almost 2,000 members of Matawa First Nations communities were addicted to opioids. In the Cat Lake First Nation, an estimated 70 per cent of community members had opioid addictions -- including children as young as 11.

Matthews says the province has just introduced a prescription-drug monitoring database, which records information on prescribing doctors, dispensers and patients. The real-time monitoring allows a pharmacist to ascertain whether a patient received a similar prescription on the same day or recently, inappropriately and from more than one doctor.

"We never had the ability before to actually tie those three pieces of information together," Matthews said in an interview.

"So we'll be watching that very closely. We'll be able to identify those people and take those appropriate steps, including, in the extreme outlier cases, involving law enforcement," she said.

"We've got a long, long way to go," Matthews admits, "and we've got a lot of work ahead of us, but we're at least moving in the right direction."

Experts suggest more education is needed, teaching the public about the risks associated with prescription drugs and physicians and pharmacists about the dangers of prescribing high doses.

A 2009 study of health-care faculties across the country concluded veterinarians received five times more training in pain assessment and management than medical doctors.

Dalhousie University professor Dr. Mary Lynch, who was involved in the study, says the numbers have not improved.

"Experts in pain management across the country continue to work very hard to try and get pain curricula into our medical schools," says Lynch. "We feel very strongly that the national pain strategy must address improving education of health-care professionals regarding pain assessment and management."

We really will not be able to get a full handle on the issue of prescription-opioid abuse without addressing pain across the country, she says.

In the U.S., prescription-drug abuse is considered the nation's fastest-growing drug problem.

A new safety plan announced by the U.S. Food and Drug Administration earlier this week calls for pharmaceutical companies that make powerful painkillers to be required to fund training programs to help doctors and other health professionals safely prescribe the drugs.

Training for physicians and pharmacists is a strong component of the Canadian national strategy, under which each province would be responsible for its own federally funded monitoring program.

Doug Spitzig, who manages a prescription review program in Saskatchewan, says privacy laws may need to be amended across the country to provide health officials with access to patient information.

"The vast majority of physicians are good prescribers. There are just a few of them that need a more educational aspect with regards to prescribing," says Spitzig, whose office at the College of Physicians and Surgeons has screened about 190,000 patient profiles since 2006 in an effort to track prescription-drug abuse in Saskatchewan.

Cpl. Taylor Mickleborough, of the Moose Jaw Police Service in Saskatchewan, provides Spitzig's office with street-level information from prescription-drug abusers across the province.

"By gaining these relationships with confidential informants, it kind of allows you an inside look at the drug scene and it allows us to combat the problem that way, by targeting the dealers and the sources of the problem," Mickleborough says.

Traditional policing methods often fail when it comes to prescription-drug abuse, he says.

"Many of the people that are dealing these pills have obtained prescriptions for them," he says. "It's like trying to bust somebody for cocaine that has a licence to have cocaine."

One of Mickleborough's informants is a recovering morphine addict who agreed to speak with The Canadian Press on condition of anonymity.

"(Mickleborough) was there for me 24 hours a day, and I was pretty lucky that I got to meet him because I don't know where I'd be today if he wouldn't have been there for me," said the informant, who credits his work with police for his one year of sobriety.

"It's 100 per cent better," he said. "I'm not looking at a jail sentence today or up on any charges, and that's a huge turnaround."


-- The Canadian Press

Republished from the Winnipeg Free Press print edition July 12, 2012 C12

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