Conference aims to cure doctors’ reliance on opioids

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This article was published 12/06/2017 (3195 days ago), so information in it may no longer be current.

It’s not just patients who have become too dependent on opioids to treat pain — it’s also many doctors.

That was one topic of a federal conference of physicians being held in Winnipeg, where the lethal effect of the opioid epidemic is being seen through the eyes of health-care professionals from across the country who are now in the process of redefining the whole notion of pain treatment.

And that includes a history where opiates, such as Oxycontin and fentanyl, have been for years been falsely promoted by drug companies and doctors as a quick-fix pain remedy with no significant side effects, such as addiction.

With 16 per cent of all deaths between the ages of 25 and 34 in Ontario in 2015 related to opioid use, the medical community is only now grappling with the fallout of the massive increase in opioid use, both legal and illicit.

At the Federation of Medical Regulatory Authorities of Canada conference at the Fairmont Hotel on Sunday, the issue of doctors prescribing opiates was a centre of discussion: how much is too much and what can be done to stem the tide of opioid addiction?

Keynote speaker Dr. David Juurlink, head of the clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto, cited the push by drug companies, such as giant Purdue Pharma, of pumping millions of dollars into shaping the medical communities’ attitudes towards opioids.

Juurlink said Purdue “actively” mislead physicians about the risk of addiction at less than one per cent. Evidence now suggests the addiction risk to be somewhere between five and 10 per cent.

In the United States, more than 250,000 deaths from 2000-2014 have been attributed to opioid-related causes.

Dr. David White, president of Canada’s College of Family Physicians, believes too many doctors have become reliant on opioids as a medical tool. And now, in many cases, they’re uncomfortable about admitting they were wrong about the risk.

“They (drug companies) really put a lot of time, effort and money into educating us to do this (prescribe opioids),” White said. “Now we’re trying to educate physicians out of it. It’s going to take a long time.”

Juurlink and White said convincing the medical community to use opioids — even though initial studies were questionable at best — was not a difficult task. Why? “Because we want to help people,” White said. “It (the drugs) appears to work in the short term. It’s a quick thing to do.”

There are still other factors complicating the addiction and use issue: the lack of treatment centres and defunding of alternative treatment, such as physio or massage therapy.

Dr. Anna Ziomek, president of FMRAC and registrar of the College of Physicians and Surgeons of Manitoba, said there simply aren’t enough treatment centres to deal with the growing number of patients addicted to opioids.

“We wait months for access to addiction services,” Ziomek said. “If I have a patient who I’m trying to taper their opioid use, what do I do? We don’t have enough addiction spots.”

Waiting lists are three to six months, even for just consultation. “How is that helpful to a patient who is in crisis today?” she added.

As for prescriptions, Ziomek said this isn’t the first time the medical community has had to deal with evolving information related to drug risk.

“One can safely say that what we were being taught in school and through drug reps and through literature — all of that today has been proven to be wrong,” she said. “I mean, we’ve done that with other drugs as well. Everybody used to take sleeping pills. Everybody took Valium. Mother’s little helper, right?

“We don’t do that anymore. Because over time we’ve figured out through patient experience and more research that this is not a good idea.”

At the same time, Ziomek cautioned that opioids can not only be effective, but the best treatment available. It’s a matter of striking the right balance, and not using opiates as a first resort, especially for non-cancer treatment.

In Manitoba, plans are in the works to introduce a “prescribing scorecard” for opioids made for individual doctors, based on comparable settings and similar client bases.

Dr. Marina Reinecke, medical consultant for the Physicians and Surgeons of Manitoba, said doctors will get their scorecards on a quarterly basis to see if their prescriptions match up with peers. Are they outliers? If so, why?

“So physicians are going to get a real-time look using data from their own practices,” Reinecke said.

Reinecke said some physicians have already volunteered for trial runs of the system. She doesn’t expect much resistance.

“I think there’s always some physicians who are going to be resistant to any kind of regulatory measures,” Reinecke noted. “But I think in the current climate, physicians have to realize over-prescribing and not being cautious enough about prescribing is part of why we’re in an opioid crisis across North America.

“And I don’t think any physician has the luxury to say they do not need to be paying attention to current guidelines, that they do not need to look at their own practices, to ensure that they’re doing the best possible job they can.”

randy.turner@freepress.mb.ca Twitter: @randyturner15