Ontario doctors tackle opioid abuse

The dramatic increase in the abuse of opioids such as Oxycontin has led the Ontario College of Physicians and Surgeons to propose some dramatic initiatives to curb addiction.

Key among the recommendations is more information-sharing among doctors, pharmacists and police. Along with establishing a drug monitoring system, the college is also calling on the Ontario government to change the Personal Health Information and Protection Act to compel doctors to contact police if they believe a patient is breaking the law.

"If patients are misrepresenting the reasons for getting the drug, and if there are reasonable grounds to believe that there is an offence being committed, [we recommend]that these be reported," Dr. Rocco Gerace, registrar of the college told CBC News in an interview.

Other recommendations include better training and ongoing education for doctors, along with a public awareness campaign with a special emphasis on high-risk populations.

The college, which regulates Ontario doctors, also wants a new strategy developed to help treat patients with chronic pain that doesn't risk addiction orresale of opioid drugs to addicts.

"The goal of these recommendations is to improve patient care and health outcomes by ensuring effective treatment for patients with chronic non-cancer pain, while also supporting solutions to help stem the diversion of opioids," said Gerace.

Abuse escalates

Opioid abuse has been increasing at alarming levels in Canada since 1995 when Purdue Pharma introduced controlled release Oxycontin tablets.

The drug quickly displaced heroin as the drug of choice of opiate addicts in Canada.

Last year, it was also a drug of choice for Ontario high school students. A survey done by the Centre for Addiction and Mental Health found that 18 per cent of students from Grades 7 to 12 had used prescription opioids for non-medical reasons in the past year.

That made opioids the third-most abused drug by high school students behind only cannabis and alcohol. CAMH estimates 180,000 Ontario high schoolers abused opioids in 2008. The source of the drugs was overwhelmingly the student's home.

CAMH also reports that people seeking treatment for addiction to Oxycontin went from 3.8 per cent of opioid related admissions in 2000, to 55.4 per cent in 2004.

The result has been a serious strain on addiction services.

'These drugs play a very important role in helping these patients' Dr. Rocco Gerace, Ontario College of Physicians and Surgeons

Deaths due to Oxycontin went from 35 people in 2002 to 119 in 2006, a rise of 240 per cent.

Yet in spite of Oxycontin's dismal record of addiction, personal destruction and death, doctors value the drug for its pain-fighting abilities. Oxycontin and other opioids such as Dilaudid revolutionized pain management for patients.

"These drugs play a very important role in helping these patients," notes Gerace.

The problem is that too many of the prescribed painkillers make to the street.

"As a result, these drugs are sold, bartered, shared and stolen," according to the college's report.

While Gerace admits some doctors over prescribe the medications, the larger issue is a lack of coordination, which allows patients to search out multiple prescriptions.

"A doctor may prescribe very appropriately, but not know that their patient has been to five other doctors, prescribing appropriately."

He says that's why there needs to be a co-ordinated approach to the problem which involves government, law enforcement, health professionals and the public.