Opioid-overdose deaths for now a tiny fraction of Canadian deaths

This week, Ontarians experienced a new, unusual and tragic milestone. That’s right, health officials confirmed this week that 9,757 Ontarians have died, or are in the hospital, from a drug overdose since the fentanyl-overdose crisis began in 2014.

Out of these deaths, 687 were from the untested drug carfentanil, which was first confirmed in Ontario last month. While these numbers may seem horrifying, it is important to remember that they fall in a country with a population of about 37 million and are a tiny fraction of the opioid-overdose deaths throughout North America.

The opioid-overdose crisis, while a national and international public health issue, is a local crisis for many communities. Some of the highest rates of opioid-overdose deaths are in areas of the province of Ontario, including Ottawa and Toronto. In the past decade, no other Canadian province has had more than 3,000 deaths; Ontario has exceeded that number in just six years.

Our opioid crisis began in 2001 with the launch of OxyContin. By 2008, it had become one of the world’s most widely-prescribed painkillers. With more patients looking for prescription opioids, pharmaceutical companies used their marketing resources to push the drugs to doctors, even though they were misbegotten.

Doctors were specifically directed to speak in those years to what they now call the “narcissistic pushback” so that patients would be more likely to “go the extra mile” with them to get more pills. Because the first opioids had side effects, many people didn’t take the medications for long, resulting in addiction and overdose. By 2013, the use of Schedule II drugs in Ontario had increased by 70 percent; there were fewer doctors aware of the proper use of opioids.

Then in 2014, a painkiller known as oxycodone (which is a Schedule III drug) was deemed safe for widespread use. Previously, oral opioids like oxycodone and morphine were only used in medical emergencies, yet prior to 2014 they were preferred in pain because they were “not as easily cut off as needles.”

Earlier this year, there was an announcement that the Ontario government would cut the cost of medication for people with chronic pain, which is the largest drug expenditure in the province. This decision will add to the problem.

All the emphasis placed on pain management (and lack of care for the addicted) may be coming back to haunt the population. In case you don’t know, there is a phrase in the Canadian medical profession that describes a time when a patient dies from a drug overdose, due to poor maintenance of the painkiller. With opioids, some patients will die because they become addicted to the opioid medications and overdose. For the people who die from opioids, this “prescription for death” occurs two or three times per week, which can lead to further medical problems, like pneumonia, pneumonia-like conditions or even major surgery.

In the interest of public health, we cannot allow this to continue. It is just sad. It is tragic. And it hurts.

— Dr. Nicholas Mammen is professor of medicine and president of the Ontario Medical Association, a provincial membership organization that represents all physicians in Ontario.

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