The limits and role of
opioids in chronic pain
must be reassessed
T
lion to settle a class action lawsuit with
he medical profession
as many as 2,000 Canadian patients.
must re-evaluate the
The settlement, which must be ap-
role and limitations of
proved by the courts, includes $2-mil-
opioids in the manage-
lion in compensation for provincial
ment of chronic non-cancer pain if
governments.
Canada has any hope of emerging
“The culture around opioids today
from its public health epidemic, a
has been shaped by the pharmaceutical
drug safety expert told Council.
industry and its agents, and while these
“We need to re-think how we treat
drugs have a place in the management
pain and how we treat people with
of chronic pain, it is nothing like the
addiction and if we do those things
Dr. David Juurlink
one that they have enjoyed for the last
correctly, then hopefully we can
20 years,” said Dr. Juurlink, who has
prevent more people from losing their
trained as both a physician and a pharmacist.
children,” Dr. David Juurlink, a medical toxicologist
He pointed out that no randomized control trial com-
from the Hospital for Sick Children, told Council dur-
paring opioids with placebos has run longer than six
ing a recent meeting.
months. “We’ve put patients on high doses of opioids
More than 20 years in the making, Canada’s opioid
for months and years at a time in the absence of evi-
crisis has been propelled by corporate misrepresen-
dence that it is a good thing to do,” said Dr. Juurlink.
tation, well-intentioned doctors, and patients with
The goal of prescribing pain medicine is to afford
expectations for quick relief. The absence of affordable
patients more benefit than harm. And yet, the benefits
alternatives to pain relief within the health-care system
of opioids decline with time as the analgesia wanes due
has only exacerbated the situation, said Dr. Juurlink.
to tolerance, while the harms persist and indeed increase
Until the 1980s, opioids had been restricted to short-
as patients are put on higher doses, he said.
term surgical pain, treatment of cancer and terminal
He urged doctors to prescribe less readily and start
pain conditions and accidents. But then Purdue Pharma
fewer patients on opioids, keep doses low and prescribe
– the producer of OxyContin – and other pharmaceuti-
sensible quantities after a surgical procedure. He also
cal companies began to aggressively market opioids even
urged empathy for patients who are currently on high
for minor procedures, assuring physicians that they
doses of opioids. “These are people whose lives revolve
were safe and non-addictive.
around their next dose. You can’t take them off sudden-
In 2007, Purdue Pharma pleaded guilty in US federal
ly, it’s a very dangerous thing to do. You need to engage
court to criminal charges that it had misled doctors and
in a very gradual taper. They didn’t get to this point
patients when it claimed, among other things, that Oxy-
overnight – so treat it as a marathon, not a sprint,” he
Contin’s risk of addiction was negligible.
said.
This past May, Purdue Pharma agreed to pay $20-mil-
MD
Issue 2, 2017 Dialogue
21