Dialogue Volume 13 Issue 2 2017 - Page 21

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