A pain management and advocacy group in British Columbia is worried that BC’s new guidelines for prescribing opioids could cause more chronic pain sufferers to turn to street drugs for pain medication, a risky prospect according to Pain BC, as pain sufferers can’t be sure of what they’re getting when they buy illegally.
“Our fear is that the standards will result in patients being denied access to appropriate options for pain relief and that in turn will drive people to the street-based trade in pain pills,” says the group in a written statement. “An unintended consequence may be an increase in overdoses as desperate pain patients seek medication through illicit sources.”
On June 1st of this year, BC’s College of Physicians and Surgeons instituted a new set of standards for doctors prescribing opioids for pain management, advising doctors to avoid long-term treatment with medications where possible, to prescribe the lowest effective dosages of opioids and to tell patients that alternative approaches to pain management are to be preferred over treatment with drugs.
The change has come about in part due to an acknowledgement by the college of its own role in creating the current opioid crisis -one that saw 371 illicit drug overdose deaths in BC during the first half of 2016, a 75 per cent rise from 2015.
“The public health crisis of prescription drug misuse has developed in part due to the prescribing of physicians,” reads a statement from the college. “The profession has a collective ethical responsibility to mitigate its contribution to the problem of prescription drug misuse, particularly the over-prescribing of opioids, sedatives and stimulants.”
Yet for many pain sufferers, alternatives to medication such as counseling and physiotherapy are not easily accessible, causing many to run out of options. “It’s fine to say to people you need physical therapy, you need some psychological support,” says Maria Hudspith, executive director with Pain BC. “But then, when patients go to find that, they either have no extended health coverage for that or they can’t find a practitioner with the skills in chronic pain in their community. What is available to them is medication.”
The new guidelines are similar in many respects to those issued by the Centres for Disease Control and Prevention in the United States in March of this year, which urged doctors to limit opioid prescription and to offer instead non-opioid painkillers such as ibuprofen and recommend physical therapy. Reaction from pain management advocates in the U.S. echoes that heard in Canada, with some asserting that the new “war on prescriptions drugs” has created a climate of stigmatization for opioid users.
Dr. Jerrold Winter, professor of pharmacology and toxicology at the University of Buffalo worries that chronic pain patients are being “thrown under the bus” by the new guidelines. “I think they go much too far and a) will leave many in pain and b) will drive some seeking pain relief into the illicit market with all its hazards,” says Dr. Winter, who points out that heroin-related death rates in the U.S. have spiked in recent years, a sign that some using prescription opioids may be turning to illicit street drugs in greater numbers. “I fear that this trend will only worsen under the CDC guidelines.”