Why has Ontario introduced a new narcotics strategy?

Deaths from prescription opioids have increased in Ontario over the past two decades as opioids have become more commonly used to treat pain.

The Ontario government has introduced legislation to better monitor opioid prescriptions and to educate doctors and the public about the danger of opioids.

The only unusual thing about the death of Heath Ledger, the Oscar-nominated star of Brokeback Mountain and the Dark Knight, was his fame. Like thousands of other North Americans each year, Ledger died from a prescription drug overdose. His death was ruled an accident, and the autopsy that followed his death in 2008 found several prescription drugs in his bloodstream. The two that probably played the most important role were oxycodone, the active ingredient in OxyContin, and hydrocodone, a similar but less potent narcotic.

Several hundred deaths related to this class of medications—opioids—occur each year in Ontario. The annual number of deaths related to opioids is more than double that from HIV infection.

As with cocaine and heroin, most deaths are accidental and occur in young people. But in contrast to cocaine and heroin, it is the health care system that is responsible for distributing prescription opioids like OxyContin.

Doctors prescribe opioids for patients who are suffering from pain. While many patients do benefit from these medications, others become addicted, and some accidentally overdose. Other patients sell their drugs to people who simply want a high.

For these reasons, the Ontario government passed the Narcotics Safety and Awareness Act last year. The government hopes that the new law will reduce the rates of addiction and death.

But how did we get in this situation in the first place? And what should we do to reduce opioid addiction and overdose, while still making sure that people who will benefit from receiving opioids have access to this class of medications?

How We Got Here

For most of the 20th century, physicians shied away from using drugs like morphine because of the risk of addiction and overdose. Many patients with terminal cancer suffered unnecessarily as a result. Today, virtually no one needs to suffer from excruciating pain as death approaches. Because opioids are so effective in treating pain, they have become one of the most widely used classes of medications in palliative medicine. They are also very useful to treat acute pain, from a kidney stone or after an operation, for example.

About 20 years ago, a small number of pain physicians started to promote the use of opioids for chronic pain that is not related to cancer—back pain or knee pain, for example. Doctors want to ease suffering, and prescribing opioids seemed to be a good way to do that.

But because pain is subjective and experienced only by the patient, and because the risks are unpredictable, it is very difficult for a doctor to know whether prescribing opioids to a particular patient is the right thing to do. And if the opioids don’t work, then what? Many doctors feel obliged to increase the dose. Although this strategy sometimes works in the short-term, the long-term effects of high-dose opioids have been poorly studied.

With very little evidence to guide practice, pharmaceutical companies stepped into the arena and aggressively promoted products like OxyContin. In fact, the company that marketed OxyContin went too far, and was eventually punished with a $630 million fine in the United States for illegally marketing the drug.

What Ontario is Doing Now

Through its new narcotics strategy and the Narcotics Safety and Awareness Act, the Ontario government is focused on more closely monitoring the prescribing and dispensing of opioids and other monitored drugs. The Act provides the government with the ability to collect data on prescribing and dispensing practices. The narcotics strategy also proposes to produce a database to monitor opioid prescriptions, provide better education to doctors, pharmacists and the public, and facilitate better access to addiction treatment. The database will allow for the central monitoring of prescribing behaviors and patterns, and can support the identification of individuals or groups for education or programs around opioid prescribing.  However, the details of exactly when this database will be up and running are not clear.

What Others are Saying and Doing

Some critics wonder whether Ontario’s new strategy will curtail access to pain medications and start us on a road back to the 1940s, when doctors wouldn’t prescribe opioids even to patients with terminal cancer.

Some pain specialists believe that pain is already an underserviced domain in medicine, and that doctors are being scared away from prescribing opioids, therefore depriving patients of important pain relieving medications.

Others wonder whether the government is doing enough.

In Canada, Manitoba has moved most aggressively on this issue. In March of last year, the government introduced a policy requiring doctors to obtain permission before they can prescribe certain opioids. In Saskatchewan, the College of Physicians and Surgeons monitors drug prescriptions using provincial data and investigates unusual prescribing by physicians, advising physicians directly on inappropriate use of prescription opioids. In the United States, the state of Washington is mulling over the idea of forcing doctors to register and undertake additional education if they want to prescribe opioids on a long-term basis to patients who don’t have cancer.

Some people, like the group behind, have even suggested that specific opioids be removed from the market. Although this would be a drastic step, advocates of this approach argue that complete removal may be the only way to redress the harms caused by inappropriate marketing.

Ada Guidice Thompson, whose son Michael died in 2004 from an opioid overdose, stresses that the stigma attached to drug addiction is extended to those with opioid addiction, influencing public perceptions and policies. “They don’t become addicted overnight, it’s a gradual process. Many of these individuals are patients under the care of a physician who receive a legitimate prescription, for a narcotic, for pain.”

To watch a CBC news feature on prescription opioid use in Ontario, click here.

The comments section is closed.

  • Chris says:

    WellI am in the kind of pain these drugs were desined for…if they would give real pain patiants (with medical findings)enough of the drug they need it would stop 50 percent of thier deversion prollem…the other 50 is people getting a bottle of oxys because they say they have some prollem pain in thier but or somthing then they take the drugs and sell them on the street…it is insaine…their is no solution and real pain sufferers are paying the price…i Hate the whole system.Chris

  • Karen says:

    Wet Fluffy?? Best laugh all day. You made my day!

    I don’t have what you have so part of this is hard for me to appreciate. But I am behind you 100% when it comes to arbitrarily changing the rules with no thought for those with long standing chronic pain who are already on a regimen.

    Making one dependent on a drug? It can happen but usually, I think, it takes two: One to supply the drugs and the one who takes them. Well maybe make that three – the pharmaceutical company who often suggest higher than needed doses and at more frequent intervals than is really needed.

    The days of blindly trusting doctors is over and has been for eons. They have no training in drugs so for me, research anything they give and be sure you feel ok taking it. Also, just because they can offer people totally pain free living, does not necessarily mean you have to take a drug for every little ache and pain you get. The day may indeed come when, if you succomb to a drug for everything, that when you really, really need one, your body will rebel and say, enough is enough. Now you can suffer.

  • Chris says:

    What a crock of wet fluffys…I have recuring shingles inside my left ear…the pain is unbearable …for six years I was treated by my family doctor …I am one of those lucky people who are highly tollarant of opioids….i started on morphene b ut the side efects were realy crappy…so we treied oxy contin…it was a life changing event I was able to function and work on most days…due to my incredibly high tollerance i was tacking 2 eighty mg oxys 3 times a day…I had no side effects no itching constipation …I was alert able to sleep i was still in pain but it was managed…then my beloved doctor retired…she left me a years worth of meds…after being treated like a junkie by most of the medical establishment i found a docto who would play ball he gave me five pills a day re tried all the crappy amnetripteline and all the othe usual cerap but i still had my oxys and a semblance of normal life…then the guidlines started to get inforced so now im down to 3 a day w a 25 mg patch…im out of my script after 4 dayts and then to not get the horrible withdrawls and my pain back…i find the rest of my script on the street for 25 to 50 bucks a pill so needless to say my marrage is now failing due to horendas financial strain…does this sound like (no harm) in the hipocratic oath i think not…iv never double doctord i dont chew my pills but they have made me dependant on a drug and then took it away this is not fair.

  • Karen says:

    About doctors: Some are great and others are totally useless. Probably the biggest asset the great ones have is that they listen to their patients.I have enough unfilled prescriptions to paper my entire living room wall. I am one of those lucky folks with a high pain threshhold for anything below the neck (I am not so lucky with eyes and teeth type pains) When I had breast cancer I asked for codeine or 292s for the pain. I was refused and they gave me the usual heavy duty opiate based stuff. They were palmed until the nurse’s back was turned and then flushed down the toilet. Doctors need to get over that idea that one drug fits all. We are 34 million people with 34 million different reactions to pain.

    Doctors also have to decide if they are doctors hired by their patients or salesmen for the pharmaceutical companies. Karen, in your article you say “pain physicians started to promote “. Your choice of words is interesting. Promotion is what salespeople do with their products. You cannot turn on American tv without seeing prescription drugs being promoted ad nausium! And a little research tells me that doctors are given next to no training in drugs. A little time spent just sitting in my doctors office and I see more drug reps going through some days than I see other patients going through. Doctors who get paid, with money or with perks, should be outed for the frauds that they are. Anyone with an IQ of 70 can be taught to sale something.

    Governments need to tackle the Big Pharmaceutical companies and the doctors they have in their pockets first and foremost. Then the doctors who whip out their prescription pads at the mention of an ache without listening to what the ache entails. It would not hurt to train police that resellers of prescription drugs is an offense that needs to be addressed, not fluffed off as “small potatoes” not worthy of their time. But I, for one, do not expect to see that happen. Too much money involved and these days more than ever before, Money Talks.

    I cannot close without noting that the fine – 630million dollars – would put several successful non pharmaceutical companies into bankruptcy but not the pharmaceutical companies. Hmmmm Makes one thinks, doesn’t it?

  • Nancy says:

    My pain finally dropped enough to read through this post properly to see that it was a debate and that I repeated some arguments. Here is one point I have that I think is important.

    1) Considering advancements in neuroscience about pain re-inscribing itself, chronic pain needs to be recognized as something that needs to be treated in order to stop this process of continuously wiring the brain into pain. Chronic pain patients are a community, just like HIV patients.

    2) What is the incentive to this above policy in terms of dollars? The golden question. Percocet and Oxycodone are available as generic drugs. Since when does society care so much about addicts. If they did, they would take more effective action on alcohol. Drugs like Lyrica, Cymbalta, tridural, etc all are VERY expensive. These meds are NOT available to people on Ontario Provincial Plans because the GOVERNMENT LISTED percocet as the alternatives. In the case of Tridural, the alternative is percocet. Then they create policies that make it VERY difficult to get percocet. In effect, the government works in direct opposition to the human rights of chronic pain patients without cancer. Not to discount cancer, but who says only these people suffer. Check out: (highlight of recommendation bullets)

  • Nancy says:

    I know for a fact that narcotics work for chronic pain. I have tried all the wonder drugs and do take these as well, but plain old percocet is crucial to my content existence and quality of life. I was LUCKY ENOUGH TO ACTUALLY GET INTO A PAIN CLINIC CONSIDERING HUGE WAIT LISTS. These really are the only doctors not subject to such scrutiny.

    I STRONGLY BELIEVE THAT THIS POLICY WILL LEAD TO MORE DISCRIMINATION. In my opinion, a better step would be to have a central computer that looks for multiple refills of the same medication within a given period. Double doctoring for the same script in the same month is a good way to catch abusers. Another idea would be to invest in whatever machine picks up on activity in the part of the brain that registers pain. I have read about this machine several times in relation to biofeedback. The technology exists and yet the government would rather invest in policy to monitor doctors prescribing rather than give them access to a tool they can use to assess patients.


    Alcoholics have an addiction and we don’t shut down the lcbos or socially frown upon the sale of booze. When any person purchases wine, we do not look at them with skeptical eyes, judge them and occasionally refuse to sell them a bottle, just to be sure that we don’t sell a bottle to a sober person who might be an alcoholic based on our internal hunch about their home-life habits. Better, lets treat all people as thought they are alcoholic just in case they are so we catch them all.

  • Karen Copeland says:

    Why does everything end up with an “all or nothing” solution?

    In the 50s they gave heroin to terminal cancer patients. My Grandmother was on it until the Government, in a questionable move made it illegal for everyone. She died in agony because morphine, good as it may be, was a step backward into pain for her at that point. Did the Government’s move stop drug addiction? No, it made it worse. Now all those dare devils out there knew about it and had to try it. And like drug addicts everywhere, they found a way. Now instead of being a little problem, addiction is a big problem. And instead of dying with a little dignity, terminal patients in pain must die in agony and hooked up to machines to drag that agony out for it’s maximum amount of time.

    There are answers to chronic pain. I have MS and was in pain a good amount of the time. A little research and I now am taking a non addictive pain reliever, Soothanol, and I only need to use it where it hurts and when it hurts. I have a friend with Fibromyalgia who also uses it instead of the addictive drugs his doctor prescribed. The neurologists are not happy with either of us. (You might figure out why here

    Perhaps the answer to the medically induced drug addictions would be to put a rein on the individual doctors instead of on the individual drug. To do that though, we really have to get past this insane notion that doctors are somehow on the right hand of God and can do no wrong. They are not! They are as human as you or me and are just as likely for yield to the temptations held under their noses by the pharmaceutical companies as anyone, maybe even more likely.

    Patients also need to stop crying at the very thought of an ache. A little pain is a good thing. It tells the knowledgeable doctors where to look. Trouble these days is that doctors do not listen to patients. They hear the word pain and they drag out their prescription books. Something sadly wrong with this picture but the picture the Province of Ontario is offering is just the mirror image and corrects nothing much and opens the door for more illegal drug pushers.

    • themacguy says:

      Soothanol is just DMSO. It’s been around a long time and is a well known topical pain reliever. There have been studies that have shown it to be a carcinogen in high doses. I tried it for a while and found that it wasn’t particularly effective for me but the research that I did on it indicated that it’s efficacy varied from person to person. Good for you if it’s working as I don’t recall that it was particularly expensive compared to a lot of the stuff that I have tried.

      “Perhaps the answer to the medically induced drug addictions”….I take serious exception to your use of the term “addiction.” People with chronic pain do not become addicted to our medication. We may become tolerant or dependent but not addicted. Please take note of that.

      • Karen Copeland says:

        Sorry, I did not intend to include you or any chronic pain sufferer. There IS a difference but I do not think Ms. Matthews appreciates that difference. I was talking about the people, and I know several, who had what should have been a short lived pain episode, usually following surgery, who have become addicted. I know one guy here who gets them for a non existent pain so he can sell them. When I mentioned this to a policeman friend, he said the guy was small potatoes and to forget it. They didn’t have time for small potatoes. I have to live here so I did drop it. I’m in a similar boat – unemployed because my symptoms don’t allow me to work anymore and I do not like it one bit more than you do.

      • themacguy says:


        Sorry as well. Didn’t mean to be so touchy. Things are really tough right now. Losing my job was a really hard blow to handle. because my wife is employed it means that I have no ability to get any sort of help from the government money wise. The last job I had I took because it could accommodate my very specific needs but it was a cash paying job so there is no EI and low and behold, even thoug I really never wanted to go that route, when i looked into it, because my wife is employed, if I wanted to apply for ODSP they will turn her life upside down and inside out in order for me to get it and I’m not about to do that. It’s bloody ridiculous too because she has a decent job but she makes decent money for 1 person not for 2. Why on earth the government wants to drag her into the ODSP process is beyond me. I don’t want anything to do with government money anyway but looked into it as a last resort.

        It was just announced today that Ontario lost 75,000 full time jobs in October. Good for you to the people that voted Dolton McLiar back into office. This is all just too much. The Fibro on top of my back issues makes life without my pain meds impossible and work almost impossible to find and even if I was 100% healthy work is hard enough to find…sigh…

  • Jeremy Petch says:

    Great to see this thread has been picked up again recently. I just thought I would share that Andrea Furlan from the Institute for Work and Health has recently secured grant funding to conduct a systematic review of the evidence about the long-term efficacy and safety of opioids for non-cancer chronic pain. Hopefully this study help resolve some of the issues that are in contention here.

    • themacguy says:

      I won’t be holding my breath waiting for anything positive to come from her review. It’s obvious from the guidelines that she helped to pen originally that she lacks a fundamental understanding of the problems faced by people with non-cancer chronic pain. In the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain section “Cluster 5” – Managing Opioid Misuse and Addiction in CNCP Patients, the fact that the term “Addiction” is used shows quite frankly that these “grant chasers” don’t have a clue what they are talking about. People, like myself, with quite severe chronic pain do not become addicted to our pain medications. We become tolerant to them and may require adjustments to our dosages but addiction is not even remotely the correct term to use and doing so puts us in the same boat with junkies that you see in back alleys sharing spoons and hypes and it is both insulting and demeaning.

      In the last several years I have gone from leading a very full and rewarding life to now being unemployed and almost unemployable, feeling useless and now, because of these new policies being put forth by our government I am being made to feel like a drug abuser.

      I was hell bent on continuing to work no matter what but I recently lost my job and have had no luck as of yet finding something that can accommodate my need for working part time afternoon shifts and my need for a combination of sitting/standing at regular intervals because of my back problems in addition to my Fibromyalgia. I still have rent and bills to pay so I have been forced to take whatever temporary work I can and some of that has been physical labour work that I have been taking through a friend that has a construction company. I don’t suppose that I need to describe to you what kind of shape that has put me in by the end doing what little bit of physical labour I can still do. I work one day and then have to recuperate for two days. Every time I go back I can do less and less. If the company didn’t belong to the father of a friend of mine I wouldn’t even be getting this work because it’s pretty much charity at this point. And even though I am trying my best to stretch them as far as I can I am going through my pain meds much faster than normally obviously and when I run out early I am going to have to explain that to my doctor and he will understand but because of what the government is doing I’m going to be putting him in a bind by refilling my scripts early and finally having to force the issue about getting my doses increased like I’ve been asking for the last several months because of my tolerance and now aggravated further because of my having to do this work.

      These government people sit in their ivory towers passing judgement on us without having any idea whatsoever what they are talking about. Then the grant chasers get involved and they are just as bad. Then the doomsayers get in on the game and between the lot of them they decide that they have the right to decide how those of us who live day in and day out with debilitating levels of pain are able to deal with that pain. Exactly who the hell do these people all think they are? A few people that are junkies overdose from prescription pain meds and because of that they think they need to take those medications off of the market. Before Oxycontin ever existed people were overdosing from other things and if Oxy was gone something else would take its place and the only difference would be that the people, like myself, that rely on it would be going without needlessly. That is not only unfair but it’s ridiculous.

      I have some really choice words for the people that have posted in this thread saying that these pain meds need to be taken off of the market and for the government people behind this etc but there is no point in posting them because they will just get censored.

      The bottom line here is the fact that these meds are necessary and the new rules that the government is putting in place are ridiculous are are going to do nothing but inconvenience the people who need these medications to improve the quality of their lives. The people that are abusing the drugs will still get them and the people that are diverting them will still do so. Meanwhile myself and others like me will have anxiety,embarrassment, anguish and disgust to deal with on top of our pain.

      Good job, well done. You’d think that the Ontario LIeberal government would have their hands full. Guess they had enough time left over to mess with us chronic pain sufferers too. Too bad I don’t need gender re-assignment surgery because they’d pick up the tab for that too but as my insurance allotment for physio for my back has run out for this year I’m screwed because OHIP won’t cover my Chiropractor!

      • Karen Copeland says:

        Somebody with some clout really needs to tell them they cannot turn us into a “one size fits all” province. We aren’t; we never were and all their efforts to create this will fall flat on its derriere.
        Trouble is no one from any party had a decent Medical platform last election and they will probably have killed me and other MSers and chronic pain sufferers off before the next election with programs like this and a total lack of useful problems for things like MS. They certainly are trying hard enough to.

  • MARI LAKE says:

    I think this is a shame for people who legitimately need painkillers to control life changing pain in their lives. My mom has been crippled by arthritis, a bad hip replacement that resulted in her having her hip removed for 3 months and she has suffered since that operation. She is very much bedridden, and I regularly pick up her medication for her. I watch her interaction with pain medication very closely and can assuredly say that she doesn’t abuse it

    Now she has heard she has to drag herself to a drugstore in order to obtain it, show id each time. This is a lady who can barely walk, whom i stand in front of and behind when she is traversing stairs, whom I have to physically lift in and out of the bathtub, who cannot stand for more than 5 minutes, cannot comfortably drive her car, can barely get out of bed.

    IF the problem is addiction, the government should look more closely at the prescribers and why they are approving this medication. The onus should not fall on the terminally sick and crippled. If the problem is drug theft, pharmacists should serve the public behind bullet proof glass. If the problem is the underground drug trade, the cops should hone in on people who are trafficking or even producing this stuff. But to make life difficult for people who genuinely need the product is cruel, selfish and thoughtless.

    The government should reexamine where the problem exists, and rightfully dispense the medication to patients who are in need of it. They should also allow their family or approved representative to be able to pick up their painkillers.

    This subject makes me really mad.

  • themacguy says:

    At my last Doctor’s appointment I was picking up my prescriptions as I was leaving. My pharmacist is in the same office as my Doctor. Now, I have had the same Doctor for over 20 years, there was a break of a few years in the middle where I left the province but we have known each-other for over 20 years. For the convenience of his patients he allowed a young pharmacist to open a pharmacy in the front of his office building and I have been using this pharmacist for the last 3 years. So anyway, while I’m picking up my latest prescriptions I am told that because of the new Ontario regulations regarding narcotics that I will have to show ID from now on when I pick up my meds. That is absolutely ridiculous. They see me at least once a month as my Doctor monitors my Fibromyalgia very closely and because we have tried so many different cocktails in the hopes of hitting on something that would alleviate a lot of my pain. I am going to be writing a long letter to Deb Mathews and straighten her out on a few things. Enough is enough!

  • Tom Liberman says:

    Here we go again. Yet more pointless bureaucracy that is bound to fail to address the problem and is almost certain to cause blowback effects. More politicization of presrciption practices and definitely more pain and suffering for patients. I note that all the people making these childish arguments against opoiod use are usually young, healthy, and have never had significant suffering in their lives. Not that I wish them suffering, but they are naive. Opiods are prescribed for a reason. The reason may not always be obvioius to non-sufferers and sometimes they may be abused, but is ratcheting up silly bureaucratic rules really going to help? This nonsense has been shown time and time again in other states and provinces to fail.
    If you want to lower preventable deaths, go after alcohol. How many needless deaths do we have from drunk drivers? How about cigarette smoking?
    @Sandra: are you an expert on morphine dosing? Just what are your ‘high doses of morphine’? Before you go around making ridiculous statements like this, I suggest you visit a few hospices. It might open your eyes a bit. I sincerely hope you are never in a position to find out the hard way.

  • themacguy says:

    The research has also shown that they are neither “safe” or effective in the long term. They do not improve quality of life in the long run” You have no definitive studies to back up those statements. That being said, a great many studies supporting the use of opioid pain medications for the treatment of chronic, long term pain can be found with a simple Google search. You don’t have any idea what you are talking about, much like the people with the Ontario Govt. that are spearheading these new policies.

    • themacguy says:

      Just a little more on this topic.

      I have been on the same dosage of Oxycodone and Oxycontin for about 18 months. Oxycontin Controlled release 20mgX3/day and Oxycodone 20mg Instant release X4/day. During that time I have also been on other medications aimed at helping to alleviate my fibromyalgia pain. As yet, my doctor and I haven’t been very successful at that. I was on one medication for a few month,Cymbalta, that was helping but the side effects became too much to cope with. Not to get off topic. At my last 3 appointments with my doc (over the last 3 months) I have asked for a small increase in my daily dose because of the tolerance I have built up. I have needed an increase for a while but I have been toughing it out. Now, in the beginning of my treatment with Opioid medication, I had to endure the indignity of peeing in a cup for my doc every month so that he could verify that I was not taking any other drugs either by prescription or recreationally. I have no history of any type of substance abuse so this was done purely for his comfort level. On all 3 occasions that I have asked for an increase in my medication dosage I have been turned down flat and on one occasion I was even forced off of one of my medications and onto another one that was not only ineffective but had horrid side effects almost immediately upon taking it. I don’t understand the science of how that particular medication works but it also affected the efficacy of my Oxycontin and Oxycodone once I was back on those and reduced the pain relief I was getting from it. I can only imagine that these new government policies are what is scaring my doc out of allowing me to up my dosage. he had no issues with my medication previously but has had a complete about face and at every appointment is talking about his comfort level and not being comfortable increasing my dose. I have been the poster child for the responsible use of my medication, never taking more than prescribed (until lately and it’s been a choice of that or suffering), never giving any to anyone to use recreationally or otherwise and I even go so far as to lock my meds up in a minisafe so that if my apartment was broken into they would not be stolen and end up on the street. So for several months now I have been suffering due to lack of sufficient medication and there are days when I can barely stay on my feet while I am coming home from work. Oh yes, I work AND WILL CONTINUE TO WORK EVEN IF IT KILLS ME. That’s how I was raised.

      So because of these new initiatives by our government, I am suffering through pain that i shouldn’t have to suffer through. I have insurance that covers my meds and some physio but I burned through my yearly allotment for physio in 2 months so medication is the only option I have. I have wasted literally thousands of dollars over time, that i really couldn’t afford, on supplements and natural remedies that have done pretty much nothing except drain my bank account. I even had one of the specialists I went to suggest some reading material that might help me, written by a famous doctor that specializes in treating Fibromyalgia and also is a big supporter of using narcotic pain medications to treat chronic pain and Adderall/Ritalin to help with the fatigue that fibro patients suffer. Then the specialist turned right around and said that she would never suggest that narcotics or ADHD drugs be given to a fibro patient. Why on earth would a doctor do that after raving about this other doctor being the authority on something and then going against his recommendations?

      The bottom line appears to be that the government now has doctors scared and the only people that are suffering for it are the people like myself that need these medications to lead a somewhat normal life and don’t need the added stress and anxiety of having to either beg our doctors for them and end up looking like junkies that are farming for meds or worry about having our meds cut off entirely because our doctor has ended up more concerned about what the government might do if they decide, in their infinite wisdom lol, that we are not worthy of our medications. I can honestly say that, given my condition, if my medications were cut of entirely then my life wouldn’t be worth living. I would lose my partner, who is the light of my life, and I couldn’t blame her for not wanting to be saddled with someone that can barely function and certainly can’t participate on an equal level in the relationship let alone contribute equally financially because I definitely wouldn’t be able to keep working no matter how much I tried or wanted to.

      So to all of you who talk about the evils of these medications, just stop and think for a minute how you would feel if your very life depended on these things. If you think that i want to depend on these medications for the rest of my life then you are sadly mistaken but I don’t have any other choice. Perhaps my doc and I will luck into some other combination of meds that will give me sufficient relief but until that day comes, if it ever does, this is how it is and these meds are what I need.

  • John Hancock says:

    The numbers of people who are becoming addicted to or dying from prescription opioids.are not pateints that suffer with pain, they are drug addicts, and if they don’t get opiods, then they will make their own concotion meth or anything else, they die that way, by the thousands.
    Take opiods away, what happens?, Chronic pain management can only be controlled in a very very small way with acetaminophen, over 100,000 north Americans die from acetaminophen, trying to control pain , so that they can work and bring in a pay chegue, but that’s OK, isn’t it.

  • themacguy says:

    To Stephen G. Gelfand, MD, if you actually are a doctor, if one patient and one patient alone is forced to suffer with pain that can’t be managed by something like Tramadol or Nucynta and then be denied Opioid medication that is enough. I have spent the last 2 years of my life being poked and prodded and having every test imaginable run on me. In Canada we have archaic equipment most notable our MRI machines that are prehistoric and can’t properly diagnose specific back issues, where nerves are literally being crushed by lumbar and sacrum disks, because while lying down there is no load on the disks. Persoannly I have arthritis in my spine, degenerative disk disease, a blown out disk at L5/S1 that puts varying amounts of pressure on my sciatic never ranging from very painful to excruciating, given the day and also has caused a near permanent loss of sensation on the outer portions of my feet. On top of all that I was diagnosed about 8 months ago with Fibromyalgia. You have the nerve to insinuate that because I don’t have cancer I am not entitled to pain medication that is effective enough for me to lead something that even remotely resembles a normal life. I have been put on both Tramacet and Nucynta both of which were completely ineffective and the side effects were horrible so don’t you dare try and tell me that I am not entitled to opioid medication. Without my timed release and instant releas oxycodone I couldn’t get out of bed most days.

  • Khris says:

    To the above poster, I live everyday with chronic pain that makes it difficult to do everyday things. It is more common than you think. By your comment I assume that you do not have pain everyday, so don’t go bad mouthing these medications or the people that use them to live a normal life because you don’t know what its like. The reality is that people who are prescribed opioids and take them as directed rarely ever actually get addicted (less than 5%). Most people will develop what is called a dependance but its not the same as addiction, also most opioids are not harmful on your liver at all, its the added tylenol and other nsaids that are bad for your liver (tylenol can be toxic for your liver in doses above 4000 mg-day, and you can die from tylenol overdose so its not just narcotics). Opioids have side effects as do all medications, like euphoria, nausea, etc and other things but you need to understand that your body gets used to the medications and many of the side effects subside. People who have been taking these medications for years are not getting high off of them. Opioids are medicines, and there’s a reason they are some of the oldest medicines on earth and people have been using them for thousands or years. Yes people can and will abuse them but look at alcohol and cigarettes which are of no medical value, how many people abuse those? How many people die from drinking and smoking and the effects of them every year? More than probably have ever died from opioids have died in one year from those two. Yet you can go buy both at pretty much any store, they do not help Anyone. This Is huring many chronic pain patients because for many these medications are the only thing that helps amd believe me we have tried all of the other options (Chiro, physio, injections, massage, non-narcotic medicines) but there is a reason that these medications are called pain relievers, because that’s what they do. Tylenol doesn’t work for everyone, or for real pain.

  • Carol says:

    Can you not imagine there are many people who can not live a functional life with their chronic pain without narcotics? My daughter has been cut off of her narcotics from our family physician. She was taking them for close to 5 years. Her dose was never increased but it allowed her to function on a day to day basis. She was able to attend school and carry on with her life. She was taken off of these drugs and now can not attend school and must rely on ODSP to survive. Does this make sense to anyone? It is called pain relief. Not addiction. How can we let so many people suffer because a few mistreat. Has anyone considered people who are dying from overdose are the people who can not stand the chronic pain anymore? I know my daughter will somehow end her life by some means because no one will help her.

  • for ever in chronic pain says:

    Well I found this article very informative. I for one have actually had my life drastically effected by pain medication. I once was a person not able to work due to severe joint damage in extremities from prior trauma. So the damage to the joints has resulted in a bone on bone pain. Pain rules my life and I even started to think irrationally and had dreams of cutting off the pain affected areas. It even got so bad that I had visions of the future and it was just black.

    after a number of corrective surgeries to take away the pain , I was ultimately left with even more pain. My options were limited and it looked like I would be on long term pain drugs such as in the guidelines for the rest of my life. I thought this was not much of an option but what choice did I have.

    after the 3-6 month adjustment period I actually started to become less and less overwhelmed by the pain. Plus the medications once stabilized were fine, it was like there was not a drug, just pain relief, no clouded head , just less pain than I had experienced in years.

    This went smoothly for 10 years.. until the guidelines came out..

    My specialist who is an anesthesiologist, pain specialist and acupuncturist was shut down with out warning. I am now in such a position that I have no idea what I will do. The treatments of nerve block stopped the medications stopped with out warning. 500 patients left twisting in the wind. The college of physicians and surgeons had no answers for us. I have been actively seeking any doctor that will take me but I am now in a extremely difficult position. No doctor wants to take on a pain patient for fear of the wraith from above. The huge investment in educations by these doctors could be snatched away by the powers that be.

    As a patient I am idea, no increase in meds in 6 years , actually reduction in fact. I educate my self about possible options to help me deal with pain in other ways. I also read the latest studies on pain issues. So I like to think of my self as proactive, but not anymore. As far as the medical profession is concerned I am a drug addict and present drug seeking behavior. I am discriminated on the bases of my medical conditions. I am a second class citizen and its apparent as soon as any new family doctor I apply at reads the medications I am on.

    To everyone else I am a mid 40s business man with breif case and middle class life who donates 3% of all his earnings every month to charities such as Plan canada and others. I am a tax payer and contributor to my community in many ways.

    Well all that’s gone on a helter skelter ride down.

    I am now with out any family doctor or pain specialist as Im an outcast. I am on a leave of absence from my job, I am dealing with extreme pain and withdrawal as well as the rest of what life usually give. Its become unbearable and I feel like Im going to wither away.

    These new guidlines are not in the best intrest of the atients that need these medications. Yes diversion of drugs is a very slipper slop and I wish I knew how to fix that issue. For the patients that actually need there medications its another subject altogether. Canadas guidlines were already lower than the international stand , now there even lower.

    Where is the compassion. Should we have to suffer as influence peddlers toy with big pharma and the great insurance lobby.

    If any Doctors in southern ontario that really do understand long term treatment of chronic pain and still believe in the Hippocratic oath , Please I urge you to post here and help me on compassionate grounds…..

  • Jeremy Petch says:

    The problem with Ontario’s approach, in my view, is that it does not reflect a best practices approach to the monitoring of prescription of pharmaceuticals – it focuses on only a single ‘front page’ issue, rather than addressing key structural problems with our current system. The gold standard for pharmaceutical monitoring was established by British Columbia more than 15 years ago. BC introduced Pharmanet, an electronic system that links every pharmacy to a central database. Every prescription (including opioids) is entered into the system. Pharmanet analyzes every prescription, and identifies potential drug interactions. It virtually eliminated the issue of double-doctoring, and provides the perfect vehicle for monitoring the prescription (and dispensation) of all potentially dangerous pharmaceuticals (not just opioids).

    Why spend time and money developing a specialized system, when another province has already developed the technology necessary to accomplish everything Ontario’s system would do, and a great deal more? The development costs have already been paid. Rather than reinvent the wheel (poorly), our government should bite the bullet and enter into negotiations with BC to purchase a genuine solution.

    For more on Pharmanet:

  • Sandra says:

    The new opioid guidelines are way too lax and still allow for high doses of morphine. These new guidelines mentioned by Jeannette Smith will do nothing to stop the death and addiction caused by opioids. Recent medical research has clearly shown the destruction these narcotics are causing. The research has also shown that they are neither “safe” or effective in the long term. They do not improve quality of life in the long run, but cause “narcotic induced pain”. Narcotics should be restricted to terminally ill patients and at the very least prescribed in an evidence based manner.

    Kudos to Healthy Debate!

  • Jeannette Smith says:

    A key point missing from this article is mention of the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain, a collaborative undertaking of Canada’s medical regulatory authorities. Published in 2010, it was developed precisely to fill the gap in evidence-based prescribing guidance for Canadian physicians as a means to help address issues of over-prescribing, under-prescribing and abuse of opioids.

  • Stephen G. Gelfand, MD says:

    This was a timely and important article. In regard to the worn-out refrain made by certain pain specialists that “doctors are being scared away from prescribing opioids, therefore depriving patients of important pain-relieving medications”, the following fair and appropriate question should be asked of any person who makes this comment: With a mounting toll of addiction and death from prescription opioids which is increasing every day, what kind of chronic pain patient other than one with cancer, are you alleging is being ‘hurt’ because doctors are ‘too scared’ to prescribe opioids? Please give specific examples of this and how you think it is a bigger problem than the growing numbers of people who are becoming addicted to or dying from prescription opioids.

    When did questionable long-term benefits of opioids for chronic noncancer pain become more important than the dramatic increase in addiction and death related to these narcotic analgesics?

    • Stacy Robinson says:

      Dr. Gelfand I suffer from endometriosis, which, due to a lack of physician education is still widely perceived to be a painful menstrual cycle – this is a falacy. I have had 4 surgeries within 4 years and each time they have found body parts stuck to other parts of my body (i.e. tube twisted and ovary stuck to my pelvic wall), I have endometriosis on my bladder, on my bowel, in my leg, etc. I am in constant pain – never ceasing and never ending and have had many whole body parts and pieces of body parts removed because of atrophy and adhesion due to the disease. Following surgery, where they fix the most obvious traumas I am in need of no medications, other than Nexium for the ulcers that have been created due to shots of Toradol in an effort to avoid narcotics due to physicians with your perspective (which obviously does not include a history of significant chronic pain) on narcotics. Despite the extremely high doses of NSAIDs I crashed in February and oral doses of narcotics didn’t even come close to relieving the pain enough that I could will myself to get out of bed to care for my children. I went through hell with three different physicians, being shuffled to someone else’s daysheet, precisely because physicians were more suspicious of me than empathetic, until I finally was treated by a physician who had a realisitic perspective on my situation and started me on the Fentanyl Patch – until I started on this every moment of my life was spent in agony though I still managed to hold down employment (managing a medical clinic). The Fentanyl Patch is what enabled me to get out of bed, care for my children and drag myself through life while I waited an excrutiating 8 MONTHS for a 3 hour surgery that would negate my need for pain medications – due to the fact that I’m not dying just in crazy pain which doesn’t help triage. I am NOT a singular case, there are many people with similar stories to mine. The issue is that when patients are speaking to their physicians, their physicians are always wondering whether they are telling the truth or trying to score drugs and physicians don’t have enough education about narcotics to be able to balance adequately dosing suffering patients and not overdosing patients..when in doubt they air on the safe side to protect themselves and then the patient drags themself home to beneedlessly overwhelmed with getting through the basics in life – not to mention the impact on the family situation. Chronic pain affects the sufferer physically and psychologically and this is not understood by enough physicians. I hope that instead of hold a defensive position you take 30 minutes to do some research on how chronic pain affects patients and maybe spend some time to dispel your myth that “chronic pain is an ache or ignorable level of pain. I had an ecoptic pregnancy where the fetus grew to 5cm x 8cm in my tube and didn’t seek care because the pain was on the same level that I experience every day, it was just a little more acute…I am not alone even if it makes your job easier to think so.


Karen Born


Karen is a PhD candidate at the University of Toronto and is currently on maternity leave from her role as a researcher/writer with

Irfan Dhalla


Irfan is a Staff Physician in the of Department of Medicine at St. Michael’s Hospital and Vice President, Physician Quality and Director, Care Experience Institute at Unity Health Toronto. Irfan also continues to practice general internal medicine at St. Michael’s Hospital.

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