Canada’s prescription opioid crisis

There is a prescription opioid crisis in Canada. While these drugs are effective in treating acute pain, and pain near the end of life, the evidence to support long-term use in patients with chronic pain is weak, and for many people the harms exceed the benefits. Prescription opioids are also highly addictive and easily misused.

In Ontario, the number of deaths related to prescription opioid overdoses increased five-fold from 1991 to 2004. Recent media reports suggest that the numbers are still climbing. Studies have found that prescription opioids are now the street drug of choice in large Canadian cities.

However, the national picture of harm related to prescription opioid use is hazy. Canadian researchers have noted that that there is  “fragmented, unsystematic and insufficient” national data and monitoring of prescription opioid use, misuse and deaths. Beyond monitoring, experts have suggested that Health Canada needs to do more to regulate the pills themselves, and the uses that they are approved for.

While Health Canada has a defined regulatory role in the approval and labeling of new and currently available drugs, the federal government has been criticized for not doing enough. There are other federal government bodies – including the Public Health Agency of Canada – which experts say could play a larger role in improving the monitoring of prescription opioid use and harm.

Prescription opioid crisis: national leadership needed?

The toll of prescription opioid-related harm is manifest through the growing number of overdose deaths, increased demand for opioid addiction treatment programs and a state of emergency declared in some First Nations communities due to prescription opioids.

There is a growing chorus from advocacy groupsnon-governmental organizations, and health care providers that the federal government needs to step into more of a leadership role to help tackle the complex problem of prescription opioid-related harm.

One area that has been identified is around Health Canada’s drug approvals and decision making.

Experts have pointed to the November 2012 Health Canada approval of the generic form of OxyContin, oxycodone, as an example of poor Health Canada decision making related to prescription opioids. The patent on OxyContin expired, and it was replaced with a more tamper –resistant formulation, known as OxyNEO, which is difficult to snort, chew or inject. Generic oxycodone lacks the same tamper-resistant formulation, which makes it easy to snort or inject.

Leona Aqlukkaq, federal Health Minister at the time, responded to critics by saying that approval of this drug was appropriate, given the evidence supporting its safety and use.  In a letter to provincial Ministers of Health, Minister Aglukkaq articulated that much of what is needed to deal with prescription opioid misuse “all clearly falls under provincial and territorial jurisdiction” as well as “the medical professionals they regulate.”

Provincial regulatory bodies for physicians, pharmacists and dentists are among the organizations which have taken a leading role in sharing guidelines to educate members about prescribing and monitoring practices for prescription opioids.

For example, the College of Physicians and Surgeons of Alberta does a great deal of education and quality assurance about prescription opioids. Education initiatives include the Prescription Prescribing Practices Program which provides education and peer support to physicians about prescription opioids. The College also has a long-standing monitoring program in place, known as the Triplicate Prescription Program, which monitors the prescribing and use of drugs prone to misuse and abuse, and includes drugs like Oxycontin and Dilaudid. Research from the United States has found that such monitoring programs work and can reduce misuse, drug diversion and overdoses. Janet Wright, Assistant Registrar for the College says that the education and monitoring programs are in place “to make more information available to physicians about their own prescribing practices, and their patients.”

Rona Ambrose, appointed as federal Health Minister in July 2013, has hinted at prescription opioids becoming an area where the federal government will take a more active role. Ambrose stated in November 2013 that the National Anti-Drug strategy is being expanded to include prescription opioids and that research is underway to “provide much needed information on this important topic.”

What would a more active federal government role look like in dealing with prescription opioids?

Learning from the US approach to prescription opioids

The International Narcotics Control Board reports that prescription opioid misuse and harm represents “a major public health threat” in North America. Canada has the the second-highest prescription opioid consumption rate worldwide, just behind the United States. The United States Centers for Disease Control and Prevention (CDC) has called prescription opioid misuse a “dangerous epidemic”.

In the United States, overdose numbers from prescription opioids like Oxycontin and Percocet have quadrupled in the last 15 years. The United States CDC reports that for every death caused by prescription opioids, there were nine admissions to drug treatment centres.

The United States Food and Drug Administration (FDA) has a mandate to protect public health and ensure drugs are safe and effective. Unlike Health Canada, the FDA did not approve generic OxyContin. The FDA decision noted that the risk of misuse and harm outweighed the benefits of this medication.

A Canadian Medical Association Journal news article wrote that the FDA decision “calls into question” Health Canada’s approval of generic Oxycontin.

The FDA has been seen by some Canadian observers as more transparent and activist in their approach to tackling prescription opioids. The FDA makes efforts to get public input, as well as share decisions in a transparent, open way, including through blogs by leading FDA decision makers. Morgan Liscinsky, a FDA spokesperson notes that these strategies are compelled by “strongly held opinions regarding prescription opioids” and that public input “contributes to the agency’s [FDA’s] decision making process.”

In contrast, there are no comparable Health Canada communications, and responses to criticisms are often met only with statements published in the media releases section of Health Canada’s website.

Although Health Canada has been described as lagging behind the FDA, the FDA still has its critics, including Andrew Kolodny, a psychiatrist and President of Physicians for Responsible Prescribing (PROP). Kolodny argues that the FDA isn’t doing enough to “have a serious impact on the epidemic.” He says the FDA could do more – including narrowing the scope of uses for prescription opioids to only severe or end of life pain. “Had the FDA done this a decade ago, thousands of lives could have been saved” he says.

In addition, the October 2013 FDA decision to approve Zohydro ER, a new extended-release prescription opioid that lacks tamper-resistant formulation has been widely criticized. Critics include attorney generals from 28 states who submitted a formal letter to the FDA requesting that they reconsider the Zohydro decision.

Anna Mehler Paperny, a journalist who has covered prescription opioids says “the FDA approval on Zohydro is out of keeping on their approach to prescription opioids.” She highlights that observers will be watching carefully to see how Health Canada responds to a request by Zohydro’s manufacturers approval.

Advocates press Health Canada to narrow labeling, better monitor prescription opioid use and misuse

“Health Canada and the FDA aren’t doing enough” when it comes to regulating prescription opioids says Ada Guidice Thompson. She describes herself as a bereaved mother. Guidice-Thompsons’ son Michael died of a prescription opioid overdose in 2004. Michael had been prescribed opioids by his physicians to treat kidney stone pain.  Guidice Thompson is now active in RxReform – a group made up largely of family members of those who have died due to prescription opioid-related harm.

She believes that “overprescribing is fueling the epidemic”, and the uses for prescription opioids need to be narrowed. Guidice Thompson says that these powerful drugs should only be used for end of life, or acute pain. She believes that Health Canada should change the labeling on these drugs to vastly narrow the permitted uses. She notes Health Canada’s mandate to ensure drugs are safe, and highlights that while the safety of short-term use of prescription opioids for acute pain has been well established, “no one has proven that they [prescription opioids] are safe and effective for long-term chronic, non-cancer pain.”

David Juurlink, a physician and researcher at Sunnybrook Health Sciences in Toronto agrees saying, changing the labeling would be helpful, but may not make a difference in practice. Juurlink notes that “doctors are free to prescribe” and “the practice is entrenched.”

However, Juurlink does note that changing the label could be part of a larger approach by the federal government to deal with prescription opioid misuse. He also highlights that a lack of national information around “the harm of these drugs ” saying “no one at the federal level can tell you how many Canadians last year died of prescription opioid-related causes.”

First Do No Harm Report – will it lead to change?

In March 2013, a landmark report First Do No Harm: Responding to Canada’s Prescription Drug Crisis was released by the Canadian Center on Substance Abuse (CCSA). The CCSA is a non-governmental organization with a legislated federal mandate to reduce the harm of drugs and alcohol. The CCSA receives funds directly from the federal government. Report recommendations were aimed at improving prevention, education, monitoring and surveillance as well as enforcement to curb prescription opioid-harm and misuse.

Recommendations which relate directly to federal government ministries and agencies include the development of  a standardized pan-Canadian surveillance system to better grasp the harm these drugs are causing nationally and bring together the current patchwork of provincial and territorial information sources on prescription opioid-related harm.

A Canada-wide prescription monitoring program was also recommended. Such a program could build on prescription monitoring programs already in place in some provinces through regulatory colleges, like the Alberta Triplicate Prescription Program. 

The recommendations also highlight that Health Canada could strengthen regulation and review legislation related to the safety of these drugs, but did not explicitly mention narrowing the labeling of uses for prescription opioids.

However, nearly one year after the publication and release of this report, it is unclear what steps have been taken to act upon, or respond to the recommendations. The recommendations outline which levels of government, agencies and organizations should act as leads on these recommendations, and identified leads include Health Canada, the Public Health Agency of Canada, as well as regulatory colleges, industry, First Nations groups and patient and family associations.

David Juurlink says that “it isn’t clear how the government is responding to the CCSA report” saying that “perhaps they are doing something, but if so it isn’t apparent.” Juurlink says this is one more reason why increased federal government transparency is needed to deal with the prescription opioid crisis.

The comments section is closed.

  • Susanne St Jean says:

    I am a disable lady recently my doctor retired and I move to a safer place, I have not found a new family doctor and no one will refill my pain med, What I have done in the pass with my family doctor purchase a safe and sign a note. May 31 I have been without my meds my pain level is a constant 10 my doctor had me on a good regiment which help me to function during the day. Where i could do all my stuff clean my house cook a meal. I understand we have a addiction problem here in Canada, but why is every single person like me being put in that same majority of people? Why do I have to pay for this where are my rights as a person my entitlement to have a help with my pain. Years ago when people were driving drunk the government never limit the amount people should buy beer. But to cut people off totally that is sad. and wrong.

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  • Richard says:

    I am a little concerned that those with legitimate conditions are getting caught up in this. It appears that the poor and uneducated are far more likely to be denied regardless of their condition. The private for profit methadone model also appears to be disproportionally filled with the poor and uneducated. In a city of 100k we now have some 13 of these “clinics” In speaking with some of the patients I found many had ended up there after there doctor and moved and/or retired Some 30% of the city lack a family doctor. The current MMTP is little more than drug dealing under the guise of medical care. Are we not simply substituting one prescription opiate with another? In the process these “patients” find themselves in a condescending patronizing program designed to sap the last bit of self esteem they may have. As such it is no surprise that the vast majority of the “patients” are poor and uneducated What few rights they do have are simply ignored for example they are apparently required to consume their medication in full public view when the CPSO indicates a private room should be available to those who want to retain their privacy. on the one hand we are up in arms over the crisis however I see no difference in whether these patients receive their medication in the same way as anyone else The gov’t ran this program for many years and until the private providers realized what a money maker this potentially was and instituted a number of “safety related” requirements which coincidently also generate a great deal of profit. Treating opioid dependency with another Rx opiate at a huge cost to the taxpayer is not solving anything At some point there will be a huge class action and they will be treating methadone addiction with a short half life drug such a oxycodone. If MMTP was a good program it would not be restricted to the poor and uneducated Where are all the high earning well educated addicts certainly not in any methadone clinic I have heard of

  • Laura says:

    Daily 24/7 pain at a level of 8 on 10. Try living with that for more than a few weeks and you’ll be begging a doc for pain meds. Chronic pain comparable to cancer,not a chance. So,why compare. Cancer has so much research and funding and chronic pain conditions get left I tbe dust. We suffer in silence and are punished for criminal activity and doctors who over prescribe. Why not ask those who suffer what pain meds help with:you want research that shows it works. I am young,have a chance to follow my dreams but my chances for a life get cut when doctors don’t hear how pain meds help people function. It’s worse than cancer,at least with cancer you win or loose,with chronic pain you loose,but don’t die.YOU EXIST and suffer in silence. That’s not a life. Doctors have an oath to do no harm well Taki g away pain meds from those who truly need it is doing g harm. If there is criminal activity punish that, if there are irresponsible doctors punish them not the people I pain who only want a life. The surgeon that ruined my foot who gets paid over 300 grand a year still has a life but I’m being denied one because I have chronic pain. Ever try to do relaxation exercises when at a level of 8 on 10 pain,a supposed pain management technique? Then if you think that works think again, and you wonder why people get drugs off the street. Imagine having hip surgery and the doc handing you a relaxation Cd intead of some pain meds. How would you react? Chronic pain is not s mental health issue, so stop treating it like one. If you dont want to use pain killers as a solution do research on causes and treatments that work. Doctors ignore what they don’t understand but that doesn’t mean that’s not one living life lost. To do no harm. Until useful treatments are found pain meds are what help people with pain function.TO DO NO HARM! Taking away pain meds from those who truly need them is doing harm-against a doctor’s oath of practice.

  • Peter McCorduck says:

    MOST CRITICAL. Doctors Prescribe Scheduled OPPIATES for more than “6 weeks” instead of sending the patient to a Specialist. I for instance Have been on non schedultd Opiates for Years now For the rest of my life My surgeries cann no longer be done SAFELY the COMMENT ” IF you had come to me 5 years Earlier I could of done this Safely NOW its Dangerous too close to the C2 Spinal chord. ” have WE Chronic pain sufferers hear this far too regularly. Now left on a life of Chronic pain For Ever . Reasons CANADA had no specialists especially in Neurosurgery. 6 weks is the recommended Point to question a Problem as being self healing. Spines once Broken and disks once herniated Do not heal ( my issue ) 17 Disks and 15 vertebra. Come into my LIFE.
    Because Doctors are not Pharmacologists they prescribe the wrong opiate. instead of a simple T3 or EMTEC 30 they OPT for a drug that causes TOO MUCH DRUGED UP sensation sending the DOPY feeling as what is needed Before Pain reduction can begin. BEGIN os still in pain and that person needs more to ELIMINATE the PIAN . NO matter how much a person takes that will never happen .
    Little to no experimenting with NeuroEpileptics is done to reduce NERVE damage Pain . This is 90 % of the chronic pain although the muscular skeletal Pain is real and Cannot be helped with THe Nerve med the 2 cam make live tolerable This is how I live for 25 years mild OPIATES and Lots of Gabapentin. I had to Promote the Program and get off Oxycodone .
    All OXY’ did was make me enter a stupor. on my Pain free program I am totally lucid all Day. I never feel drugged as All my OXY’ friends do. I thus question doctors and ask IF I can do this with my damage WHats going on Certainly we have an IOPIATE OVER prescription but is it Right to simply say all OPIATES are BAD I must live With SO much muscular Skelital pain ( Nociceptive pain) and so much Neurological pain NO Scheduled OPIATE would help me. Could 99% of Opiate users benefit from this Method .
    MY LAST COMMENT IS FENTANYL the Current issue this is the Suicide Drug of choice risen in proportion to those of us Inappropriately taken off needed Prescription OPIATE SCHEDULED OPIATES. From pain tolerated to pain engorged. IF I am removed from T3 or reduced dose I have one Question to ask myself Do I opt for Death With Dignity or Fentanyl. C

    • Peter McCorduck says:

      OPIATES will Always be an ISSUE as long as they are Addictive ?? USER Dependency to live a potential real life. I hope tis clarifies what I wrote above. Gibberish! I am dependent on T 3 + Gabapentin and live with Just Tolerable pain . Nothing surprises me or Gives me more pain as long as the Gabapentin is ON strict schedule . Pluss or minus 100 Mg /day. The Opiate is needed to manage the Nociceptive Pain. and I could titrate down to 2 T3 per day. and stay there for 5-6 weeks then it slowly rose to 8 again AFTER A successful Chemo therapy for Cancer. The Chemo attacked the Nerves in the feet hands and I have MOBILE Spots of intense Sharp neural pain in my Quadricep’s That is a Pain out of the RUILE book on how pain should feel. Ugly Awoken from a Sleep that has mostly Drug induced . Rising 618 to 40 cm’s from the mattress . AUTOMATICALLY. the mix of opiates Simply stop the Neuropathies getting worse and Hide my Other Pains from it. .During the last Chemo session I slept and This pain caused the same Gymnastics. triggering various nerves to vertically launch me Almost perfect but they put they sides of the bed up and L launched OVER the rail one leg and arm. Woke myself to find the nurses removing the Chemo drugs from my Pump. End of chemo half way thru the proposed , Add the new Neural pains to the Line up awaiting their turn to Torture me . I am still at the max dose of both and live in excruciating pain from the Chemo. The saying if your left foot hurts I know the cure ____ Stamp on the right one you simply forget the left foot exists. that’s me Chronic headache Due to Nerve damage in the brain . L SPINE Nerve and Nociceptive pain and Nerve damage . C spine Left hip Right Femur Right knee. Trigeminal Nerve Severed most are 19968 Wounds now disintegrating . And a list of Super pains awaiting the night to All stab me for days on end . A torture Worse than a 10 day suffocation process then loosening the rope . need I say more the Nerve damage in now 5 pronged so far only 3 have combined hatefully That’s the day I am trapped in Hell. More pills Emtec 30 OR GABAPENTIN . It was the missed do at bed time that they clamor for. That let them, all out of the Box.

      NOW DR. PRESCRIBE FOPR ME the missed Opiate or an opiate Free Program I have tied after I have Rid Codeine as a dependency a dependency that will last only 1 monthT3 Sorry I have tried them all YOU HAVE no Evidence that ANY of the top 20 Replacements will help me one tiny bit. NEVER PRESCRIBE A nerve blocker WITHOPUT a small dose of T3 OPIATE. That can be spread over a day in small quantities . IE 1/2 a T3 per 4 hours that’s 3 Per day 90 mg of Codeine. Very well tolerated And Monitor it By having urine tests at random . E-mail is fast Be able send a RRED letter ordering him to Go Pee a text on his cell what E communication he has . Not all are so privelidged But we do have Mail delivery.
      OPIATES ARE NASTY demons and its this we need to control Some are Easily Pilled under this bus. But use them wisely minimal dose closer together as Codeine has a short half life. But ass Gabapentin to the mix. MAKE ALL opiates Ie. Emted30 40 scheduled and routine testing must ne done . On the small dose You have. CONTROL places RULES in the pain game and Learn to accept Your pain

  • Lana Kirby says:

    Canada should not rely on what is going on in the US as guidelines that should be adopted by Canada. The statistics are terribly skewed when it comes to the deaths truly attributable to true prescription drugs that came from a pharmacy. In counting the statistics for opiate overdoses in the US, ALL overdoses are counted as “prescription drug” overdoses. Highly inflammatory and misleading. What has happened in the US is that most chronic pain patients have lost their lifeline to any quality of life, the opioid component of their pain management plan. People are losing functioning. Avoidable decline. People aren’t being tapered, they are cut cold turkey and sent home to gut it out unsupervised by medical personnel. People are committing suicide. Don’t make the same mistakes the US has. Their trumped up “war” on prescription medication is having ABSOLUTELY NO EFFECT on heroin overdoses. Look at the “real” stats. Heroin overdoses continue to rise and good, law-abiding citizens who have never abused are paying the price … which has absolutely no impact on what they’re supposedly trying to do.E.

  • Margaret Ann Killin says:

    The solution here is physician case monitoring on an individual patient basis. The research on opiate treatment is not comprehensive enough to inform drastic changes as recently introduced in BC. Alternative soft treatments suitable for early intervention and prevention, cannot possibly be effective for late stage chronic illness and debilitating pain. And there is inadequate research into the effectiveness and efficacy of alternatives for late stage pain. More anecdotal patient research is needed together with careful monitoring of patient outcomes.
    Primary care and tertiary care , at least in BC, is being further restricted and withdrawn as wait lists continue to grow. Clearly, in the context of massively reduced Medicare services, and poor quality of care I might add, BC’s new drug policy will increase morbidity, patient suffering, self medicating and illegal substance use. Patients here are already forced into the private sector to access primary care physicians , diagnostic imaging and surgeries, if they can afford it. Those who cannot, are simply not getting treatment for years at a time, or intermittent, ineffective conservative treatments that do not match the persistence and severity of their condition. These issues require urgent attention by Health Canada and Provincial Health Authorities.

  • Conni says:

    I am in Chronic Pain, every day from Lumbar Spinal stenosis, 3 bone spurs, 3 bulged discs and facet joint osteoarthritis. I am 41 years old and I work full time in a Residential Care Facility.. How am I supposed to work without breakthrough medications.. I went to my doctor yesterday and he refused to give me percocet, which I need in between my oxy neo.. he just increased my oxy neo to 30 mg from 20.. thank you so much.. I am not a drug addict.. I am in pain all the time and no one seems to care

  • HUMAN says:

    I realized something today. Social Justice worries i.e DEA + CDC, are dangerous people! this entire view point is laced with lies and supposed white knight philosophies. People do drugs for fun. Others use drugs for medical conditions.

    in the end it is “We the individual who makes choices” not government, schools or teachers! What makes life reality, is my own walk and talk!

    Keep this argument simple and you will see the lies from Government within seconds. We, do not need your SJW thought from a broken rule ages past that only demonizes our safety to be “HUMAN” !

  • VPowel says:

    Part of the outcome of this will be that the distrubution of these medications will move to the hands of organizations like the one run by “El Chappo”. I think at least half the truth has to do with creating a demand for newer formulations by Big Pharma for so called “non-narcotic” medications. Once a drug has been on the market for a period of time the price/profit margin goes down and there is a lot of economic (thus political) pressure to allow creation of demand for newer medications.

  • Hugh says:

    God help those of us with multiple sources of chronic pain AND CRPS Doctors helping themselves by cutting us off.
    The current GP says “Pain is merely a side effect of missing your pain meds”

  • wayne watkins says:

    what about the people in horrific pain like I am. I had a lower back operation and a metal bar with 3 metal discs put in my neck. I was taking 1 8mg dilauid every 6 hrs. and 2 zopaclone for sleep. my doctor retired and a new one from africa took his practice. he cut me completly off med. and sent me to a drug and alcohol counseler. I was taken off all medication. she told me I COULD HAVE BACK EITHER THE DILIAUID OR ZOPACLONE. I tried the dilaudid for 2 months couldn’t sleep. lost 40 lbs. in 2 months almost died. I then asked to go zopaclone, at least I can get a few hours sleep. I also have a bad condition called spasmatic torttacallis. my head is always jerking back causing severe pain in neck. this happens every second. I do not consume alcohol, smoke or take any other pill or drug. my life is now total hell, I can’t even mow my lawn with out 3 hours of heat pad. the doctors are now protected., but what about me? what about the people that don’t abuse the system, like me. how many people are going to die trying to stop the pain? do you even care?

    • Hugh says:

      I hear you. I recently had to find a new doctor as the other one retired. He was fine with my use of oxyneo for mobility.
      Until he learned of the paranoia surrounding opiates.
      I have serous arthritis is multiple locations and am denied surgery due to very pain CRPS (nerve disease) and have some metal plates too.
      New doctor is Nanaimo says “pain is merely a side effect of not having pain medication’
      As he continues to cut me off after 10 years of no abuse at all
      You can not get a new doctor if you have one.
      God help us!!

      • joanna pinne says:

        hugh: i completely understand. horrible situ in nanaimo. i am a patient advocate here and am ready to shoot myself some days. docs are lazy, weak, cruel…ad your own adjectives. we need more MEDIA on this disgusting politically motivating situation. i am undertaking media campaign first thing in new year. any and all support/advice welcome. hang in there and god bless you altho these sorts of words don’t do much for my clients given the nightmare their lives have become. joanna pinne

  • Bonnie Stein says:

    Sorry to say, but if our narcotic prescriptions are going to be stopped , I have heard by the end of November 2015 for Alberta , they want everyone off of triplicate medications, where we will turn to?
    to continue living a daily productive life.
    A lot of patients have said they will commit suicide, and a lot of the patients have said they will turn to the streets out of desperation, how many deaths will this add up to compared to what there is now?
    Having legit pain patients turning to the streets for their medication? This is going to be huge!!!
    Cannot we start a coalition to keep our pain free lives?
    I have a right as a chronic pain patient to try to live a normal as possible life, and if my pain pills help me do that so be it !!!!

  • Travis Keeler says:

    As a former daily user of Oxycontin for many years due to chronic and debilitating back issues I fully understand and sympathize with all of the people who are suffering from chronic pain. Having said that, there is absolutely NO denying that we have an epidemic on our hands in north America arising from the misuse of opioid medications. The solution is NOT to discontinue the use of these legitimately effective medications but to seek out alternatives to ensure that the medications are properly prescribed, properly monitored and appropriate punishments are meted out to those who perpetuate the cycle of abuse. There are many methods now in place to ensure that the link between Doctor and Pharmacist is not compromised by “Doctor Shoppers” or altered prescription doses etc. The next link in that chain is the consumer. This is where it begins to get a little more complicated. How do we ensure that the patient presenting the prescription is going to end up the “end user” of the medication?? We CANNOT. Therein lies the problem. Unfortunately for those who DO take their medications properly and as prescribed there has been a ‘cottage industry” created by those who would seek to profit from the misery of others. BUT…there IS a solution. A process of random, mandatory re-counts of medication enacted to weed out those who divert and sell their medications would drastically reduce the availability of these drugs on the open/black market and allow individuals who are truly benefiting from them and using them properly to be recognized and lauded rather than subjected to inference of criminality/misuse. I am very curious to hear feedback from chronic pain sufferers on this subject. Would you be willing to consent to random re-counts of your medications in order to eliminate or drastically reduce the diversion of opioid medications on the black market???

    • END IT says:

      Or I have an idea! We end the drug war all together?

    • Richard says:

      I am uncertain how this would be effective? Would the seller not simply wait before marketing the drugs? I think the problem lies with the poor quality of care we have in Canada. It seems so impersonal The best practice is for the doctor to KNOW HIS PATIENTS. I recently accessed care in what we would consider a 3rd world banana republic. I was in for a shock, the care I received was GREAT…I had an abscessed tooth for 20.00USD I got a real check over a Rx for antibiotics and 12 T3s My wait was very short, the office was clean tidy and professional. In comparison to an E/R visit at home THIS WAS A DREAM. I am not really that surprised by our painkiller use in Canada especially when you consider our aging population. Careful monitoring in a pain management program is the safest way to go. Self medication by those who are being “helped” through denial of medication appears to be when deaths occur

  • John says:

    Keep government out of our medicine cabinet’s. I think the problem is education, most Dr’s do not give enough information, on how dangerous these drugs can be. But at the same time these opioid’s, help alleviate pain, and true, they have side effects but let me tell you what is going to happen if you restrict these people in pain and have them use co-analgesic’s. You will have people bleeding out and such a run of liver damage, never seen before because these analgesic’s do not work that well and the result will be, people will be taking them by the bottle. I do agree something has to be done, but your going to kill a lot of people your way, because when you’ve been in pain along time, you will do what ever it takes to have pain relief. And if one can’t get the relief, the thought of a permanent solution is eminent….john P.S. You need people that have or are dealing with this debilitating subject, ( pain ), to have a voice, because if you haven’t been in pain, you have no way of knowing what is at stake.

  • Michele Peterson says:

    My husband was on oxycontin , prescribed by his doctor for 160 pills per month in 1995 , he chewed nicotine gum all day to quit smoking, all of his teeth started cracking and falling out because of the oxycontin and then he was diagnosed with throat cancer, had his first chemo treatment and died of a heart attack! Bottom Line, drugs kill and Big Pharma gets away with murder. It is all about money. Everything we need to cure every disease is on this earth.. Our bodies are not meant to deal with all these chemicals, I now have a Superbug caused by antibiotics. All of us, the people, it is up to us, The government , serves and protects……Themselves

  • M. Morris says:

    I sincerely agree with above mentioned. However I believe that people in chronic pain that are not dying should be able to live without pain and continue to go about their regular routine the best they can. When you can prove….ie…ct scan , MRI , states clearly you can’t function without help, and medication is not prescribed because of abusers there’s something wrong with our healthcare system ! Please help those of us that really need it. Thank you.

  • Alice Boring says:

    If opiod anelgesics ate not going to be prescribed for chronic pain, what is .

  • Johnathan says:

    The FDA approves Zohydro while pulling Oxycontin, while Zohydro is not tamper resistant. Purdue Pharma introduces OxyNEO 2 years after they did in the USA and yet said they ddid it as fast as they could, also the patent was about to run out, so they changed the formula to keep copyright protection, not to help patients. Health Canada under the Conservative Government really helped pain patients who only Oxycontin works for when they decided to allow a generic cheaper version of it. While the abusers have moved to another Purdue product to abuse, hydrmorphcontin, which could be made tamper resistant tomorrow, but is still in a format that can be manipulated, howcome Purdue Pharma, somebody please ask Randy Stefan who comments for his employer Purdue Pharma, why this is so.

    With all this deceit and some pills being made tamper resistant at the expense of the users health, OxyNEO has a cancer carcinogen, classed by the World Health Organisation and Canada as class 2 carcinogen, obviously it makes a lot of people sick and no long term tests were done to make sure it is safe when used long term, one has to wonder what is really the truth as both sides keep spinning the truth. Opiods have been used for hundreds of years.

    Texting kills more people in Ontario than opioids and drunk driving combined so please get your priorities straight when reporting about abuse of substances. Some people need opioids to function, and while diabetes sufferers never have their insulin use questioned why should pain patients who are legitimate? People metabolise medicines at different rates so some require higher doses. To arbitrarily put a 200 mg per day recommendation as the limit for pain patients is very ill thought out. Why not go after the source of these drugs that make it to the street, such as crooked doctors and physicians and those few who sell some or all of their medication. This alone would take most of the drugs from people who should not have them.

    What about the people who use them as prescribed and work, pay taxes, who have to take a high dose? There is a better way and it is Law Enforcement, that is the proper domain for illegal drugs, of which diverted marketed opioids are, and leave those alone who have been helped by them.

  • Tim Chauvin says:

    I am so sick of being lumped in with the people that only get these medications for the so-called”high”that some people get by using these meds. Or the people that only get it to resell it on the street. I am a 42 yr old father of two. I have been experiencing chronic back and neck pain since I was sixteen yrs old. I have had 2 cervical spinal surgeries, and the only time that I ever felt normal, where I could goto work everyday and actually enjoy my life was only when I was prescribed and taking on a regular basis methadone. But now due to the fact that new laws have made it all but impossible for doctors to feel comfortable enough to prescribe these types of the more heavy duty pain medications, people like myself cannot get very much relief from the lesser more mediocre narcotic pain medicines, all because there are those rotten apples out there that are ruining it for the people that really need it to try and live a happy productive life!

  • Dorothy Garner says:

    These reports do not cover the normal persons situation for quality of life. We should have the proper dosage of opioids to make day to day life liveable. Closer monitoring of people who have a history of misuse and abuse is highly recommended. If a person who “obeys” the Doctor’s prescription continually,then “LET LIVE”. I cannot accomplish any household chores or go and get groceries (on foot),about 3 or 4 blocks,without substantial pain. I say it isn’t humane to tell me that I can’t have my medication. I recently had open heart surgery due to a Staph infection caught at the local hospital,and when I returned home I found that my dosage had been reduced greatly,without telling me or getting further medical testing to substantiate the decrease,now I have to “SUFFER” and also be made to feel like a addict. My history is nothing but greatly improved and we did without any assistance, just each other. The person who almost killed me, by strangulation, and set fire to his house and my belongings received a slap on the wrist, while I now have a ongoing deteriation of my back that causes debilitating pain. I am told that I can’t have the medication that I’ve been on since the year 2000′, and that it has to be decreased due to “WHAT” my back getting all better??????? PLEASE HELP!!!

  • Roger says:

    July 8, 2014 at 3:45 PM

    I SYMPATHIZE for people who suffer from chronic pain, but the problem with people is that even if you show him a natural way to get pain relief even within minutes, they’ll hesitate since it didn’t come from a so called (an over inflated ego doctor) then they shun you!!! I know I’ve tried, some do listen, yes it is possible to get pain relief within minutes, I even treated a lady at a market place, she was even on morphine and took less during the day so that she can do shopping with her husband, her pain was 7 to 10 – after 5 minutes I reduced it to about a 2, which she hadn’t this relief within the last year, never the less she left without any intention of following my procedure … pain can be resolved withing minutes and without anything entering the body! – don’t wait till health Canada or our health system get involved, today money is GOD ……

    • Tim Chauvin says:

      Hi Roger, I’d love to hear what your method is for immediate relief from pain? Having pain from the age of 16, now I am 42, I’m willing to give anything a try.

  • Endless Pain says:

    It is frustrating to read these headlines. People who are going to abuse prescription opioids will find a way to do it no matter what drugs are banned. Banning effective, legitimate pain medications only serves to cause additional pain and suffering to those who need them to get by with their daily lives to live with a tolerable level of pain. I take pain medications daily and require them to reduce my pain to allow me to assume regular activities – not eliminate my pain, simply reduce it so it’s tolerable. People who do not suffer terrible chronic pain daily do not understand what it’s like. Those of us who live in pain do not take these medications for any kind of high/euphoria that everyone seems to think is the only purpose of the drugs. There isn’t even a euphoric feeling of any kind when taken appropriately and in the proper dose for legitimate pain… it simply brings the pain down to a tolerable level. People who do not suffer this do not understand that.

    Oxycodone is effective for my pain and I have not been responding to the reformulated, “tamper resistant” OxyNEO, so my doctor has authorized my scripts for generic forms of the old OxyContin which everyone is all up in arms about. And it works. We even tried Hydromorph Contin, the extended release version of one of the most potent opioid products available on the market Dilaudid, and it was not effective like OxyContin was for my pain. Fortunately, I do not have to pay an arm and a leg for my proper medical treatment because my private drug insurance plan covers generic OxyContin with a written explanation from my doctor, but for those that rely on provincial drug plans it does not make sense to make the sufferer pay hundreds of dollars a month for their medication out of pocket, all because of the abusers.

    It boils my blood to hear that governments are trying to ban the drugs to protect those who abuse them, and think that leaving those who actually need them out to dry is perfectly ok. People will abuse drugs no matter what. What will the governments want to do when abusers start targeting Dilaudid/hydromorpone, which I take an immediate release form of for my breakthrough attacks, because they got rid of oxycodone? Ban Dilaudid too? Then the one after that? Until there are no pain medications left?! It is not realistic because there will always be something and abusers will always abuse. Any ban on oxycodone, or any drug, will not fix the problem. Easily accessible addiction treatment is needed for those struggling – as easy as finding an addiction clinic and walking in just like you would go to a walk-in clinic with a cold. Eliminating medication won’t fix the problem as there will always be ways for the abusers to abuse. Provide proper abuse and addiction treatment for them instead of eliminating the drugs that others actually need to live a happy life without excruciating pain.

    • Chronic but managed says:

      I agree with Endless Pain. It irks me no end for those of us in society who are saddled with chronic pain to be denied a useful necessary remedy. I am not an addict – stop treating me like one. I treat my medication with respect and do not sell it, lend it or otherwise dispose of it. The solutions being proposed in this thread are like making everyone put governors on their cars just because the occasional driver decides that they are going to speed.

      When I was first diagnosed with my condition (about 30 years ago), I was very leary of the pain medication, so much so that I was denying myself relief and spacing the doses far beyond what the prescribed dosage was (instead of once every four hours – I was cresting once every eight). At my next appointment with my specialist, he wrote out a new prescription at the end of the visit. I told him that I didn’t need it because I still had some left from the previous visit. At that point he leaned back in his chair and started to quiz me about my progress because I certainly was not recovering as fast as he anticipated. I “fessed” up and told him that I was muscling my way through the pain as I got closer and closer to my “self-prescribed” timing. At that point, he got quite angry and said that “he could not get me better if I was spending all my energy fighting pain”! I needed to be working in partnership with him and he saw that pain management was just as important as physical exercise or any other activity that he felt was necessary. He also indicated that addiction was a very remote possibility if I was truly taking the medication for real pain and he would work with me should I become addicted to the meds. At that point I undertook to work with him and take what was necessary to control pain. BTW – my health returned (it is a chronic condition that occasionally flares up but with proper pain control I can function pretty well as a contributing member of society) and I still occasionally (once every 2-3 years) take pain medication when I need it.

      If we proceed on the premise that all people who take pain medication don’t need it and they must justify it to every minor “officio” who has absolutely no idea what the true condition of patient is, we are embarking on a very slippery slope that will result in many people living (and dying!) in agony. People abuse alcohol, people abuse cigarettes, people even abuse food! Why don’t we get to the root cause of the abuse rather than target the moderates and end up without a whole bunch of unintended consequences. Civil servants (those who are charged with recommending solutions to policy issues) are notorious for only looking and thinking about process. (ie: if they think if they fix the process then the outcomes will be different). The elephant that is in the room (that they can’t answer) is “….how do we get the medication to those that need it without opening up avenues for those who want/need to abuse that same medication?” The easy answer is to eliminate the medication and make those that take the medication societal villains. Lets make those that formulate and decide policy explore the tough solutions first. This problem can not be fixed by process alone.

  • Ed Labossiere says:

    Suffering from chronic pain? Consult TMS theory and treatment employed by Dr. John E. Sarno.
    Also consult Wiki. Also excellent summary of all of this by Dr. M. Sopher, “To Be or Not to Be…Pain Free”

  • Colleen Bramall says:

    I also live with a chronic pain disease that, though not terminal, is progressive. I went through a surgery four years ago for it and was told 1-1/2 years ago that I should have yet another surgery, which I chose not to have at that time. Like a couple others who have made comments on this board, I feel that unless and until you walk a mile in my shoes, you have no idea what I endure on a daily basis for pain. I also choose not to change a few things about my life, in that I continue to work in a rather physically demanding job, which I love, as well as being an active partner with my husband in our large farming operation. So I consider myself to be an honest, hard working, tax paying, highly productive and stand up member of society and my community.

    As far as pain control, I have never been offered anything that is as effective to replace my prescribed opiates. I am well aware of the problems that opioids can and has caused to a large number of people across the country. That being said, I am also sick and tired of being tarred and feathered with the same brush because of my opioid use. I do not “misuse” or “abuse” my prescriptions. I do not sell my pills. I am not a “drug-seeking” patient who goes to multiple doctors and have gone to my same family physician here in Saskatchewan for seven years. I had gone to the same pharmacy for most of those years until recently, whereby I changed pharmacies. A new pharmacist had come on staff who, as well as being totally rude and ignorant, would also make me wait for hours before filling my prescriptions (he said he was contacting my doctor), after I had just left my doctor’s office with prescriptions in hand. And a new pharmacy technician there informed me that he had been a police officer for 30 years and “read me the riot act” regarding opioid addiction, misuse and overdoses and blah, blah, blah…. Considering that neither of these two at the pharmacy know me nor anything about my medical background, I do take this as insulting and degrading.

    Fortunately, I do have a wonderful relationship with my most excellent physician and he has always stood behind me. He has received letters from the Sask. College of Physicians and Surgeons and has always replied to them, although I have been called into my doctors’ office out of the blue to do “pill counts’, urine samples, etc. which, like the interrogation by the pharmacy employees, is also degrading, humiliating and a total judgement of my honesty and integrity. I have also signed two affidavits swearing that I don’t misuse or sell these medications. We are apparently not allowed to get more than 30 days of prescriptions at once, so it feels like my life has to revolve around travelling to see my doctor (150 kms. one way). As I tell my Doctor, and the College of Physicians and Surgeons, I am not a criminal. I have no criminal record, nor am I on parole or probation. As an oilfield Consultant, I make more money than my doctor does, so I have no reason to sell my damned pills. There have been times, though, that I can’t stay longer on a job than my scheduled shift since I need to get home to see my doctor for prescription refills. And God only knows what will happen when I decide to visit family in New Zealand or go to Europe and would like to vacation for longer than my 30 day “prescription parole” will allow me to.

    Please do not think that I have no sympathy for some of the many people who abuse opioids in a terrible way, up to and including death. But, I can tell you the same thing I told my meddling (former) pharmacist and his “ex-policeman” pharmacy technician. I DON’T CARE!! I did not create their problems, I am not contributing to their problems, and I certainly can’t solve their problems. So by raking me over the coals every time I walk in the door for my refills, they just contribute to the frustration I feel at having a bloody chronically painful life and I don’t need to listen to their rantings about my very legal pain medications and other peoples’ inability to control their drug habits. DO NOT try to make me feel guilty about being prescribed opioids so that I can get out of bed in the morning, try to walk upright without being in a wheelchair, and wishing to carry on as normal a life as possible. And as long as these painkillers assist me in being able to do that, I will continue to request them.


    • Ed Labossiere says:

      Do consult the work of Dr. John E. Sarno, theory and treatment of chronic pain, TMS.
      All the best, EL

    • Carolyn Campbellm says:

      Please read my reply to Chronic Pain Guy. I would like to share with you further if you care to. I feel strongly that those of us who have been helped, continue to be helped with the relief of acute chronic pain, that like your, is progressive and worsening, by this drug. The balance is skewed badly, with negativity and poor behaviors on the part of both the medical & dental professions with inappropriate prescriptions, poor to no monitoring of their patients’ use of this medication, poor behaviors on the part of patients and individuals who perhaps require psychological counseling and CBT rather than pain medications and need to be taught and supported. I am currently dealing with the same a situation as you have experienced with my current pharmacy. That there is even one iota of thought process on their part to think that I will tolerate and accept their unprofessional and disrespectful behaviors is laughable. In 7 seven years of this medication being a part of my day to day existence, I have never been spoken to or treated in the manner that I am now experiencing with this pharmacy, having had an excellent and supportive relationship with my former pharmacist for 6 years. Like you, I do not abuse my medications. I am grateful that there is something available to me that has given me back my life. I stay in close contact with my doctor, who is willing and does provide me with up to date information, does listen and does hear me, does pay attention, and I am grateful for his willingness to see my unique needs as a unique individual – that no two patients are the same.

      If you would like to get in touch … please let me know. Perhaps it’s time that those of us who use this medication properly, follow the rules …. start to tip the scales to one of balanced information.

    • prooxyitworks says:

      I too suffer a very debilitating progressive disease and have been managing my pain for 3 years( yes I have tried the pain clinic etc, IMO bunch of mumbo jumbo I have carefully and as per doctors orders taken these, with random testing , and always have passed as I do not use drugs on my pain meds, so I should not be lumped in with those tha abuse it, sell it etc, I now have moved to a new city and have no DR, and it is brutal having to fight every Doctor i see to legitamize my pain etc, and now have had my quality of life reduce as pain control medication is reduce. It is a disgrace, I wish I knew a Doctor in Victoria BC, who understands that this is an avenue that is working for me and I do not want to go back to not getting out of bed, One size does not fit all, I have tried ever other pain medication to no avail. I am reaching out to this community in the hopes of someone messaging me about a great pro active doctor that will not be opposed , say I have to get off these quality of life meds and not give me grief, MY pain, my body MY LIFE!!! xo

  • Karen Leslie says:

    Over-prescribing is the biggest problem. How do we regulate physicians from handing out prescriptions for opiates when a Tylenol would work. The patient may not Buse the drug but the prescription can be stolen, sold, or used inappropriately.
    This is a very powerful and, unfortunately enjoyable drug.

  • Linda Wilhelm says:

    Until there are more effective treatments for those of us living with constant, unrelenting chronic pain we have no other option but to take the medications that are currently approved and funded. The majority of Canadians cannot imagine how hard it is to live every day in pain and until someone actually experiences it they will never understand. Newer, non-narcotic drugs are not covered by most prescription drug programs and access to appropriate, quality care for people in chronic pain is dismal at best. It is easy for those in positions of authority to decide to deny access to opioid medications, they are not the ones trying to live their lives as best they can in less than ideal circumstances. Until the wait times for pain clinics are addressed and access to newer pain medications granted, we are stuck with the current treatment options and any decisions around limiting access will unfortunately catch those of us who do not abuse the drugs but use them as appropriately prescribed.

    • Ed Labossiere says:

      Do consult the work of Dr. John E. Sarno and TMS theory and treatment of chronic pain.
      I wish you the best.

      • Lady Ehlers-Danlos says:

        Most of Sarno’s work is pseudoscience that fails to acknowledge the true causes of chronic pain and takes an it’s-all-in-your-head, you-just-need-to-relax approach. If you are suffering from MS, cancer, or a severe connective tissue disorder, this approach simply will not work. You can’t wish away severe joint damage or muscle spasms, and you can’t deny the realities of the deleterious effects of living with a flood of stress hormones due to the pain. Trying extra hard not to feel the pain through thought techniques and whatnot just creates more stress. Pain medications may not be perfect, but they are still a valuable part of the pain management toolkit, and can be used responsibly by people who have no interest in recreational use.

      • Rache says:

        Lady Ehlers-Danlos,
        I also have Ehlers Danlos Syndrome…and completely agree with all that you have stated. As you well know, there is (woefully) a serious lack of current, *realistic* awareness/ knowledge, (especially here in Canada :( about the true nature of how EDS causes both chronic and acute pain, in addition to the numerous and highly variable co-morbid health issues that accompany it. Unfortunately, this is often due to medical professionals unwilling to broaden their decades old learning from medical school days. By not updating and thereby accepting that there genuinely an exponential awareness about EDS manifestations in the past two decades means we the patients continue to suffer bc of the doctors ignorance and stubbornness to learn! So much for first Do No Harm! :/

    • joanna pinne says:

      i am a patient advocate who has been studying this issue of (pain) medication denial, for over four years. it is sickening beyond belief what is happening to people in british columbia. also have a list an arm long of patients ripped off of psych meds (and i mean benzodiazapenes which have been prescribed long term for DECADES). my clients are suffering horribly as the result of massive political interference in the dr/patient relationship. i hear from my clients who are well educated about their meds and risks/rewards, such things as: ‘it is MY BODY’, ‘why is my level of suffering subject to political mandate’ and MORE TO THE POINT COMMENTS SUCH AS ‘my doctor is a cruel, lying coward’ I recently spoke to a general practise doctor in Seattle. He had this to say: “Canadian doctors are WEAK. They are too afraid to challenge their colleges and advocate for their patients”.

      it is my contention that ALL this hoohaw about the opioid crisis is just an excuse to punish long term opioid/benzo patients so that theDOCTORS and their college can look to be politically correct to the public at large. i have been advised by several senior physicians that the situation IS POLITICAL.


      • Erin Norwood says:

        I have suffered from a Severe form of Endometriosis for over 35yrs. I have experienced a very ODD swing in Opioid treatment. For the first 25yrs. of my disease I was constantly being harassed by my many Doctors for refusing to take both the quantity and high dosage levels of the many opioids they were throwing at me and being criticized for occasionally tapering off them to assure I was not over using them, to having these same Opioids taken away from me without any explaination! My Doctor tells me that Her Medical licence is in danger if she continues to treat me for a VERY legitimate medical condition. I DO NOT BELIEVE Her! I think she is behaving more like a politician than a Doctor and I’m sick of it! I am determined to aid in anyone’s cogent attempts to bring this to the Public’s attention. Anyone have any good ideas about how to fight this?

  • David Walker says:

    At the start of my career, opioids were prescribed sparingly and for very specific purposes, invariably malignant pain scenarios. Now some forty years later many patients with serious non-malignant pain are helped by these drugs, but in the process our profession now prescribes them as the default in just about any situation. They have become the standard for post-op pain control, minor trauma and dental procedures (when I had my gum recession fixed recently I was given a Rx for oxycontin, thus anticipating pain that never came!). The potential thus for diversion or dependence has been realized and our society is awash in opiates.
    %featured%The profession needs to acknowledge this as a very serious problem and establish clear indications for the use of opioids with monitoring and accountability to our regulators and our public. After all, we write the prescriptions.%featured%

    • Karen Born says:

      Thanks for your comments David and also for mentioning the role that dentists play in prescribing prescription opioids, which is often overlooked. A 2011 paper in the Journal of the American Dental Association notes that dentists prescribe 12% of immediate release opioids in the United States. Full link here:

    • Karen Leslie says:

      Hello David
      Thank you for your wise comment. I recently had a minor surgical procedure and made sure I requested not to be prescribed the standard opiate prescription upon release from hospital. I had absolutely no pain but could have had a tempting and dangerous prescription in my home. My family has a long history of addiction disease therefore I always request no mood-altering drug to be given me.

  • Kathleen Finlay | Patient Protection Canada says:

    Opioid abuse also occurs in the hospital setting. I know this all too well, having discovered my mother in a state of constant over-sedation from Dilaudid, which was being administered every two hours over a period of weeks in order to keep her sedated in an ICU. This is not the purpose for which Health Canada approved the drug. There was never any informed consent sought or given for this potent form of morphine, which can quickly depress the respiratory function. At the time, my mother was breathing with the assistance of a tracheostomy. When I insisted on seeing her medication record and questioned why the drug was being given to her, I was told it was for extreme pain. Yet my mother always denied being in pain ⎯ that is, when she could still respond.

    The trick nursing staff used to give the drug was to score her high on the pain scale, then immediately administer the drug to put her in a sedated state. After I insisted that it be stopped because of the risks to her recovery and respiratory function, her pain scores magically returned to zero within 24 hours, where they remained for the duration of her hospitalization.

    If this type of abuse can happen in an advanced clinical setting with experienced doctors and pharmacists enabling the deception, you can imagine what is happening elsewhere in the healthcare system.

    There are similar problems involving the over-sedation of patients using Seroquel, a drug approved only for the treatment of schizophrenia and bipolar disorder. My mother, who was never diagnosed with either condition, was also given that drug for several weeks without my knowledge or consent, but that is another story. We talk about the life-threatening risks and clinical abuses of this medication at

    • phyllis keller says:

      Please call me
      I am that lucky patient in ICU who survived!!
      Trying to get an explanation for 3 yrs! No luck

  • Joel Lexchin says:

    I think that all of the measures discussed in the article are valid and should be acted on. At the same point I think that the article overlooks the aggressive way that companies market these narcotics and that this issue also needs to be dealt with. Here are some recommendations that were made in an article that I wrote along with Jillian Kohler:

    1. Prior to the approval of any product that has a high potential for abuse the company marketing the product needs to develop a plan to deal with misprescribing;
    2. For the first two years, or until the potential for abuse can be evaluated, promotion of the product needs to be strictly overseen by regulatory authorities. This should include a review of the marketing plan for the drug in question;
    3. There should not be any distribution of samples;
    4. A panel of doctors who see sales representatives should be recruited to provide feedback about the messages that the sales representatives are delivering;
    5. Regulatory authorities should set up a prescription event monitoring program for these drugs with identifying details for all patients receiving a prescription are recorded for the 6 months after the drug is marketed. Doctors who wrote the prescriptions would then be contacted to ask about any adverse events that happened to these patients in order to identify early trends;
    6. Drugs felt to have a high abuse potential should have a special mark on all prescriptions to alert doctors and patients of this danger.

    • Karen Born says:

      Thank you for bringing up this important point. There are many stakeholders in this complex issue, including the pharmaceutical industry. Thanks for sharing these recommendations of what more the pharmaceutical industry can do to deal with prescription opioid-related harm and misuse.

    • RxOd says:

      Good suggestions and if not for the substancial Pharma lobby and influence, there might be more optimism for change. Its hard trust repeat, convicted offenders.

      In general, what baffles many is the continued insistence on higher-order, time-consuming and expensive proposals AND the absence of concrete, actionable and cheap remedies to reduce, prevent harm.

      This is not a new crisis and yet we can’t get naloxone out the door except in a limited way in BC and, very limited, in ON. A WHO Essential Medicine not provided during a public health crisis? Thats scandalous, and a much different response than we’ve seen to other major health issues. IMO, Canada needs to reconsider if we are providing universal health care or are neing morally selective about it.

  • Chronic Pain Guy says:

    This entire article is nothing but alarmist bunk. The increases in harm situations can almost entirely be attributed to very specific demographics and you could remove all opioids from the market and it wouldn’t matter a whit. Would all of these so-called advocacy groups then go after paint manufacturers because people are “huffing” their product. Not to mention that the populace of Canada is aging and that alone l is leading to higher instances of opioids being prescribed to manage chronic pain.

    All that is happening as a result of these “know-it-all” organizations making a loud fuss and putting pressure on the government and physicians is that people, like myself, who are chronic pain patients and whose day to day relies on these medications, are finding it more and more difficult in dealing with our doctors who are quickly becoming more concerned about their own welfare than ours. The article mentions generic oxycontin being allowed into the market as a failure by the government. This is wrong in so many ways. The new formulation, OxyNeo, that was brought to market by Purdue Pharma not only was done so with ZERO clinical trials for efficacy against the old formula but it also contains a substance that has been banned in many countries of the world, including the UK, as a cancer causing agent. That substance is BHT. I won’t go into detail on BHT as there is tons of info on the web regarding the nastiness of the substance. Because of these problems, the generic form of oxycontin was needed in the market. Why should I, as a chronically ill person, be forced to take a medication that not only has not been tested properly but that also contains a chemical that has been proven to cause cancer? The answer is that i should not have to.

    All of you “Henny Penny” types that love to run around screaming the sky is falling about every little thing need to stick to things that you know something about as it is obvious, from the usual comments made, and from pieces like this article, that you are sorely lacking in “real world” experience and/or knowledge about this topic.

    Put simply, MIND YOUR OWN BUSINESS. Live your own life, take care of yourself and leave the rest of us alone!

    • Ed Labossiere says:

      Do read “To Be or Not to Be…Pain Free” by Dr. Mark Sopher. Consult references to life work of Dr. John E. Sarno. life-altering

    • Carolyn Campbell says:

      Being a chronic pain sufferer myself, acute and for the rest of my life … I agree with the majority of what you say. However, I disagree that the issue should be left alone. I agree that those who are abusing OxyContin among other prescription medications, doctors who over prescribe or do not monitor their patients, parents, family members or friends who share their prescriptions etc do need to be dealt with in a positive, teachable manner. I share your frustrations of being a patient who does not abuse her medications, stays in close contact with her doctor, does a lot of research on both her conditions (3) and the drug itself. I do feel that people do need to focus on those this drug is working for, where the benefits far outweigh the “addiction” threat. I have been on it for 6 years now, still on a low dose, and have my life back. The positive needs to be recognized, and people who follow the rules need to be left alone to continue doing what they’ve been doing with no issues or problems whatsoever – outside of those caused by fearful, self interested professionals including doctors and pharmacists.

    • Brian Taylor says:

      As a person who has lived with and managed chronic pain with opiod meds of for over 35 years, I agree with the previous poster regarding Oxycontin.

      Since being put on the new formulation, Oxyneo, I’ve had far more undesirable side effects. Due to government policy, my quality of life has suffered a great deal.

      Those who abused Oxycontin have in large part moved on to Heroin, putting profit into the pockets of unscrupulous criminals who will cut the product with nearly anything to increase profit.

      The whole Oxyneo push by Perdue came at a far too convenient time, right when their patent was about to run out. Anyone who believes that money and power are not the prime movers in this situation are the ones with their heads in the sand.

      Pandering to US policy is not going to help solve the problem. We should ally ourselves with the much more intelligent, effective and compassionate policies in the UK.

    • jan soho says:


    • Chronic says:

      Hmmm looks very familiar to the research i have done are you by any chance on the Chronic Pain site?

    • Robert says:

      Perfectly articulated!


      Another guy with chronic persistent pain

    • Margaret Ann Killin says:

      Well said. The real agenda driving this panic is to transfer Medicare costs of chronic care onto patients. Services to chronic care/pain patients are actively, unapologictally being dismantled. There is still no accountability to patients, there is still no continuity of care, there is still no access to early stage remediation, and some of the BC College recommendations are simply bizarre, such as random urine screening on all patients using opiate medication.

    • Margaret Ann Killin says:

      Yes, I’m not able to walk for the past 4 months due to failure to treat pain related to nerve/spine compression. I’ve had two emerge visits -not prescribing enough meds to ‘bridge’ me into primary care, with no apologizes and no shame. Health Canada needs to focus on quality of care issues and provide some oversight here in BC.

    • Erin Norwood says:

      Responsibility for those who choose to miss-use Opioids should NOT be foisted on the shoulders of those who live in Severe Chronic Pain, and yet it IS! It is Not the fault of many chronic pain suffers that Opioids are basically the only effective option left to us! And by the way, being in chronic pain is often the real cause of many suicides and overdoses! Keeping people suffering in severe chronic pain is akin to Torture. It is obvious to me that author of this artical has little to No experience with these harsh realities.

  • RxOd says:

    The “regulators” -FDA, Health Canada and elected officials- get off pretty lightly in this piece. I mean, this was/is a preventable, deadly crisis of epic proportions, in USA and Canada- and not a new crisis either.

    %featured%Health Canada can’t count tombstones, for any year, and the political-ideological interference at HC and CCSA leaves us without any national leadership. The White House has a funded plan, with targets and timelines. This includes evidence-based harm reduction initiatives proven to save lives such as improving naloxone access. In Ottawa, harm reduction is a dirty word, absent from our so-called Anti-Drug Strategy(as are opioids and alcohol) and, tellingly, from CCSA’s “Do No Harm”strategy (unfunded, no targets, no timelines) on opioids.%featured%

    In the absence of higher-system government/regulator interest, it is local communities, agencies, parents and others who are left to mop up the mess and holding bake sales to fund essential health services.

    Meanwhile, those in the corridors of power appear to be on an extended, opioid fuelled nod.

    • vijay patel says:

      Health Canada narcotics department need to more frequent audit and focus on drugs manufacture companies narcotics return information. Go detail information reason of return especially fentanyl paches and track those customers showing reason drugs are not effectives.
      I work as AQPIC position almost more than 10 years and I believes something going wrongs in streets. need join action RCMP, POLICE and health Canada.


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

Greta Cummings


Greta is the Dean of, and a Professor in, the Faculty of Nursing at the University of Alberta.

Andreas Laupacis

Editor-in-chief Emeritus

Andreas founded Healthy Debate in 2011. He is currently the editor-in-chief of the Canadian Medical Association Journal (CMAJ)

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