Canada does not know how to deal with chronic pain. That’s the troubling picture presented in a comprehensive report on pain management published yesterday (July 18) by Health Canada.
“There is a clear deficit in education of health professionals in the causes, types, underlying mechanisms, and effects of pain, as well as how best to treat it,” reads a Pain B.C. and Canadian Pain Society (CPS) response to the study’s findings.
“People living with chronic pain need better access to a range of treatment services beyond medication, including psychological support, physical therapies, integrated healthcare services, and others,” it continues.
As the Straight has reported in detail, a sharp increase in illicit-drug overdose deaths has led to a backlash against prescription opioids, sometimes without factual justification.
There’s a perception that legitimate painkillers like OxyContin played a significant role in sparking the country’s opioid epidemic. But B.C. health officials have said that’s not entirely accurate. The rise in overdose deaths is primarily the result of the dangerous synthetic-opioid fentanyl adulterating illicit-drug markets. Yet that perception has led to a crackdown on doctors who are prescribing opioid-based drugs for legitimate pain. Tragically, that’s resulted in many patients to lose access to prescription drugs they need. Some have then gone looking for illicit substitutes on the street, intensifying the opioid epidemic instead of reducing deaths.
Pain B.C.’s release emphasizes the extent to which this situation is hurting people who suffer from chronic pain.
“Efforts to reduce the number of opioid-related overdose deaths in Canada have had significant consequences on chronic pain patients, including increased stigma and reduced access to treatment,” it reads. “For some patients, it has also resulted in inappropriate prescribing practices such as abrupt stoppage of opioids or tapering without consideration of the risks associated with withdrawal or the medical needs of patients.
“Data and evidence need to be improved to make more informed decisions on individual treatment, health system change, and policy.”
The Canadian Pain Task Force report itself explains the situation in further detail.
“Recent dramatic increases in opioid-related overdose deaths in North America have heightened awareness around the risks associated with both short- and long-term opioid use,” it reads. “A toxic illegal supply of opioids is currently the main factor driving drug overdose deaths. However, increased availability of prescription opioids has also contributed to opioid-related hospitalizations and deaths since the early 2000s.”
Health-care professionals are not always responding with due care, the report explains.
“Some people who could benefit from opioids in the management of pain now face significant barriers to obtaining a prescription,” it concludes. “Many people who have been using opioids for several years and/or who have been taking them at higher doses than currently recommended are being weaned off the medication. Some of these individuals have seen their quality of life and functioning improve when doses were reduced gradually with their consent. Others report being cut off or aggressively weaned without consent, contrary to the updated Canadian guidelines, resulting in debilitating pain, serious withdrawal symptoms, and higher risk of potential overdose for those who turn to illegal sources to manage their pain.
Canada’s overdose crisis continues to get worse with no end in sight.
There were 3,017 opioid-related deaths across Canada in 2016, 4,100 the following year, and then 4,460 in 2018, according to Health Canada statistics released in June.
Last May, Health Canada reported that the country’s life expectancy had stalled for the first time in over four decades. The primary reason was drug overdoses in B.C.
“Increases in life expectancy in four provinces [plus Nunavut] are largely offset by a marked decline in British Columbia,” the report explained. “Life expectancy at birth in British Columbia fell for the second year in a row, decreasing by 0.3 years for men and by 0.1 years for women from 2016 to 2017.”
Meanwhile, the task force's report states, chronic-pain patients are suffering unintended consequences of authorities’ response.
“Ultimately, many people living with pain feel stigmatized, scrutinized, and in some cases dismissed by health care professionals,” it states.