The opioid crisis is not about pain

(MENAFN – The Conversation) Opioid-related deaths have increased in recent years in North America and around the world. New data released by the Public Health Agency of Canada reveal that more than 10,300 Canadians have died as a result of an apparent opioid overdose between January 2016 and September 2018.

There is no doubt that this is tragic and requires special attention.

However, Canadian decision makers have mainly reacted to the excessive prescription of opioids as pain medication. Interventions included limiting prescriptions, strengthening physician supervision, and providing advice on reducing or reducing opioid medications.

In January 2019, Ontario announced an agreement with the federal government to inject an additional $ 100 million into the fight against the crisis. These funds will likely be used for secure injection sites, naloxone kits for medical and emergency personnel, public education on how to respond to an overdose and working groups to improve the management of the disease. pain.

I am concerned that this focus on pain and overdose will focus only on the symptoms of a larger crisis – a poorly managed mental health crisis and unresolved emotional trauma across Canada. Pain and addiction are related, but they are not synonymous. The opioid crisis is not, at the base, a problem of pain.

In the meantime, almost half of adult Canadians living with daily pain do not seem to have been heard.

Live with chronic pain

"Without pain medication, I can not walk or do the simplest household chores. Going to the bathroom will be beyond my abilities. I've always used narcotic badgesics to lead as normal a life as possible; without them, I am only a burden for myself and for others.

As a physiotherapist, educator and researcher in pain for 19 years, I have heard this story, shared with me by email, countless times. In the shadow of the alarm about the opioid crisis, an important message seems to have been lost: many people are living with daily pain and depend on opioid-based medicines to lead a bearable life .

Ramona Poppe, 56, from Onaska, in Washington, is presented at her home in September 2018. Poppe said she understands the risk badociated with the use of opioids, but wishes to retain the possibility of use them to reduce chronic pain related to health problems. (Bill Wagner / The Daily News via AP)

Many people find that opioid medications, such as codeine, OxyContin, morphine or even fentanyl, can be used effectively in combination with other treatments like exercise, meditation or psychological counseling to maintain a tolerable quality of life.

Without any fault on their part, these people are now portrayed in the same breath with people suffering from disorders related to the use of substances. And they find themselves in the middle of a fiercely North American struggle between policymakers, doctors, pharmaceutical companies and the public. Many of them find themselves in the impossibility of accessing the prescription opioids they need to lead a tolerable life.

Record of death of opioids

When alarms were launched in 2015 on the rising rate of opioid overdose deaths, the speech of the time was almost exclusively focused on manufacturers of opioid-based painkillers such as Purdue Pharma and the doctors who prescribe them.

The arguments were that Purdue Pharma's aggressive marketing of the potent OxyContin opioid badgesic as addictive, as well as low prescribing standards, was at the root of the crisis. The response has been swift – from the creation of new prescribing guidelines and limitations to a very real attempt by Oregon lawmakers to completely eliminate the prescription of opioids by 2018.

Although these arguments are well-founded, making the opioid crisis almost exclusively pain-related has allowed policymakers to focus on dangerous parameters. In particular, many focused on the total number of opioid prescriptions.

Opioid prescriptions have decreased – from 21.7 million in 2016 to 21.3 million in 2017 – and some may welcome this decline. However, opioid-related intoxications, at least according to available data, have not decreased in their turn.

At the same time, the global burden of chronic pain has steadily increased since at least 1990.

Until now, it seems that we are losing on both fronts: Opioid intoxication continues as the burden of pain increases.

Opioids vending machines

The opioid crisis must be understood in the context of a diagnosable health problem, now called Opioid Use Disorder (OUD). Chronic pain is best viewed as an umbrella disorder – often defined as the duration of pain – that can take many forms.

UDU is in part an impaired impulse control disorder, characterized by an inability to stop taking opioids, even in the presence of clear evidence of harm. While this may affect people from all walks of life, there are more and more clear links between UDA factors and environmental factors such as homelessness, poverty and interpersonal, intergenerational and child trauma.

I recently explored data on access to mental health care provided by Mental Health America and compared it to the Milliman group data on the prevalence of OUDs.

A man injects drugs in downtown Vancouver on February 6, 2019. Poverty, homelessness and childhood trauma all play a role in the opioid crisis. THE CANADIAN PRESS / Jonathan Hayward

It is therefore not surprising that since the introduction of opioid prescribing guidelines in 2017, there has been a change in the behavior of people with unmanaged SAD. For example, recent trends have shown that fentanyl, a drug that was rarely prescribed by physicians even before the onset of the attack, was the main substance involved in opioid-related overdose deaths.

In 2018, cocaine overtook opioids as the leading cause of overdose deaths in Newfoundland.

Strangely, forcing people with unmanaged LCUs to use more risky illicit drugs has been so devastating that Vancouver has seriously considered installing opioid dispensers.

This means that we are faced with a very real situation in which some people may have access to opioids through a vending machine, while people with uncontrolled pain can not do so through their doctor.

Invest in mental health

The good news is that the $ 100 million of Ontario government funds could have a real impact if they were properly geared.

For example, advances in pharmacogenetics toward personalized medicine mean that doctors can sometimes prescribe the most beneficial type and dose of opioids based on the patient's genes. This line of research should also improve the ability of physicians to identify those most vulnerable to substance use disorders through routine clinical screening.

This will help us provide the right treatment to the right person at the right time and avoid potentially harmful treatments for people at risk.

Other strategies could include investing in mental health services, especially for at-risk youth. These services could provide them with the resources needed to cope with trauma and stress and ensure access to other pain management strategies such as physical therapy, awareness or cognitive therapies. behavioral.

The focus on opioid prescriptions as a measure of success in the opioid crisis has not come to fruition. We must think of a world once the opioid crisis has pbaded – to make sure that mental health services are available and that those who need opioids for intolerable pain have options.

Chronic Pain Opioids Pain Mental Illness Fentanyl Trauma OxyContin Opioid Crisis Purdue Pharma

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