Opioid and crisis. Two words that we often hear together, yet I'm curious how many people actually truly understand what these words mean. Think of this post as a simple lay of the land and to shed some light on why there's hope. Please remember, I am not a medical doctor, and this is not meant to be used as medical advice. If you have specific questions, you should probably dial your doc's digits.
In Canada, between January 2016 and September 2020, there were 19,355 apparent opioid toxicity deaths. In the six months following the implementation of the COVID-19 prevention measures (April to September 2020) there were 3,351 apparent opioid toxicity deaths, representing a 74% increase from the six months prior (October 2019 to March 2020 – 1,923 deaths).
Opioids, maybe you've heard of them? Codeine, Morphine, Oxycodone, Hydromorphone, Methadone are frequently prescribed medications to treat a variety of disorders, but most commonly known for their work as pain killers. I want to clarify that opioids do not treat or eliminate the cause of the painful stimulus, they only reduce the person's pain perception. Therefore, opioids are most helpful short term, for example after a bone fracture, surgery or cancer-related pain, and should be prescribed very carefully due to their power and high potential for abuse and dependency. Opioids for long-term pain relief is totally NOT ideal and should be avoided.
Here's the thing, chronic pain is one of the most common reasons people go see their doctor and opioids are known for their pain relieving effects... pair these two together and this situation contributes to the ever growing opioid crisis. The gold standard treatment for chronic pain involves physical, psychological and pharmacological therapy. Sometimes medication is needed but the opioid class should be last resort. There is no evidence that long term use of opioids work well to reduce chronic pain. There is evidence however, for addiction and rapid tolerance, meaning that you require a higher dose to feel the same relief. This can ruin people's lives even when the doctor is truly trying to help.
The opioid crisis is complex and there are many factors involved. Chronic pain being poorly understood and not having access the proper layers of care are key players. Left over pills also leads to abuse and misuse. Illegal, toxic supply of opioids is currently the main driver for drug-related overdose deaths, but over the last 20 years use of prescription opioids for short and long term pain relief has definitely contributed to this disaster.
The hope is that we are now paying attention. Canada is starting to see change in opioid prescribing practices and less people are using opioids long term. We are beginning to have an increased understanding on the science of pain and acknowledging the importance of treating holistically.
As mentioned above, the gold standard treatment for Chronic Pain is physical, psychological and pharmacological therapy. If pharmacological therapy is needed, it should be seen as an enabler and not as a band-aid solution on its own. It is essential that medication be combined with the other forms of therapy, or else we are doing more harm than good. The person living in pain must play an active role in their plan of care and it is our duty as health care professionals to educate on this topic.
Stay tuned for my post on our endogenous opioid system AKA our homemade, 100% natural pain relievers.
If you are interested and would like more information on the opioid crisis in Canada, please read the following:
Belzak, L., & Halverson, J. (2018). The opioid crisis in Canada: a national perspective. La crise des opioïdes au Canada : une perspective nationale. Health promotion and chronic disease prevention in Canada : research, policy and practice, 38(6), 224–233. https://doi.org/10.24095/hpcdp.38.6.02