OPIOID DEATHS, MOST INADVERTENT, SOAR SINCE OXYCONTIN HITS CANADIAN MARKET

TORONTO - Accidental deaths due to opioid use in Ontario have soared
over the past couple of decades, increasing dramatically after a new
long-acting version of the drug oxycodone - sold as OxyContin - hit
the market, a new study suggests.

Opioid-related deaths claim more people each year in Ontario than HIV,
with 27 in a million people dying from an opioid-induced overdose
versus 12 in a million to HIV, the researchers reported Monday in the
Canadian Medical Association Journal.

Lead author Dr. Irfan Dhalla said there's been a suspicion among
physicians that deaths due to prescription opioid use were on the
rise, but this was the first effort to quantify it in Ontario. He
admitted the effect was greater than he anticipated.

"When you think about the fact that there are far more people dying
from prescription opioids than from HIV, that to me is surprising,"
said Dhalla, who practises general internal medicine at St. Michael's
Hospital in Toronto.

A leading addictions researcher said the work underscores that the
substantial increase in problems related to prescription opioid use is
a "major public health challenge" for Canada.

Benedikt Fischer, interim director at the Centre for Applied Research
in Mental Health and Addictions at Simon Fraser University, said the
findings are especially important as Canada and the United States have
the world's highest rates of medical opioid use.

"Thus, emphasis should be given to the questions of why these
extensive increases in the use of prescription opioids ... have
occurred, whether these compounds are necessary for the intended
health outcomes and what may be done to reduce the use of prescription
opioids to maximize pubic health without undue collateral damage,"
Fischer wrote in a commentary that accompanied the study in the journal.

Opioids are strong analgesics - a.k.a painkillers - which bind to
receptors in the central nervous system, decreasing perception of pain
and increasing pain tolerance. Though morphine and heroin are also
members of this class of drugs, opioids used in pain control include
codeine, oxycodone, and its slow-release cousin, OxyContin.

Dhalla and his colleagues examined trends in the prescribing of
opioids in Ontario from 1991 to 2007 and went over coroners' reports
of deaths in which opioid use was listed.

Over the period, all opioid-related deaths doubled, to 27.2 per
million in 2004 from 13.7 per million in 1991. But after OxyContin hit
the market in the mid-to-late 1990s, deaths involving that specific
drug increased fivefold.

Over the period, opioids were implicated in 3,406 deaths. Most
appeared to be accidental; coroners ruled the deaths were
unintentional in 52.4 per cent of the cases and suicide was listed on
only 23.6 per cent of death records.

The majority of the deaths involved other substances that also serve
as a nervous system depressant, such as alcohol or sleeping pills.

Dhalla said opioids on their own can slow breathing to the point where
a person slips into a coma; when combined with alcohol or sleeping
pills, the risk is even greater.

"I think the saddest cases are probably where somebody has gotten into
a friend's OxyContin or relative's OxyContin and just taken what
appears to have been a very small amount just for kicks and then not
woken up," he said.

"And we did see some of those cases."

He stressed, however, that the problem isn't simply about recreational
or illegal use of the drugs - it's also about over-prescription of the
drugs.

"I think there is a perception that this is a recreational drug use
problem. And what our data have clearly shown is that most of the
people who are dying are not outside the health-care system. They are
seeing physicians frequently and they are more often than not
receiving prescription opioids by prescription," he said.