THE PRICE OF PAIN RELIEF

It's sad, but no doubt necessary that police want Ottawa pharmacies to
start behaving more like banks as a way of dealing with the growing
number of robberies of opioid painkillers such as OxyContin.

Whatever their clinical benefits, these painkillers are dangerously
addictive. The slang term for OxyContin is Hillbilly Heroin, and it
has played a cameo role in the southwestern Ontario murder case of
eight-year-old Victoria Stafford (some key players were reportedly
addicts). Canadian actor Corey Haim, who died earlier this year, had a
long history of prescription drug addiction.

Normally, police are preoccupied with crack, heroin and other illegal
street drugs, but their growing concern about the abuse of opioid
painkillers -- available at your corner drug store -- has rightly
caught the attention of health professionals.

With the release of the first guidelines on opioid painkillers for
treatment of chronic, non-cancer pain, Canadian doctors now have a
resource to help them understand when and how to prescribe the
painkillers -- and, more importantly, when not to.

The guidelines, just published in the Canadian Medical Association
Journal, are designed in part to help doctors limit access to the
drugs by those who want to abuse them. Of course, it will be
impossible to keep the drugs entirely out of the hands of addicts or
the hands of those who want to sell to addicts. The demand for opioids
is simply too high.

This country's opioid painkillers consumption rate increased by about
50 per cent between 2000 and 2004. Canadians are among the highest
consumers in the world of opioid-based pain relievers. These pills are
everywhere.

The guidelines represent a useful attempt to slow down the flow. The
guidelines, for example, suggest that when patients first go on the
drugs, doctors should consider it a trial period and monitor the
patients closely. Doctors must stop prescribing the painkillers if
there are any signs of addiction or if the treatment is not working.

This sounds like common sense, but the health-care system, like any
other bureaucracy, is not always good at following up. A patient can
end up taking drugs for a long time before anyone discovers if they've
been effective. This is a bad way to manage patients no matter the
drug, but it is especially bad when the drug has the addictive
properties of these painkillers.

The guidelines will only go so far. Some experts say that what is
really needed is more information on how these painkillers operate.
These are very powerful medicines, and if health professionals and
researchers don't fully understand how they work, then it's hard to
minimize the risks and maximize the benefits.

That there are benefits is without question. OxyContin and related
painkillers have brought immeasurable relief to people who were truly
suffering, but, with every new case of overdose, dependency and
opioid-related crime, the benefits become obscured.

The new guidelines set a suitably cautious tone for doctors, the
result being that physicians might become more discriminating in how
they distribute these drugs.

Everyone, it seems, wants a prescription. Effort must be focused on
better understanding the pharmacological properties of these pills, so
that patients who need them to relieve debilitating pain have access
to them, but addicts and criminals do not.