PRESCRIPTION PAINKILLER DEATHS ON THE RISE IN CANADA

We Should Learn From Australia's Prescription Drug Misuse Strategy,
and Start Saving Lives

The combination of alcohol and the prescription painkiller oxycodone
that proved lethal last month for 28-year-old NHL player Derek
Boogaard of Regina is an increasingly common cause of death here and
in the United States.

Ruled accidental by a medical examiner in Minnesota, the New York
Ranger's demise is the latest in a series of high-profile deaths
linked to prescription painkillers. The Australian actor Heath Ledger,
of course, also comes to mind.

In the U.S. last year, drug-induced deaths, led by prescription
painkillers, were second only to car crashes in accidental fatalities,
and prescription painkiller misuse is the leading cause of death in 17
American states, according to the Centres for Disease Control.

Canada has also experienced an alarming increase in such unintentional
deaths. For example, oxycodone-related deaths in Ontario increased
nine-fold between 1991 and 2006 and, in most cases, the deceased had
taken a non-opioid depressant (alcohol, benzodiazepines,
antidepressants) along with the pharmaceutical, according to recent
research.

But where is the national leadership on this issue? We would do well
to look to Australia as a model.

Canada and the U.S. have by far the highest per capita consumption of
the painkiller oxycodone in the world -more than double the rate in
Australia, which is the third ranking country, according to 2008
figures from the International Narcotics Control Board.

But Australia has taken action. Last year, it initiated a National
Pharmaceutical Drug Misuse Strategy, with a focus on opioids,
benzodiazepines and over-the-counter medications containing codeine,
since these medications "are associated with greatest levels of harm,"
according to background documents. (Opioids include drugs such as
codeine, morphine, hydromorphone and oxycodone. Prescriptions written
for drugs containing oxycodone, which is 50-to-100-per-cent more
potent than morphine, have increased significantly in Canada and
internationally over the past 15 years.)

The Strategy, supported by all states and territories in the
commonwealth, is due to report later this year. But it was not
Ledger's 2008 death that prompted action -Australia has long
acknowledged the risks of prescription drugs, and since 1985 included
them in its National Drug Strategy.

In contrast, Canada's National Anti-Drug Strategy concerns itself
solely with illicit drugs. The five-year strategy, launched in October
2007 by the Conservative government, is led by Justice Canada and
devotes the majority of its funding to law enforcement.

As the National Anti-Drug Strategy comes up for renewal, it is time to
acknowledge the problems associated with prescription painkiller
misuse. These drugs obviously have legitimate uses, especially for
people suffering from acute pain and cancer.

But the past 10 to 15 years have seen a huge increase in prescribing
opioids for chronic pain not related to cancer. The evidence
supporting the effectiveness of long-term use of opioids for chronic
pain is, however, not robust and the benefit-to-risk ratio is unclear.

Many Australians "may have developed unrealistic expectations of what
medications can offer in terms of ameliorating pain, discomfort and
dysphoria," states a background document for Australia's National
Pharmaceutical Drug Misuse Strategy.

"Over-reliance on medications may have resulted in their use as a
first line response when often non-pharmacological interventions may
be more appropriate."

No doubt the same is true in Canada.

Prescription painkiller-related harm is not a new issue. Alarmed at
rising numbers of deaths, Sudbury, Ont., had a narcotics abuse task
force in 2004 and Newfoundland and Labrador had an OxyContin Task
Force the same year (OxyContin is a slow release form of oxycodone).

In 2004-05, Health Canada led national consultations that resulted in
the creation of a National Framework for Action on Substance Abuse.
The framework, which called for a broad approach to the issues of drug
abuse (including pharmaceuticals) and alcohol abuse, was re-endorsed
by key signatories in 2008.

As a top priority, those who took part in the consultation felt that
"a significant paradigm shift is needed in order to frame substance
abuse as first and foremost a health and social issue (their emphasis)
rather than a criminal one, and to dedicate funds accordingly,"
according to the report.

If we in Canada want to prevent more accidental deaths like that of
Derek Boogaard, we should learn from Australia's example and launch a
high-profile national initiative to address a situation described, by
the normally cautious College of Physicians and Surgeons of Ontario,
as an "opioid public health crisis."