This May, in response to the ongoing opioid crisis affecting every province in Canada, the Canadian Medical Association Journal published new guidelines for prescribing painkillers. One of the guide’s central tenants is its recommendation that doctors avoid prescribing opioids as a first defence against non-cancer related pain. The efficacy – and morality – of this clause is now being debated by patients, physicians, and medical malpractice lawyers in Canada.

What is the current scope of the opioid crisis?

Communities have been impacted by the opioid crisis in different ways, but the effects are felt nationwide. In 2015, approximately 2,000 Canadians died from overdoses of both prescription and illicit opioid narcotics.

In Toronto alone, more than 90 people fatally overdosed during the first six months of 2016. For comparison, the city recorded 69 homicides, 43 pedestrian deaths, and a single cycling death over the entire year.

What role do prescribing practices play?

The Province of Ontario, like other Canadian jurisdictions, has been able to track opioid deaths fairly effectively, but its data doesn’t differentiate between overdoses involving prescription medication and those caused by street-bought substances. This makes it difficult for the Province to effectively enact preventative measures.

“Unfortunately we don’t have that easy availability [of those numbers],” said Ontario’s chief coroner, Dr. Dirk Huyer, in an interview with the CBC about overdoses linked to prescription opioids. “I don’t have the ability to be specific about the commonness of this, certainly we know it happens, we just don’t know the percentage compared to what’s occurring on the streets.”

What we do know is that somewhere between 500,000 and 1-million Canadians are currently long-term users of prescription opioids, and that Ontario is one of the world’s top prescribers for non-cancer pain. With that in mind, some researchers, like Benedikt Fischer of the Centre for Addiction and Mental Health, believe that reining in “excessive prescribing … will likely make a dent [in] this problem,” according to the Globe and Mail.

That is also the view taken by Dr. Jason Busse of the National Pain Centre at McMaster University, who is the lead author of the new opioid prescribing guidelines. In addition to avoiding first-defence opioid prescriptions, the guidelines also suggest experimenting with alternative medications and non-pharmaceutical treatments in order to avoid opioids’ adverse side-effects. This tact has been criticized by advocates for patients of chronic pain who rely heavily on the drugs.

Ethical dilemmas around opioid prescription

Though law enforcement officials, medical malpractice lawyers, and physicians are keenly aware of the dangers of opioid use, there are also substantial risks to restricting doctors’ ability to prescribe them.

“It really comes down to the paradox of trying to provide important relief for patients dealing with unrelenting chronic pain while at the same time balancing the risks associated with the medications,” Busse told the Toronto Star.

Numerous experts have warned against abruptly restricting access to painkillers. Patients who have formed a dependence on the drugs would be at serious risk of withdrawal or the return of the debilitating pain that initially warranted their prescription.

“Undertreated chronic pain … is deadly,” wrote Halifax writer Dawn Rae Downton in a May 2017 opinion piece for the Globe and Mail. “Undertreated patients risk immense physical and emotional dysfunction, endocrine failure, cardiac collapse, immune problems, dementia and early death, sometimes by suicide.”

There is no consensus in the debate over opioids in Canada. While the suffering caused by illicit opioid use is clear for all to see, there is also universal agreement that opioids offer much-needed relief to victims of chronic pain, and that restricting access to these patients would result in a new round of suffering. Doctors, legislators, medical malpractice lawyers and patients must work together to develop a strategy that limits illegal opioid use while ensuring access to individuals who require the powerful painkilling medication.

If you or a member of your family has been harmed by what you believe the irresponsible prescription of opioid medication, contact the medical malpractice lawyers at Neinstein Personal Injury Lawyers’ Medical Malpractice Group today.

Greg Neinstein