Over the past few weeks Get Prescription Drugs off the Street Society has been collecting signatures from stakeholders and the public urging Health Canada to deny the approval of the powerful new pain narcotic Zohydro ER.
Today in the Chronicle Herald there was an article titled : STEPHENSON: Nova Scotia doctors need to confront prescription drug abuse. While it is nice to see the prescription drug use epidemic acknowledged and reported on, there were some serious flaws in Dr. Gus Grants comments.
First of all , saying the N.S. Prescription Monitoring Program is ” stellar” is a long shot. The short comings of this program were highlighted in the 2012 Auditor Generals Report. Not only were these deficiencies highlighted , but some were dealt with by widening the net of what is considered acceptable thresholds of prescribing. In essence , increasing the level of acceptable prescribing so fewer red flags would have to investigated.
Our methadone programs are very much needed to reduce the harm in our opioid dependent population but it is concerning that our guidelines are considered the “gold standard”. After numerous deaths in our province due to diverted methadone including Joshua Ballard, Robyn Brown and Katanna MacDonald coupled with long wait-lists in areas, there is a lot of room for improvement. The methadone treatment handbook did not facilitate proper care in the case of Stephanie Benham. The program actually did more harm than good.
To require physicians to pre-screen patients’ prescription histories before narcotics are provided in urgent or emergency-care situations is only a drop in the bucket. That is one of the few facets of prescription monitoring that is usually effective. It is the patients who pick up medications as prescribed , routinely , and becomes dependent, with legitimate chronic pain or intent to divert who have the most community impact. These are the patients who fly under the radar and do not set off any red flags with prescription monitoring.
The article states between 2008 and 2013 there were 201 deaths due to opioid overdoses. This number is very restrictive as it does not include overdoses that include other rx drugs or opioid & alcohol related overdoes. The medical examiner confirmed in December 2013 there had been 437 RX drug overdoses between 2007 and 2012 in the province of Nova Scotia.
Dr Gus Grant states ” Social determinants such as poverty and crime are significantly linked to the disease of addiction”. This may have some truth to it but in what order did that occur? Was it crime and poverty that lead to addiction or addiction that lead to crime and poverty? I believe the latter. This statement exacerbates the stigma of addiction. Addiction has no socioeconomic boundaries.
“The good and proper need for the use of pain medication to treat a painful condition is not a terribly powerful driver of the disease of addiction.” says Dr. Gus Grant. This statement is misleading. This is a myth that continues to perpetuate the prescribing of opioids to patients who should have never been exposed. All prescriptions whether considered legitimate or not came from a doctors prescription pad. The majority of narcotics influencing the public in a negative manner are not prescribed by a malicious doctor. They are prescribed by a misinformed doctor who thinks this is an effective treatment for their patients pain.
Below is response to this article from Dr. Stephen Gelfand with the organization , Physicians For Responsible Opioid Prescribing:
“Dr. Grant is in denial about the intimate link between excessive, inappropriate opioid prescribing by many PCPs and pain doctors, and the potentially lethal disease of addiction with the mounting toll of OD deaths. He appears to be separating chronic pain patients on opioids from those suffering from the disease of addiction, and emphasizing the relationship of the latter [the "abusers"] to “criminal elements” and “poverty,” and that they may not be worth the costs of drug detox and rehab, especially if they turn to heroin. He is also implying that the “needs” of patients with a “painful condition” is “pain medication” while ignoring the fact that most patients with CNCP should be diagnosed correctly and treated with non-opioid multidisciplinary management, with opioids reserved for only a select, small percentage of this group.
It’s that time of year again. The time of year that reminds me of the day I will never forget, the day my life would change forever. Parts of me cannot believe three years has gone by already. Parts of me feel like it was only yesterday I heard Josh’s laugh and saw his smile. Still, three years later when i dream of him, I wake up forgetting he is gone. It does not take long for that horrible realization to set in followed by overwhelming disappointment.
When you lose someone you love so dearly there are many painful anniversary’s, not just the date they left this world. Every birthday, graduation, family reunion, and holiday is a reminder of another special event i didn’t get to share with my little brother. Sometimes I even feel guilty for enjoying those moments without him. I have come to realize these feelings of guilt or wallowing in my sorrows is the last thing Josh would want me to do. Josh would want me to live life to its fullest and take advantage of opportunities he will never be able to.
Josh would also want me to tell his story , to prevent the same tragedy from happening to another family. One thing about my brother was you never had to wonder what he was thinking, you never had to wonder how he felt about something. He was never ashamed about his mistakes, he owned them, and learned from them. The problem with this mistake was it was one he would never have the chance to learn from. A mistake he never should have been able to make in the first place.
The stigma of drug overdose and addiction keeps people suffering in silence. It is hard enough to lose someone you love so suddenly let alone what comes along with the social stigma. The hurtful comments like ” He was a big boy, he should have known better” or “Nobody forced it down his throat” cut like a sharp knife. We have all made mistakes in our lives, especially as young adults, the difference is we woke up in the morning and Josh didn’t. After being exposed to such hurtful and uneducated attitudes it only confirms my need to educate others.
My brother Joshua Graves was one of the 437 people who died due to a prescription drug overdose in Nova Scotia over the past 5 years. 7 people a month are dying in Nova Scotia from drugs that originally came from a doctor’s prescription pad. Where is the outrage? Its being silenced by stigma and paralyzing heartache.
We need to demand change and be loud. Public outcry will determine how fast the wheels turn on this issue. As the years go by my advocacy group Get Prescription Drugs Off The Street continues to grow. This is not a club you want to belong to. If Josh’s story can save one life I will tell it until I am blue in the face. If I can let another family going through this type of tragedy know they are not alone, I can sleep better knowing Josh is still making the world a better place, even after March 19th 2011.
CNN recently did a story about Dr. Lynn Webster and the investigations related to his patients. After watching the video, I am sure you will be a tad disturbed.
What is even more disturbing is the fact that this same doctor developed the opioid risk tool which is in our Canadian opioid prescribing guidelines for chronic non cancer pain. See page 12. This tool is used across Canada to help determine someones eligibility for opioid treatment and is mentioned in the video clip above. There is now an app that includes Dr. Lynn Websters opioid risk tool which is also being used by doctors across Canada.
Now here is the icing on the cake! Our Nova Scotia Prescription Monitoring Programs medical consultant, Dr Peter MacDougall thinks this great and will help in safely and effectively administering opioids. Dr. Peter MacDougall’s quote does not refer to his position at the Prescription Monitoring Program which was the focus of a scathing report from the Auditor General , but it does refernce his position as the Director of the Nova Scotia Chronic Pain Collaborative Care Network. This network gets funding by Purdue Pharma ( the maker of Oxycontin, Dilaudid, and other opoiod narcotics) as well as Phizer.
These are tremendous conflicts of interest in my opinion and i can draw conclusions as to why our N.S. Prescription Monitoring Program is simply collecting lots of data but doing very little with it.
Last year there were only two referrals to law enforcement out of the 782,865 narcotic prescriptions processed. Law enforcement requested to see 233 patient profiles which can only be done with reasonable cause. Patient profiles are an information file that contains all the prescribing information for a particular patient. They contain things such as the types of narcotics they are prescribed , by what doctor, dosage ect. These can only be accessed by police, doctors, and pharmacists with reasonable cause.There has been a 628% increase in law enforcement officials requesting patient profiles over the past four years. Narcotic prescriptions processed by the program have also risen by 25% over the same period of time; however referrals to the practice review committee or licensing authorities have remained relatively constant and have sometimes even declined. Why does Prescription Monitoring seem like a silent bystander while prescriptions continue to rise as well as double doctoring?
Should doctors who have relationships with opioid manufacturers be creating guidelines for the prescribing of opioids or hold key positions in prescription monitoring programs? Should our doctors be using a tool created by Dr Lynn Webster for prescribing opioids when he has had over 20 patients overdose from their own prescriptions? What is wrong with this picture?
Or is it just me?