Response to : STEPHENSON: Nova Scotia doctors need to confront prescription drug abuse, Chronicle Herald

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.

He represents the defensive posture of the medical community at large which will not admit to their mistakes and lack of knowledge about CNCP and opioids; this is the very opposite of evidenced-based research studies and the clinical observations of many quality-orientated, experienced physicians. This powerful group, however, has the money, political influence and support of the pain sector, Big Pharma, FDA and Canadian healthcare institutions, to continue their dangerous practices of pushing narcotics for “everyone in pain.”
He needs to answer for his uninformed and deceptive comments, especially when there has been such a failure of the profit-driven “opioid revolution” which has devastated the public health since the introduction of OxyContin. “

2 thoughts on “Response to : STEPHENSON: Nova Scotia doctors need to confront prescription drug abuse, Chronicle Herald

  1. Recognizing and preventing adverse drug reactions in children

    Bruce Carleton, PharmD, Anne Smith, BSc (Pharm), MSc
    Pharmaceutical Outcomes Programme, Children’s & Women’s Health Centre of British Columbia

    Adverse drug reaction (ADRs) – Canadaʼs other drug problem

    ADRs rank as one of the top ten leading causes of death and illness in the developed world.1 The direct medical costs of ADRs are US$30–130 billion annually in the United States,1-3 claiming 100,000 to 218,000 lives annually.2,4 These estimates are even more meaningful when compared with other high- cost diseases like diabetes ($45 billion),5 obesity ($70 billion),6 and cardiovascular diseases ($199 billion).7

    Of particular concern is the alarming lack of understanding of ADRs in children. While children are known to be at greater risk than adults, there is a remarkable lack of understanding of causation, and therefore the ability to avoid or prevent these occurrences is limited. Alarmingly, between 13.7 and 16.6% of paediatric hospitalizations result in ADRs, and 27.9% of these reactions are
    severe.8,9 Each year, approximately 26,500 American children die from ADRs (to age 18 years).1

    …More than 75% of pharmaceuticals licensed in North America have never been tested in paediatric populations and are used without adequate guidelines for safety or efficacy.11 Until recently, it was assumed that children reacted to medications as ‘small adults’. Clinical practice focused on adjusting dosage to account for smaller body mass, with the assumption that clinical effects would be equivalent to those observed in adults…

    It is now understood that a host of biological, developmental and behavioural factors impact the safety and effectiveness of pharmaceuticals when used in paediatric patients. Anatomic differences in body proportions and age-related differences and body composition distinguish newborns, infants and children from adults. Further- more, the biological cadence in the developing human is characterized by more rapid pulse and respiratory rates and markedly increased nutritional requirements that are necessary to support a rapid rate of brain and somatic growth.

    In addition, children often cannot verbally express their own drug therapy experiences. As a result, newborns, infants and children who require medication for acute, chronic and life saving treatment are at risk of a range of ADRs ranging from ineffective treatment and minor ADRs through severe morbidity and death.11,12 It is for these reasons that children worldwide are described as “therapeutic orphans” and are placed at an increased risk of therapeutic failure, while ADRs continue to cause unnecessary disability and death.

    What is the definition of an ADR?
    The definition of ADR as set out in the Canadian Food and Drug Act and Regulations is “a noxious and unintended response to a drug, which occurs at doses normally used or tested for the diagnosis, treatment or prevention of a disease or the modification of a physiologic function.”
    What are the mechanisms by which ADRs occur?13

    ADRs can be classified as either “pharmacological” reactions representing an augmentation of the known pharmacological actions of the drug or “idiosyncratic” reactions that are not predictable.
    Pharmacological reactions are most common, usually dose-related and are due to the primary or secondary pharmacological characteristics of the drug. Factors that predispose to these ADRs include dose, pharmaceutical variation in drug formulation, pharmacokinetic or pharmacodynamic abnormalities, and drug-drug interactions. Pharmacological ADRs occur when drug concentration in plasma or tissue exceeds the “therapeutic window” or when there is increased sensitivity to the drug (even in concentrations considered normal for the general population).

    Idiosyncratic ADRs are less common, often serious, not dose dependent and show no simple relationship between the dose and the occurrence of toxicity or the severity of the reaction. The toxic reactions may affect many organ systems either in isolation or combination. The mechanism of these is not clear but is thought to include receptor abnormality, abnormality of a biological system that is unmasked by the drug, immunological response, drug-drug interactions, or be multifactorial.

    Factors to consider when identifying and preventing ADRs:
    a)The patient medication history
    b)The toxic profile of prescribed drugs
    c) The possibility of ADRs to mimic other diseases
    d)The potential for ADRs to increase with the number of medications prescribed

    Read more: http://www.cpsp.cps.ca/uploads/publications/RA-adverse-drug-reactions

  2. Raising a Generation of Pill-Poppers; How Abuse of “Uppers,” “Downers,” and Stimulants Threatens an Entire Generation

    By Dr. Mercola — USA, May 01, 2014

    Far from being recognized for their potential health hazards, ADHD drugs have gained a reputation as “cognition enhancers” among students and young professionals. Narcotic painkillers, anti-anxiety drugs, and antidepressants are also notoriously overprescribed, which I’ll address below.

    According to data from IMS Health,1 a whopping 48.4 million prescriptions for ADHD stimulants were written in 2011, up 39 percent from 2007. As reported by CNN Health…

    … Benzodiazepines, a class of anxiety drugs, are also widely overused, and a common source of drug addiction.

    … Even more disturbing, these drugs are frequently prescribed along with opiates—narcotic painkillers such as morphine, codeine, oxycodone, hydrocodone, and fentanyl. Both benzodiazepines and opiates are sedatives that slow down your respiration, which can lead to death. This risk is greatly enhanced when these two drugs are mixed. According to the Centers for Disease Control and Prevention (CDC),9 the combination of benzodiazepines and opioids accounts for about 30 percent of all opioid-related deaths, which claim an estimated 16,600 lives each year.10…

    … Narcotic painkillers have now been officially identified as a major “gateway drug” to heroin, which is less expensive than its prescription counterparts. The US Justice Department has even declared that prescription opiates and heroin are two of the most lethal substances available today…

    …One 2008 study,4 which interviewed 1,800 college students, reported that 81 percent of them perceived illicit use of ADHD drugs as being completely harmless, or only “slightly dangerous.”…

    … Benzodiazepines, a class of anxiety drugs, are also widely overused and a common source of drug addiction. The combination of benzodiazepines and opioids accounts for about 30 percent of all opioid-related deaths

    Taking a narcotic painkiller 180 days or longer can increase your risk of developing depression by 53 percent…

    Getting Off the Drug Merry-Go-Round

    Between the rampant overuse of stimulants such as ADHD drugs, sedating anti-anxiety medications, pain-killing narcotics, and mind-numbing antidepressants, you’d think “life” was a disease to be medicated away. Of course there are situations where these drugs are warranted, but that’s not what we’re talking about here. The fact of the matter is that all of these mind- and body-numbing drugs are grossly overused. I’d be willing to bet that a majority of people taking them are not appropriate candidates, and would fare much better were they to address the basic, core issues relating to their general lifestyle and health

    This includes proper diet, sleep, exercise, and employing effective tools for stress relief. Exposure to the outdoors, such as walking barefoot through a grassy field and getting appropriate amounts of sun exposure, also should not be underestimated. If you’re suffering from emotional or physical pain, I encourage you to peruse my inventory of tens of thousands of articles, which address these issues and offer a multitude of safe and effective alternatives.


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