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.