Abstract
Non-medical prescription opioid use (NMPOU) has increased alarmingly across Canada and resulted in strict prescribing restrictions on opioids. Despite a clear need to reduce opioid prescriptions in response to this crisis, few other policies have been implemented and this singular focus is incongruent with the known characteristics of substance use disorders, negative effects of supply reduction policies, and realities of pain management. Given the recent rise of fentanyl and otherdangerous adulterants in streetdrugs, this commentary argues thatacomprehensive response to NMPOU that includes improvements to addiction management and harm-reduction services is urgently needed.
Key Words: Public health, pain, opioid-related disorder, harm reduction
Résumé
La consommation d’opioïdes d’ordonnance à des fins non médicales (COOFNM), qui augmente de façon alarmante au Canada, a donné lieu à l’imposition de strictes restrictions sur la prescription d’opioïdes. Il était clairement nécessaire de réduire les prescriptions d’opioïdes en réponse à la crise, mais peu d’autres politiques ont été mises en œuvre, et cette focalisation unique est incompatible avec les caractéristiques connues des troubles de consommation de substances, les effets néfastes des politiques de réduction de l’offre et les réalités de la prise en charge de la douleur. Devant la hausse récente du fentanyl et d’autres adultérants dangereux dans les drogues de rue, nous faisons valoir qu’il est urgent d’opposer à la COOFNM une réponse globale qui comprenne des améliorations à la prise en charge des toxicomanies et aux services de réduction des méfaits.
Mots Clés: Santé publique, douleur, troubles liés aux opiacés, réduction des dommages
Footnotes
Conflict of Interest: None to declare.
References
- 1.National Advisory Committee on Prescription Drug Misuse. First Do No Harm: Responding to Canada’s Prescription Drug Crisis. Ottawa, ON: Canadian Centre on Substance Abuse; 2013. [Google Scholar]
- 2.Alexander GC, Frattaroli S, Gielen AC, editors. The Prescription Opioid Epidemic: An Evidence-Based Approach. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health; 2015. [Google Scholar]
- 3.Leshner AI. Addiction is a brain disease, and it matters. Science. 1997;278(5335):45–47. doi: 10.1126/science.278.5335.45. [DOI] [PubMed] [Google Scholar]
- 4.Rhodes T, Lilly R, Fernandez C, Giorgino E, Kemmesis UE, Ossebaard HC, et al. Risk factors associated with drug use: The importance of ‘risk environment’. Drugs Educ Prev Policy. 2003;10(4):303–29. doi: 10.1080/0968763031000077733. [DOI] [Google Scholar]
- 5.van Boekel LC, Brouwers EPM, van Weeghel J, Garretsen HFL. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Drug Alcohol Depend. 2013;131(1-2):23–35. doi: 10.1016/j.drugalcdep.2013.02.018. [DOI] [PubMed] [Google Scholar]
- 6.Dart RC, Surratt HL, Cicero TJ, Parrino MW, Severtson SG, Bucher-Bartelson B, et al. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. 2015;372(3):241–48. doi: 10.1056/NEJMsa1406143. [DOI] [PubMed] [Google Scholar]
- 7.Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: A retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821–26. doi: 10.1001/jamapsychiatry.2014.366. [DOI] [PubMed] [Google Scholar]
- 8.Guerriero F, Reid MC. New opioid prescribing guidelines released in the US: What impact will they have in the care of older patients with persistent pain? Curr Med Res Opin. 2017;33(2):275–78. doi: 10.1080/03007995.2016.1254603. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Arch Pediatr Adolesc Med. 2009. [DOI] [PubMed]
- 10.Lucas P, Walsh Z. Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients. Int J Drug Policy. 2017;42:30–35. doi: 10.1016/j.drugpo.2017.01.011. [DOI] [PubMed] [Google Scholar]
- 11.Shi Y. Medical marijuana policies and hospitalizations related to marijuana and opioid pain reliever. Drug Alcohol Depend. 2017;173:144–50. doi: 10.1016/j.drugalcdep.2017.01.006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Rehm J, Gschwend P, Steffen T, Gutzwiller F, Dobler-Mikola A, Uchtenhagen A. Feasibility, safety, and efficacy of injectable heroin prescription for refractory opioid addicts: A follow-up study. Lancet. 2001;358(9291):1417–20. doi: 10.1016/S0140-6736(01)06529-1. [DOI] [PubMed] [Google Scholar]
- 13.McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. JAMA. 2000;284(13):1689–95. doi: 10.1001/jama.284.13.1689. [DOI] [PubMed] [Google Scholar]
- 14.McLellan AT, Hagan TA, Levine M, Gould F, Meyers K, Bencivengo M, et al. Supplemental social services improve outcomes in public addiction treatment. Addiction. 1998;93(10):1489–99. doi: 10.1046/j.1360-0443.1998.931014895.x. [DOI] [PubMed] [Google Scholar]
- 15.J Soc Work Pract Addict. 2008. [DOI] [PMC free article] [PubMed]