The use of prescription opioids has skyrocketed in Canada over the last 20 years. High doses of commonly prescribed are associated with risks including fatal overdoses, motor vehicle accidents, and falls and fractures in the elderly population. Among concerns of overprescription, the Ontario Public Drug Programs (OPDP) announced the delisting of high-strength opioids in July of 2016. These changes eliminated the reimbursement for medications such as high-strength, long-acting opioids, including fentanyl patches, hydromorphone controlled-release capsules and morphine sustained release tablets. According to a follow-up study by the Canadian government, the policy led to a significant decline in the total volume of all three opioids dispensed in Ontario through the public drug program, and reduced the number of high-strength opioid recipients by 98%.
However, another recent study published in the International Journal of Drug Policy reveals that the new policy produced unintended consequences for people who take opioids. The study was carried out by researchers at St. Michael Hospital in Ontario, and consisted of focus group interviews with two groups of adult volunteers. The first group contained patients who were using opioids for chronic pain management. The second group of participants contained individuals who were using opioids for other reasons, including those with self-identified substance abuse problems and individuals practicing recreational opioid use.
According to the results of the study, many of patients with chronic pain felt they were ‘lumped in’ with the ‘real addicts’, and perceived their identity transformed from ‘legitimate chronic pain patient’ to ‘addict.’ Patients with chronic pain also described feelings of being powerless, and losing bodily autonomy and ability to make their own medical decisions. They also described doctors’ reluctance to prescribe opioids and lack of suitable alternatives.
One patient stated, “It’s like being put on an ice floe and shoved away, and now we have to go out on our own and try and figure things out.”
Study participants who were taking opioids for other reasons were critical of stereotypes associated with non-prescribed opioid use, and of minimization of their personal histories of personal trauma, mental illness and emotional suffering in the context of their opioid use.
As one study participant put it, “Most people when they’re talking about chronic pain don’t recognize anguish as pain… Pain is pain, doesn’t matter if it’s emotional or spiritual or physical. And anguish is a horrible, horrible type of pain. I had a friend commit suicide and basically his anguish is such that he just couldn’t tolerate life anymore.”
Currently in Ontario, one in every six deaths among residents between the ages of 25 to 34 is linked to opioids. In response to Canada’s growing opioid crisis, governments and public health organizations have responded with policies designed to decrease legal opioid use, including restrictions on new opioid prescriptions by doctors, removing long-acting and powerful opioids from government health coverage plans, and forced decrease of opioid dosages in chronic pain patients. However, the results of the implemented changes on patient outcomes are still unknown, with more studies needed to address the potential shortcomings of these new policies.
