Pain expert says Ontario opioid strategy demonizes people

A Western University pain expert is critical of Ontario's move to de-list high-strength opioid painkillers for people on social assistance, saying the plan lacks empathy, demonizes pain suffers and risks driving people towards suicide as the only way out. 

Most people who I see nowadays with chronic pain will tell me that they do have a suicide plan somewhere.-  Professor Dave Walton

As of Jan. 31, 2017, Ontario will stop paying for high-strength opioid painkillers for people who use the Ontario Drug Benefit as part of a strategy to address the growing problem of painkiller addiction in the province.

Ontario to stop paying for higher-strength opioid painkillers

It means people with low income or who use Ontario Works or the Ontario Disability Support Program can no longer get help to pay for high doses of opioid pain killers such as fentanyl, oxycontin, demerol, hydromorphone and morphine.

"I'm concerned here about trading one public health concern for another and what the fallout of that would be," Dave Walton, a professor at Western University's school of physiotherapy told The Morning Edition host Craig Norris Tuesday. "Most people who I see nowadays with chronic pain will tell me that they do have a suicide plan somewhere."

Risks 10-fold increase in suicidal ideation

While Walton notes most peoples' plans "end up accumulating dust" because their pain is taken care of, he worries that the Ontario government's decision to stop paying for the medications of thousands of people risks pushing them over the edge. 

"The estimates right now are that anywhere from 30 to 50 per cent of people with chronic pain will report suicidal ideation at some point and somewhere in the range of 5 to 10 per cent will have attempted it," he said.

"Compare that to the general population, where an estimate might be three to five per cent in a given year might consider for whatever reason suicide, you're looking at a 10-fold increase between these groups of people."

People will turn to black market

When the province announced it would stop paying for high-strength opioid painkillers in 2017, it said the change would save lives and communities by ending the rash of opioid-related overdoses that have made the drug the province's third leading cause of death, ahead of car crashes. 

But by no longer helping people on low income who suffer from chronic pain pay for the drug, Walton believes the province risks sending people to the black market, where high-strength painkillers, such as fentanyl, can be easily acquired and don't come with the safety nets of the province's medical system.  

"Anyone who's had even acute pain knows it's exceptionally distressing. Imagine the acute pain of a back injury or an ankle injury that lasts for years," he said. "It really weighs on you after a while." 

"That's part of what's been lost in this narrative," he said. "There's a large group of people who turn to the streets because they can't get them from their physicians. That's not to say that they're addicts, it's because they simply aren't getting adequate pain relief and where else do you turn when you're in a crisis?" 

Internationally recognized

Walton is internationally recognized for his work in understanding acute whiplash, as well as the prevention and treatment of chronic pain. However, as a physiotherapist he isn't able to prescribe medication. A factor he argues gives him "a fairly neutral view."   

"[Ontario's strategy] lacks a certain degree of insight and empathy and in particular I'm concerned for what this means for the one in five Canadian adults who live with daily chronic pain and legitimately require effective pain management," he said. 

"This is a group of people who have lived for a long time under stigma and scrutiny from insurers, doctors, family members, friends in terms of trying to find validation."

Taken a step back

"What we've done is taken another step that's going to lead to further – almost demonizing – stigmatizing these people who quite frankly do require opioid medication as part of a more comprehensive pain management program," he said.

"We didn't have a good handle on managing chronic pain prior to the Opioid crisis and now what we've done is made that harder."

"We've taken pain management back a few steps," he added. "I'm neither pro-opioid nor anti-opioid. I'm pro-patient and that's the voice I often see missing from any of these stories."

The full list of medications no longer funded by the provincial government was published by the Ministry of Health and Long Term Care in July of 2016.