CAMH calls for review to combat opioid addiction, overdoses

Toronto's Centre for Addiction and Mental Health (CAMH) is calling for a review of how high-dose opioids are prescribed to ensure that patient pain is properly managed while minimizing the incidence of addiction and fatal overdoses.

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Dr. Peter Selby, CAMH's director of medical education, appeared on CBC's Metro Morning Tuesday and said a review could provide crucial information needed to tackle a crisis that has Canada's opioid use among the highest in the world.

Selby said an over-reliance on opioids is causing sky-high addiction rates and needless fatal overdoses.

"Patients come to harm if you do not monitor this," he said. 

In 2014, more than 700 people died in Ontario from opioid-related causes, a 266 per cent increase since 2002, the Ministry of Health and Long-term Care said in October.

At the same time, the province announced it is launching its "first comprehensive opioid strategy" aimed at curbing the growing addiction and overdose problem that is plaguing not only the province, but the rest of the country.

While a review such as CAMH is calling for was not part of that announcement, Health Minister Eric Hoskins appointed the first-ever provincial overdose co-ordinator to develop a better tracking and reporting system for opioid-related deaths, and promised to establish "evidence-based standards" for health-care providers on prescribing opioids, to be released by 2017-18.

CAMH, Canada's mental-health and addictions hospital, wants the review it's calling for to look at how opioids are prescribed in Canada and lead to measures to curb their over-use, including: 

• Guidelines for prescribing opioids only in exceptional cases and where their use is backed up by evidence. 
• Limits on dosages and the duration of prescriptions. 
• Electronic monitoring of prescription systems that doctors must consult before prescribing opioids. 
• A national surveillance system for harm indications, such as overdose deaths and emergency room visits. 

A statement from CAMH issued this week says the use of prescription opioids has skyrocketed since the 1990s. 

That's when Selby says drug companies began targeting doctors, alleging they weren't adequately treating patients' pain. Long-acting opioids — among them OxyContin — were put forward as a safe alternative to non-opioid pain relievers. As prescription rates increased, so too did misuse and overdose deaths. 

"That's when you saw the problems that come with that rampant prescribing," he said.

Selby said it's a myth that people are simply using opioids as a way to get high, which he said is "not the bulk of the problem."

"People are coming to harm even if they're using [the medications] as prescribed," he said.

He said an effective review would help develop best practices for doctors. 

"We need to start looking at what is contributing to the load of opioids in any community," he said.

"We could identify which formulations are most likely to be causing the problem and what restrictions could be placed on their use," he said.

Selby said a particular problem is the use of opioids for patients with chronic, non-cancer pain.

Despite CAMH's call for a review, Selby said he doesn't want it to lead to a limit on treatment options available to doctors.

"We want to make sure that people who are in acute pain are not denied appropriate opioids, and we also want people with chronic cancer to be able to manage their pain appropriately," he said.

He said an effective review will create guidelines for doctors and help them identify "when patients are getting into trouble with these medications and provide the appropriate treatment."