Doctors share responsibility in the 'perfect storm' of Canada's opioid crisis, expert says

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Canadian physicians must take their "share of responsibility" for the opioid crisis, according to an addiction expert.

"Individually, and as a profession we should have been more critical," said Dr. Anita Srivastava, an associate professor at the University of Toronto and an opioid specialist at St. Joseph's Health Centre.

Both individual doctors and their professional bodies should have thought more analytically about the sale pitches from pharmaceutical companies, she told The Current's guest host Matt Galloway. But she thinks a desire to help their patients led many physicians to accept claims about the opioids, now linked to thousands of deaths across Canada.

Srivastava said she also thinks "that physicians were in a difficult position."

"They had patients who were suffering, who had pain, and here was a solution that seemed to help."

It really was a perfect storm of all of these things coming together, and certainly physicians had their share of responsibility.- Dr. Anita Srivastava, St. Joseph's Health Centre

She explained that even doctors critical of opioids would be faced with patients who had already used them to overcome debilitating conditions. 

There's "somebody in front of you who says … 'You're telling me this pill doesn't work or there isn't a body of evidence to support it, but I'm telling you that I can now get up in the morning, get my kids breakfast and I can get to work,'" Srivastava said.

"To say to that person: 'Well listen, the [research] papers say this, 'is very difficult.'"

On Monday, a court in Oklahoma imposed a fine of $572 million US on drugmaker Johnson & Johnson for its role in the opioid crisis, though the company says it plans to appeal the ruling. 

In a bid to recoup health-care costs associated with opioid addiction in Canada, the B.C. government launched a class-action lawsuit last year against dozens of pharmaceutical companies alleging they falsely marketed opioids as less addictive than other pain drugs. A separate $1.1 billion class-action lawsuit was filed this spring in Ontario on behalf of alleged victims.

In Canada, the federal government's most recent figures estimate that opioids were related to the death of more than 11,500 people between 2016 and 2018.

A group of Ontario doctors were investigated in 2016 for allegedly prescribing unusually large amounts of opioids to patients. Last month a doctor in Saskatchewan agreed to give up his medical licence after he was accused of inappropriately prescribing opioids. 

Srivastava said the crisis grew from a mix of corporate irresponsibility: physicians who weren't critical enough, regulators who approved products that didn't have enough evidence to support their use, and public formularies that paid for these medications.

 "It really was a perfect storm of all of these things coming together, and certainly physicians had their share of responsibility in all of this as well."

'Disaster' to abandon opioids completely

Dr. Hance Clarke claims that physicians try to help patients using the information they have, but in the last couple of decades "where we've landed is not necessarily the safest, or the best place for the Canadian public."

"If we knew better, we probably also would have done better, and we know better today," said Clarke, the medical director of the Pain Research Unit at Toronto General Hospital.

"So how we move forward is probably the most important discussion that we need to have."

Despite the crisis, he told Galloway that it would be a "complete disaster" to stop prescribing all opioids, as they are the best medication available for acute pain. 

This fear of God has been placed into physicians, that our colleges are coming to take our licences away- Dr. Hance Clarke, Toronto General Hospital

"Where we have run into trouble is: Is it efficacious long-term for chronic pain? And at what doses?"

He said that "this fear of God has been placed into physicians, that our colleges are coming to take our licences away if we continue to prescribe these medications." 

Srivastava agreed that "the pendulum has swung from indiscriminate prescribing to whoever needed it, to now we're being very, very careful."

"Really the pendulum sort of needs to be somewhere in the middle, where we're careful about prescribing, but we also recognize that there's a role for opiates in chronic pain."

Written by Padraig Moran, with files from CBC News. Produced by Julie Crysler, Samira Mohyeddin, and Marc Apollonio.