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Prescription opioid death rate in B.C. ‘huge’

Prescription painkiller OxyContin, which will be delisted from Ontario's drug benefit program, at the in-patient pharmacy at Sunnybrook Health Sciences Centre in Toronto on Monday, February 20, 2012.

Michelle Siu/The Globe and Mail

People in southeastern British Columbia are dying from prescription opioid overdoses at the same rate they're dying in drunk-driving accidents.

The findings are contained in a research project conducted by medical health officers at the Interior Health Authority and the B.C. Coroners Service.

Across southeastern B.C., an average of 21 people are dying each year from overdoses of prescribed opioids such as morphine, codeine, oxycodone, hydromorphone and fentanyl, the study showed.

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That is a rate of 2.7 people for every 100,000 people in the Interior Health Authority (IHA).

The B.C. Coroners Service said that between two and three people out of every 100,000 die each year in vehicle accidents involving alcohol in the same area.

"People need to know that this is actually a regular occurrence," said IHA medical health officer Trevor Corneil, who wrote an alert last month to physicians and pharmacists.

What's more, Dr. Corneil said, the rate is even higher if you consider the number of people under the IHA's purview who are on opioids. He said of the 25,000 people in the region who have been prescribed opioids to deal with chronic pain, 22 die every year. Most of those – 86 per cent – overdose accidentally as opposed to committing suicide.

"That's huge," Dr. Corneil said. "There are very few things that have that mortality rate."

Looking at British Columbia as a whole, Dr. Corneil said that between 80 and 90 people die from prescription opioid overdoses each year. Each month, seven or eight people in B.C. under the age of 60 die from this type of overdose.

"That's the same rate as the number of people killed in motor vehicle accidents involving alcohol. And you know how much air time that gets," he said.

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In conjunction with the coroners' service, IHA medical health officers reviewed all opioid overdose deaths in southeastern B.C. between 2006 and 2011.

What they found, in addition to the frighteningly high rate, is that most of those who died were less than 60 years old and many, 85 per cent, held down a regular job despite their chronic pain.

"That means these were quite functional people," Dr. Corneil said.

If they hadn't overdosed, he added, "they would still be working, still be productive, still have a reasonable quality of life."

Dr. Corneil said the overdoses are easy to explain.

"You can imagine the situation where someone is on multiple medications and has a hard day at work and they might take an extra pain pill and an anti-spasm pill."

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He said that one extra pill is enough to tip the balance for a person's breathing centre and they would overdose.

Most of those who died were not on a high dose of prescription opioids – less than 200 milligrams of oral morphine – and only one person was seeing multiple doctors.

The finding goes against two misconceptions amongst medical practitioners: that accidental overdoses happen in patients taking high doses of morphine, and that they have prescriptions from multiple doctors, Dr. Corneil said.

The health authority also found that 93 per cent of the people in the cases examined were prescribed other drugs.

Now the IHA is recommending physicians and pharmacists take another look at the combination of drugs prescribed, especially if they are also taking anti-depressants, muscle relaxants and sedatives.

"If you have chronic pain, review your medications with your family doctor. [Particularly] when you are on a combination, take your medications as prescribed," Dr. Corneil said.

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