Stemming the surge in opioid-related deaths is not simple because it requires tackling a series of overlapping crises. But what is inarguable is that physicians have a central role to play in everything from smarter prescribing of pain drugs to caring for people with addictions living on the streets.
That was the message delivered to delegates at the Canadian Medical Association's (CMA) 150th annual conference by a panel of experts on Tuesday.
"This can't be viewed as a criminal problem; it's a health problem," said David Juurlink, head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto.
"It's not one crisis, it's multiple crises;" including over-prescription of pain medications, the growing availability of contaminated street drugs and a failure to fully implement harm-reduction measures.
Dr. Juurlink said the situation has degenerated and deaths have soared largely because physicians and policy-makers adopted policies and practices that were not evidence-based.
For example, opioids were prescribed far more frequently than they used to be in recent decades and in ever-stronger doses based on pharmaceutical companies' assurances that they were more effective than other kinds of pain killers and non-addictive.
In fact, there is no research demonstrating that opioids are effective for chronic pain, and users quickly become dependent and, in approximately 5 per cent of cases, addicted.
As opioids became more readily available, they also began to flood the black market. Drugs such as heroin and morphine were supplanted – and often contaminated – with stronger opioids such as oxycodone and fentanyl.
The death rate of drug users has soared because they often do not know what they're injecting. "It almost makes you nostalgic for the days of heroin," Christy Sutherland, medical director of the Portland Hotel Society in Vancouver.
Canada had at least 2,458 overdose deaths last year, more than 900 of them in B.C. alone. Those numbers could double in 2017.
Dr. Sutherland pleaded with the 1,200 physicians at the CMA meeting to embrace harm reduction because the evidence shows it saves lives.
"Rather than promoting abstinence, we have to work on keeping people alive," she said.
That means providing safe places to consume illegal drugs, readily available treatment and giving kindness to all patients regardless of their station in life.
"There are a lot of myths about harm reduction," Dr. Sutherland said. "Having the option of safety does not encourage drug use, it saves lives."
David Milne, a Calgary anesthesiologist, urged physicians to lobby for the overdose-reversal drug naloxone to be easy to access in their home provinces.
"I carry it with me all the time," he said.
Other panelists echoed his sentiments, but added that drugs to treat opioid addiction, such as methadone and buprenorphine, should also be prescribed and harm-reduction programs such as those that provide prescription heroin should be expanded.
There was also discussion of how naltrexone, a drug that blocks the effects of opioids (as well as alcohol) is underused.
Jean-Bernard Trudeau, assistant secretary of Quebec's Collège des médecins, a regulatory body, said that the "medical profession is part of the problem but they are also part of the solution."
He said it is clear that "more prudent prescription practices" are necessary but that physicians have a difficult challenge trying to ease the pain of patients without causing unwanted harm.
Dr. Juurlink underscored that point as well, saying that "opioids have a role to play in pain management, but it hasn't been well elucidated."
He cautioned physicians to remember that the benefits of opioids fall over time, while the harms increase.
In her address to the CMA meeting on Monday, federal Health Minister Jane Philpott called the opioid crisis a "national public-health emergency" and said the federal government was doing everything in its power to tackle the problem, including approving 16 supervised drug consumption sites, allowing the importation of prescription heroin and working with the provinces to improve surveillance.
Dr. Philpott also told doctors to ponder why so many people use and abuse pain medications, saying it goes well beyond physical pain.
"Doctors have a huge role, including promoting awareness that social inequity and unresolved trauma are often at the root of high-risk drug use. This includes homelessness, poverty, violence and sexual abuse," the minister said.
"Addiction is not a crime, nor a mark of moral failure."
The Canadian Medical Association represents 85,000 physicians, residents and medical students. Its annual general council meeting is often referred to as the Parliament of Canadian medicine.