Opioids overuse is the "worst man-made epidemic in modern medical history," a leading expert on workers' compensation told Canadian physicians Wednesday, urging them to take tough and immediate action to address the problem.
Dr. Gary Franklin, medical director of the Washington State Department of Labor and Industries, said two people an hour are dying of opioids misuse in the United States, and, proportionally, the problem is likely as bad, if not worse, in Canada.
"We are creating a lost generation of people whose lives are ruined by opioids," he told the annual meeting of the Canadian Medical Protective Association in Vancouver. The CMPA is a "mutual defence association" that insures Canadian doctors.
There are roughly 14,000 opioid deaths a year in the United States and an estimated 2,000 in Canada.
"The assumption is that these deaths are happening among junkies, but that is very, very wrong," Dr. Benedikt Fischer, senior scientist at the Centre for Addiction and Mental Health in Toronto, told the conference.
"The people who are dying are not street users; they are being introduced to these drugs medically."
A recent Globe investigation found that the federal and provincial governments have failed to take the necessary steps to stop doctors from indiscriminately prescribing highly addictive opioids for chronic pain. Last year, doctors wrote 53 opioid prescriptions for every 100 people in Canada, according to figures compiled for The Globe by IMS Brogan, which tracks pharmaceutical sales.
"We've been sitting on the sidelines watching this crisis unfold," Dr. Fischer said, lamenting the utter lack of regulatory action in this country.
Even basic stuff such as the tracking of overdoses and deaths is poor, and there are no national data in Canada, he said, adding that it is absurd that this kind of information is compiled by media such as The Globe and Mail rather than by health authorities.
Dr. Fischer said the fundamental problem is that physicians are prescribing opioids for all manner of conditions for which they don't work and, once treatment begins, doses are increased to dangerous levels.
"We are prescribing large volumes at too high doses," he said. "I've never heard regulators say that clearly."
Opioids, which are strong pain medications, are effective for treating cancer pain and in palliative care, but there is little evidence they are effective for long-term chronic pain. They are also highly addictive. Because they affect breathing, opioids can also be deadly, especially if taken with alcohol or sleeping pills.
Yet their use has soared. In Canada, for example, opioid prescriptions have increased three-fold in the past decade, and there is a trend toward using the most potent forms, such as fentanyl.
Dr. Gordon Wallace, managing director of Safe Medical Care at the CMPA, said pain control is not easy for doctors to navigate, and many are struggling to figure out how to use opioids appropriately.
The CMPA has taken interest in the issue, and sponsored a high-level panel on the topic, because of the potential legal repercussions for physicians.
Dr. Wallace said the CMPA has been involved in 151 cases involving allegations of patient harm caused by opioid prescribing between 2010 and 2015.
He said there were three major themes that arose in these cases: inadequate assessment when patients are prescribed opioids or when their prescriptions are renewed; oversedation (physicians prescribed opioids to patients who are already taking benzodiazepines); and not acting appropriately toward patients with drug-seeking behaviour.
Dr. Heidi Oetter, registrar of the College of Physicians and Surgeons of British Columbia, said physicians have to respect guidelines for prescribing opioids and be vigilant to avoid causing harm.
"It's not good enough to be naive," she said. "You are the prescriber, you have to be responsible."
Earlier this year, the U.S. Centers for Disease Control and Prevention published strongly worded guidelines about prescribing opioids, and physicians were urged to heed those directives.
Traditionally, doctors have been taught that opioids should be used for chronic pain and doses increased if pain worsens, and that they are not addictive.
"We were taught falsehoods," Dr. Franklin said. "Remember that 95 per cent of deaths are in people who should not be getting these drugs in the first place."