Dan Small is a medical anthropologist and lecturer at the University of British Columbia.
Since 2018, British Columbia has been pursuing legal action against pharmaceutical companies for their involvement in the opioid crisis. Within the wider context of North America, there have been over 2600 such lawsuits against the pharmaceutical companies including Purdue, Johnston and Johnson, Teva Pharmaceutical and Endo International. The Purdue pharmaceutical company, the maker of OxyContin, has recently filed for bankruptcy in response to the lawsuits. I believe a suitable strategy for examining the wider variables that have contributed to the opioid crisis: a Royal Commission. This is needed in order to widen public scrutiny beyond the role of pharmaceutical companies to include investigation of the overarching causes of Canada’s overdose epidemic.
The new Canadian guideline presents evidence-based recommendations for prescribing of opioids for chronic non-cancer pain, including maximum dose recommendations, avoiding opioids in high-risk populations, and guidance for tapering.
Jason Busse, Associate Professor in the Department of Anesthesia at McMaster University and researcher with the Michael G. DeGroote National Pain Centre in Hamilton, Ontario, co-authored the guideline (open access). In this podcast, he speaks with Dr. Diane Kelsall, interim editor-in-chief, CMAJ, and explains the recommendations.
Praveen Ganty is a Consultant in Pain Medicine & Anesthesia in Toronto
There is a new fashion in the world of Medicine, and in the world of primary care in particular. It is the reluctance to continue prescribing, or to prescribe, opioids. There are two sides to the situation. As medical professionals, we have realized the potential harm that opioids can cause to potentially any patient, especially if prescribed for chronic non-cancer pain. However, many of us have also decided to stop prescribing opioids to patients who have been on them for many years, which raises some concerns. The first principle in the practice of Medicine is Primum non nocere-first do no harm - (modified to ‘first do no further harm’ by some authors).
Managing chronic pain is not easy and - let’s face it - most of us don’t have enough training in this area. A 2011 survey revealed that only an average of 19.5 hours are devoted to the management of pain in an average medical school curriculum. ...continue reading →
Physicians from many specialties may care for inpatients with opioid use disorder. An acute hospital admission is an opportunity to engage with patients who have this common, chronic disorder, discuss addiction treatment and possibly affect the course of their illness. In this podcast, Dr. Joseph Donroe, Assistant Professor of Medicine at the Yale School of Medicine, discusses the best approach to specific problems that may arise when a patient with chronic opioid use disorder is hospitalized for another reason. Potential problems include withdrawal symptoms and managing acute pain.
Dr. Donroe co-authored a review article published in the CMAJ (subscription required).