We too quickly conjure an image of shadowy  figures with dirty needles and unsavory comrades plying their vices in darkened alleys whenever the topic of addiction comes up; but is this a true and accurate portrayal? By any reasonable standard,Canada has a MILLION addicts;and that does not include tobacco habits nor alcohol abuse. Inthe past two decades,deaths from overdoseboth deliberate and accidental and voluntary admissionsto addiction programshave nearlytripled in ourcountry. According toCanada’sCenteron SubstanceAbuse we have nowachieved the dubious distinction of numbertwostatus worldwide insubstance abuse,a close secondto our southern neighbours. The chemical offenderscan be defined in three broad categories…opioidssuchasthe all familiar oxycontin orPercocet,sedative/sleep preparations and finally Nsaidsor non-steroid anti-inflammatories.By far thelargest abuse group are the opioids.What the publicpoorlycomprehends is thechemicalproperty similarities between these drugs and thestreetuse of heroin.

Most adults have arudimentary understanding ofthe psychological dependency acquired byover-usageleading toaneed for increasing dosagetoachieve thesamelevelof relief. Then there is the physicaldependency manifest by withdrawalsymptoms when the drug is unavailableeven temporarily. Butwhat isveryrarely emphasizedin those unreadablepostage stampsizecautions on the labelsistheseriousliver,kidneybone marrow,digestivetractcomplications,even heartdisease than can stem fromlong termuse of these drugs. A classicexample wasthe recentlyintroducedand nowred flaggednextgenerationNsaidCox-2inhibitor—a so-called  “wonder” drug  forarthriticpain…untilyoung adultsstarted dyingwithuntoward cardiacevents.

 

Howdidwegethere?    In a word: the system.

 

We liveinaninstant gratification society and it’s much more expeditious topopa pill for arthritis, say,  than exerciseeach morning or hand dipthe aching handsinawax bath for thirtyminutes. It’s too easyto pop a pillthan practice logicalsleephygiene oraddressthe stress issuesinyourlife.Pharmaceuticalcompaniestapped into this preference spending  billionsin advertising to the publicfollowed by a hoard ofsales repsinvading  doctors’offices floutingthe efficacy of their particular product.Finally,the wholemethodology ofservingupmassmedicineis a huge contributingfactor. The familymedicine fee schedule promotes the “turnstile”visitcomplaint oftenvoiced by patients. Governments have done theirshare too,addingmany ofthese addicting agentstoeligible OHIP druglistings.

Much of the problemissolvable at thesystemlevel.Pharmacistsshould be mandatedto keep aprovincewide registry of patients usingthese druggroupings and patients(except for extraordinarytravelsituations)should be limitedtosingle pharmacy access oftheirownchoice. Every physicianshould be allowed prescribing authority but let us recognize that weareheaded down the same indiscriminate usage roadwe travelled with antibiotics– and lookwhere that hastaken us. There are toomany patients on pharmaceutical  pain management. I would propose any patient requiring more than six weeks of primary course pain medicine  must receive a painmanagementconsultation to explorewhole- person treatmentsand alternativemanagement  options that are available. Butreally thefirststephas tobe everyone of uslookingin themirror and answering twoquestions. Do Ineed this pilltokickstartmy day? IfIdon’t take it,willIquickly experience emotionalirritability then agitation followed by physicalsigns of withdrawal? If so, you are one of that million who are addicted.

By: Dr. David Carll

Providing a fresh perspective for Hamilton and Burlington

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