Pubdate: Mon, 10 May 2010 Source: Ottawa Citizen (CN ON) Copyright: 2010 The Ottawa Citizen Contact: http://www.canada.com/ottawacitizen/letters.html Website: http://www.canada.com/ottawacitizen/ Details: http://www.mapinc.org/media/326 THE PRICE OF PAIN RELIEF It's sad, but no doubt necessary that police want Ottawa pharmacies to start behaving more like banks as a way of dealing with the growing number of robberies of opioid painkillers such as OxyContin. Whatever their clinical benefits, these painkillers are dangerously addictive. The slang term for OxyContin is Hillbilly Heroin, and it has played a cameo role in the southwestern Ontario murder case of eight-year-old Victoria Stafford (some key players were reportedly addicts). Canadian actor Corey Haim, who died earlier this year, had a long history of prescription drug addiction. Normally, police are preoccupied with crack, heroin and other illegal street drugs, but their growing concern about the abuse of opioid painkillers -- available at your corner drug store -- has rightly caught the attention of health professionals. With the release of the first guidelines on opioid painkillers for treatment of chronic, non-cancer pain, Canadian doctors now have a resource to help them understand when and how to prescribe the painkillers -- and, more importantly, when not to. The guidelines, just published in the Canadian Medical Association Journal, are designed in part to help doctors limit access to the drugs by those who want to abuse them. Of course, it will be impossible to keep the drugs entirely out of the hands of addicts or the hands of those who want to sell to addicts. The demand for opioids is simply too high. This country's opioid painkillers consumption rate increased by about 50 per cent between 2000 and 2004. Canadians are among the highest consumers in the world of opioid-based pain relievers. These pills are everywhere. The guidelines represent a useful attempt to slow down the flow. The guidelines, for example, suggest that when patients first go on the drugs, doctors should consider it a trial period and monitor the patients closely. Doctors must stop prescribing the painkillers if there are any signs of addiction or if the treatment is not working. This sounds like common sense, but the health-care system, like any other bureaucracy, is not always good at following up. A patient can end up taking drugs for a long time before anyone discovers if they've been effective. This is a bad way to manage patients no matter the drug, but it is especially bad when the drug has the addictive properties of these painkillers. The guidelines will only go so far. Some experts say that what is really needed is more information on how these painkillers operate. These are very powerful medicines, and if health professionals and researchers don't fully understand how they work, then it's hard to minimize the risks and maximize the benefits. That there are benefits is without question. OxyContin and related painkillers have brought immeasurable relief to people who were truly suffering, but, with every new case of overdose, dependency and opioid-related crime, the benefits become obscured. The new guidelines set a suitably cautious tone for doctors, the result being that physicians might become more discriminating in how they distribute these drugs. Everyone, it seems, wants a prescription. Effort must be focused on better understanding the pharmacological properties of these pills, so that patients who need them to relieve debilitating pain have access to them, but addicts and criminals do not. - --- MAP posted-by: Richard Lake