Opiate prescription dosages to be REDUCED in B.C.
The BC College of Physicians and Surgeons is planning to limit the daily dose of morphine to 200mgs per day for all non-cancer patients who are prescribed morphine.
In other words, patients who are currently prescribed more than 200mgs of morphine per day will be cut back to 200mgs. per day.
With morphine, tolerance develops where the same dose produces less effect. To limit the upper dose for patients with serious pain conditions might be considered cruel; to REDUCE morphine amounts for patients allready recieving higher doses is unheard of. With the right attitude, it would be considered TORTURE [see note]*.
This action from the BC College is all based on one self-serving study that claims patients don't get any pain killing benefit from doses bigger than 200mgs.
This is complete and utter hogwash when considering the tolerance issue where a patient gets used to, as in "becomes tolerant" to, 200mgs per day and is getting very little painkilling effect, but then they take 260mgs per day and are fine - a story heard millions of times by doctors. That is reality, the study must therefore be bogus.
The study says nothing about the effect of reducing amounts of opiate for patients allready tolerant to doses above 200mgs per day. It is one thing to LIMIT the dosage to 200mgs, but another to reduce the prescribed amount to 200mgs per day for patients allready getting higher amounts than that.
Nonetheless, BC's physicians are going along with it.
---NOTE:
* opiate withdrawls were used by Germans [and others?] in WW2 as torture - they would put some of the drug in the food of prisoners for about a month, and then stop it suddenly and begin interrogations. They didn't offer more of the drug as enticement, it was just to soften the prisoner up with the pain of withdrawals. The prisoners often never knew what was causing their pains, but some learned about it later, if they survived imprisonment.
Prisoners have stated that the bowel cramps and other pains - due to opiate drug withdrawals - were worse than the beatings, and that "withdrawal torture" was the MOST EFFECTIVE of all torture methods in getting prisoners to tell their secrets to the torturers.
Lets review: Give opiates to them, then take it away, the result is very effective as torture. {The College is planning to do precisely that, but they may be expecting a different result}
Gee, was I wrong... I thought that there must be a few Babblers who get morphine prescriptions in BC. Apparently not... and that might explain why Babblers so often MAKE SENSE [something you may have seen me struggle with, lol].
Nonetheless, my point is that this decision is going to cause genuine suffering and most likely several suicides. I just thought... naw, never mind...
Thanks for bringing this outrageous situation to our attention, NS!
What happens if a physician disregards the BCCPS limitation and prescribes larger doses?
I have to agree with the BC Physician's College, Noah, because the current practices are causing more suffering. By giving higher doses for chronic non-cancer pain, physicians are flying in the face of evidence, for one. There aren't good data showing improved quality of life for people with chronic non-cancer pain taking super-high doses of opioids. Also, if a person gets tolerant of very high doses of opioids, it puts them in a vulnerable position. Because their extremely high tolerance, patients taking high doses end up suffering withdrawal symptoms just in the normal course of their days. And there are data suggesting that giving lots of opioids to folks for years can actually down-regulate the pain system, making a person less tolerant of minor pain. Recently I witnessed one of my patients, a recovering heroin addict, become hysterical upon getting stung by a bee, finding the pain excruciating and completely intolerable (it was not a serious sting; ie no allergic reaction).
And there's all the people dying of Oxycontin overdose, resulting in a five-fold increase in opioid-related deaths in Canada between 2000 and 2007.
So there's weak evidence for benefit, and strong evidence for harm from giving people all these opioids. What we need to do is find non-drug ways of managing pain, like physiotherapy for instance. The emphasis on pharmaceuticals is only treating symptoms and not getting at underlying causes of chronic pain.
Opioids are massively over-prescribed in North America, compared with the rest of the world: we use up most of the world's opioid supply. Maybe we could look at what other countries do in place of systemically drugging their citizenry.
Though you make a legit point, Noah, about cutting people off, and good drs shouldn't do that. What I recommend to people on high doses is a gentle taper down. The drs I work with and I have been sucessful in helping people this way, working with pain specialists who treat the root causes of the pain.
"Opioids are massively over-prescribed in North America, compared with the rest of the world: we use up most of the world's opioid supply. Maybe we could look at what other countries do in place of systemically drugging their citizenry."
I came across this article tonight, thought it was interesting.
http://politics.salon.com/2011/10/11/as_abuse_mounted_dea_boosted_painki...
"In 1997, a year after prescription drugmaker Purdue Pharma first brought Oxycontin (the first branded version of Oxycodone) to market, the total production quota approved by the Office of Diversion Control was 8.3 tons. By 2011, it had risen to 105 tons, an officially sanctioned 1,200 percent increase over the same period that saw Oxycodone emerge as what Haislip calls “the Cadillac of America’s prescription drug abuse crisis.”
That the DEA allowed for the increases in the face of widespread illegal and non-medical use shows a ”serious lack of accountability and oversight,” says Haislip."
Later:
"What’s particularly disturbing, Haislip asserts, is that the DEA has failed to draw wisdom from two clear-cut examples over the past 40 years in which manufacturing quotas were cut as a means of reducing widespread abuse.
The first occurred in the early 1970s when pill-based amphetamines became a staple of America’s black-market drug trade. In 1973, the DEA enforced a 90 percent reduction in domestic amphetamine production over two years, resulting in what John E. Ingersoll, director of the DEA’s predecessor agency, the Bureau of Narcotics and Dangerous Drugs, told Congress was “a sharp reduction” in the illicit market.
A second example occurred during the early 1980s, when Haislip had first taken over the DEA’s newly minted Office of Diversion Control. Between 1980 and 1982, the office enforced a 74 percent cut in the manufacturing quota for Methaqualone, the core ingredient of the sedative-hypnotic drugs known as Quaaludes. The quota cuts, coupled with a coordinated effort to block illegal international flows of the drug into the United States, had effectively erased the problem of Methaqualone abuse."