An Ontario coroner's inquest into the prescription painkiller related deaths of a 19-year-old man and a 41-year-old woman that begins later this week is expected to draw much needed attention to rising death rates associated with this class of drugs.
These pharmaceuticals, especially when mixed with alcohol, anti-anxiety drugs (benzodiazepines) and anti-depressants, are proving lethal for more and more Canadians.
One of the latest high-profile victims was 28-year-old NHL player Derek Boogaard of Regina, who had been playing with the New York Rangers. His death earlier this month from a combination of oxycodone and alcohol was ruled accidental by a Minnesota medical examiner.
The prescription opioids "are very useful drugs, but they are also very dangerous," says Dr. Irfan Dhalla, a clinician and researcher associated with St. Michael's Hospital in Toronto, who has co-authored a number of studies about prescription painkiller use and misuse in Ontario.
The problem is on the increase. Opioid-related deaths in Ontario have climbed to 33.3 deaths per million people per year in 2006 from 19.4 in 2000, with most of the 2006 deaths deemed accidental, according to recent research by Dhalla and others.
It's appropriate that the coroner's inquest is being held in the small city (population about 23,500) of Brockville, Ont., located on the banks of the St. Lawrence River.
The deceased, Dustin King and Donna Bertrand, were both living in Brockville. But it is noteworthy that it is in smaller centres across Canada -- not the largest cities -- that for years the alarm has been raised about the dangers of prescription painkillers. This is evident to anyone who reads local newspaper reports of pharmacy robberies, drug busts, and public meetings about prescription drug related concerns.
In the U.S., prescription opioids have been the leading cause of unintentional overdose deaths -- far surpassing cocaine and heroin -- since about 2001. The same is true in Canada, if the statistics from Ontario hold true for the rest of the country. (There is a striking lack of research in the area of prescription drug misuse in Canada, especially about the progression from use to abuse of these drugs.)
Yet in 2008, Canada had the highest rate per capita consumption of oxycodone in the world, surpassing even the United States, according figures from the International Narcotics Control Board. Oxycodone is one of the opioid; others include codeine, morphine, and methadone. Oxycodone is found in several pharmaceutical formulations including Percocet, Percodan and, in a slow release form approved for use in Canada in 1996, OxyContin.
A key issue is the widespread increase, over the past 15 to 20 years, of family doctors prescribing opioids for chronic (non-cancer) pain, and of doctors and dentists prescribing for, as criminologist Benedikt Fischer of Simon Fraser University put it, "pain at the bottom of the severity spectrum." Prescribing for acute, post-operative and cancer pain is not at issue.
"Experts recognize the urgent need for national policies and programs to address the problematic use of pharmaceuticals," notes a 2008 document from the Toronto-based Centre for Addiction in Mental Health.
Yet three years later, there is still no hint of a national push to track the scope of the problem in Canada; the National Anti-Drug Strategy is concerned only with illegal drugs.
A Coalition on Prescription Drug Misuse was established in Alberta in 2008, and there is talk of that group -- whose first goal is data surveillance to better understand the issue -- becoming formally associated up with the Canadian Centre on Substance Abuse, which wants to see pharmaceutical drugs become part of a revised national drug strategy.
Prescription opioids have legitimate uses and everyone agrees this fact makes it difficult to tackle misuse. But concerted, coordinated action is past due. Deaths are mounting and prescription drugs -- most of them taken from family medicine cabinets -- are now the third most popular drug (after alcohol and marijuana) for teenagers, according to an Ontario survey.
"Hopefully," says Dhalla, "the inquest will result in recommendations that ultimately lead to more careful opioid prescribing."
Ann Silversides has a Canadian Institutes for Health journalism award to research issues related to prescription painkillers and is writing a four-part series for rabble.ca.