Friday, September 17, 2010

Health professionals address reducing drug misuse in pain treatment - Guelph (Ontario) Mercury

General practitioner Dr. Kevin Librach sometimes treats
people for chronic pain, but doesn't relish being
manipulated, on occasion, by those consuming prescription
opiates simply to get high.

"We all get fooled sooner or later," he said Thursday, a day
after attending a forum for health professionals on treating
pain while reducing any potential harmful effects and
avoiding misuse.

It's a timely subject with growing public concern over the
risk of some patients becoming dependent, even addicted, to
prescribed opiates, called psychotherapeutic drugs, and the
ready black market in Guelph and elsewhere.

"The problem is we have a lot of people with chronic pain
and a few bad apples wrecking it for genuine people" for
whom doctors are trying "to alleviate suffering," the Guelph
doctor said.

The dilemma came into sharp focus at Wednesday's forum,
presented by the Wellington-Guelph Drug Strategy, an
organization dedicated to easing the impact and incidence of
substance misuse.

Audience member Ben Bair, a Guelph police constable, noted
almost 60 per cent of drug charges laid this year were for
misuse of prescription medications.

Police information officer Doug Pflug said Thursday the top
medications seized in that 59.4 per cent included oxycodone,
benzodiazepine, hydromorphone and morphine. The opioid
analgesic oxycodone, a popular street drug, is best known by
its brand name, OxyContin.

"They fetch a good price on the street, that's for sure,"
Librach lamented. "It's a tough problem."

The two dozen doctors and other health professionals
including addiction advisers, who made up the audience of
almost 100 at the Elora Mill Inn heard pain expert Dr. Roman
Jovey stress while the risks associated with prescription
opiates aren't minor, the drugs are a boon in the treatment
of chronic pain.

Still, health professionals must respect their potency,
minimize the potential for misuse and be wary of patient
dependency and diversion from intended use.

"Street drugs were good enough for my generation," quipped
the 30-year doctor, who now specializes almost exclusively
on pain treatment.

"Addiction's a big problem; pain's a far bigger problem," he
said, asking the audience to weight prescription drug misuse
against the larger benefit of effective pain management for
those who need this in the absence of practical alternatives.

Chronic pain and its effects, such as lost productivity,
costs the Canadian economy about $40 billion a year, said
Jovey, medical director of a chain of pain management
clinics and a past president of the Canadian Pain Society.

"Like it or lump it, opioids have evidence" of
effectiveness, he said.

Jovey reported those most likely to misuse prescription
medications, typically 16 to 34 years of age, see them as
safer than street drugs and less likely to land them to
jail, with the justice system's priorities elsewhere.

Addiction has a variety of causes, including perhaps a
genetic or biological predisposition, he continued. He
cautioned against despairing in the face of what American
doctors are increasingly calling 'substance use disorder.'

"It begins with a choice and it ends in a choice (to seek
help)," Jovey said.

The pain management goals of health professionals, he said,
are threefold: reduce pain, improve a person's functioning
and minimize medication risks.

"We're the gatekeepers," of those medications, he said.
"There's no risk-free option, including no action."

Drug strategy committee chair Heather Kerr said Thursday the
forum illuminated a hot topic in the health field. "We
wanted to talk about the whole issue of opiate misuse in the
community," said Kerr, executive director of Guelph's
Stonehenge therapeutic centre.

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