Beyond Rx

EDITOR’S NOTE: In her column Beyond Rx, Andrea Wong, a 4th year Doctor of Pharmacy (PharmD) candidate from the University of Waterloo, and a very new member to the Manitoulin community, will be exploring topics on health and wellness, medical advances, and everything in between in the pages of this newspaper. In her first column, Ms. Wong explores the current opioid crisis that is plaguing our nation.

Part I: The Dark Narcs – A current snapshot of the opioid crisis

As an almost-pharmacist, I think it is safe to say that drugs fascinate me. As a bright eyed teenager starting her first work placement at a local pharmacy as part of my high school co-op program, I remember staring up at the shelves and shelves of medication bottles. I remember thinking, “How can a tiny pill save lives?” Now in pharmacy school, what I learned is that medications tether on a rather delicate line between saving and harming lives. This double edged sword is extremely evidence in a class of medication called “opioids.” If used properly, it can relieve pain symptoms for those suffering from chronic illnesses to a point where people who were previously unable to even get out of bed are now able to move functionally and maintain a good quality of life. On the other hand, if abused or not taking properly, opioid overdoses can slow your breathing down to the point of requiring emergency room visits and possibly, death. It is safe to say that pharmacists and physicians are extremely cautious with opioids and it is definitely a balancing act to prescribe.

The buzzword “opioids” are also commonly known as “narcotics” or “painkillers.” These medications include both prescribed and non-prescribed medications. For example, common prescribed opioids include suboxone, methadone, codeine, morphine, demerol, fentanyl, hydrocodone, hydromorphone and oxycodone. Non-prescribed opioids include heroin and fentanyl analogues. Recent opioid tasks forces have reported over 40 types of emerging street opioids designed to mimic fentanyl and its effects including carfentanil and acrylfentanyl. These new types of street fentanyl are extremely dangerous since they have a longer duration of action in the body and require multiple treatments of the antidote to reverse an overdose with high fatality rates. However, opioids do not include drugs like benzodiazepines such as lorazepam and diazepam or stimulants like cocaine and methamphetamine.

Canada has the highest opioid consumption rates in the world and yet currently, there are no national level data on opioid-related mortalities. In Ontario specifically, the number of opioid-related deaths has increased by 463 percent between the years 2000 and 2013. Preliminary 2015 data also indicate that 707 people in Ontario have died opioid-related deaths, now exceeding the number of those killed in motor vehicle accidents. Needless to say, these statistics highlight the fact that this is a highly prevalent problem that needs to be addressed.

There are many emerging strategies attempting to deal with the opioid crisis from all different angles. Health Canada is funding a 2017 update of the national guidelines of opioids in chronic pain to affect physician prescribing habits. In pharmacies, there is a proposal for mandatory warning sticker labelling on opioid prescription bottles to caution people on the risk of addiction and overdose, similar to current stickers saying “Take with food” or “May cause drowsiness.” Pharmacies are also able to dispense the opioid overdose antidote naloxone at no additional costs to the patients. In the community, there are an increasing number of community outreach initiatives through public health programs to increase awareness and education on the signs of an overdose and how to management it.

The landscape of the opioid crisis is constantly changing with new laws coming out seemingly every month and every other news headline reporting on it. Although the opioid crisis is a seemly dark subject matter, the amount and the timeliness of changes happening in our healthcare system to address this issue is certainly a step in the right direction. Next week, Part II of the Dark Narcs will discuss the opioid overdose antidote “naloxone.”

Andrea Wong is a 4th year Doctor of Pharmacy candidate from the University of Waterloo currently working and living in Mindemoya.