Update Opioid Guidelines to Help More Patients
Author(s): Scott Douglas Jacobsen
Publication (Outlet/Website): Canadian Students for Sensible Drug Policy
Publication Date (yyyy/mm/dd): 2018/03/21
More than 4,000 people have died from opioid-related overdoses in 2017. The expectation is the same or more in 2018. After the United States of America, Canadians dominate in the consumption of opioids. The Canadian Medical Association Journal publication produced a set of new guidelines for doctors to follow in order to reduce addiction.
The opioids epidemic is a problem throughout the country with more deaths in city centres than in the outlying regions, as far as I know. The deaths seen with the HIV epidemic are surpassed by those in the modern opioid epidemic.
The older guidelines were written by the experts in addictions. Only 20% of those people who need addiction treatment will receive it, the Canadian guidelines should be for the family doctors and nurse practitioners rather than the experts.
As noted in the reportage by Dr. Brian Goldman (2018):
The guidelines say that medications that are readily available are the most effective treatment for addiction. The drug of choice is a combination of buprenorphine and naloxone, which is sold under the brand name Suboxone. Buprenorphine is an opioid medication, and naloxone blocks the effects of opioid medication. When Suboxone doesn’t work or is not recommended, the next option is methadone. If these two drugs fail, the next best option is for the doctor or nurse practitioner to prescribe a slow-release form of oral morphine prescribed as a daily dose that the patient swallows in front of a witness.
The medications reduce the craving in order to assist patients with the withdrawal symptoms and to permit the patients the ability to begin to restart their lives. Methadone has been extant for decades and is riskier for the health of patients than Suboxone.
“Instead of trying [to] reduce or eliminate drug use, harm reduction tries to reduce its negative consequences,” Goldman said, “Dr. Mark Tyndall of the B.C. Centre for Disease Control is setting up a pilot program in which the province will provide the narcotic hydromorphone in vending machines to registered drug users.”
It should be noted that not all addiction experts are in favour of harm reduction with a preference for non-harm reduction methodologies. The fear is the users will be high and sell Suboxone on the street. The problem: little evidence, according to Goldman, exists for this fear-based claim. I do not want to dismiss it, but the evidence supports harm reduction rather than fear. Although, granted, these fears and concerns are not the ideological ones some might find with individuals such as Jason Kenney or other politicians when they denounce some harm reduction measures such as safe injection sites.
References
Bruneau, J. et al. (2018, March 5). Management of opioid use disorders: a national clinical practice guideline. Retrieved from http://www.cmaj.ca/content/190/9/E247.
Donroe, J.H. & Tetrault, J. M. (2018, March 5). Narrowing the treatment gap in managing opioid use disorder. Retrieved from http://www.cmaj.ca/content/190/9/E236.
Goldman, B. (2018, March 5). New opioid guidelines may help more patients get treatment. Retrieved from http://www.cbc.ca/radio/whitecoat/new-opioid-guidelines-may-help-more patients-get-treatment-1.4562082.
The Canadian Press. (2017, December 18). Opioid deaths in Canada expected to hit 4,000 by end of 2017. Retrieved from http://www.cbc.ca/news/health/opioid-deaths-canada-4000-projected 2017-1.4455518.
Ubelacker, S. (2018, March 6). Doctors develop national opioid guidelines. Retrieved from http://www.timescolonist.com/life/health/doctors-develop-national-opioid-guidelines 1.23191514.
Wilhelm, T. (2018, March 6). New guidelines released to combat opioid epidemic call on doctors, hospitals to join fight. Retrieved from http://windsorstar.com/news/local-news/new guidelines-released-to-combat-opioid-epidemic-call-on-doctors-hospitals-to-join-fight.
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