Should Heroin Be Used to Treat Addiction?

By Pat Anson, PNN Editor

Some Canadian doctors are using novel approaches to treat opioid addiction, everything from safe injection sites to opioid vending machines to prescription heroin.

A new proposal would take the concept a step further by establishing the first clinical guideline for using hydromorphone and pharmaceutical grade heroin to treat people with severe opioid use disorder. The idea is to provide a safer supply to opioid addicts who currently use illicit heroin, counterfeit pills and other street drugs, which are often laced with fentanyl.

"Offering injectable opioid treatments is an effective way for clinicians to address the toxicity of the fentanyl-adulterated drug supply and help people achieve stability so they can focus on other aspects of their lives to get well, such as housing, employment, and connecting with family," says Dr. Christy Sutherland, Medical Director of PHS Community Services Society in Vancouver, BC.

Sutherland is one of the co-authors of the guideline, which is published in the Canadian Medical Association Journal. In 2018, nearly 4,500 Canadians died from opioid overdoses, with about 75% of the deaths involving fentanyl, a synthetic opioid that’s become a scourge on the black market.

"Opioid use disorder is a public health emergency nationwide; unfortunately, resources for the treatment of opioid addiction have been scarce and guidelines outlining best practices for innovative treatments have been lacking. This guideline is a blueprint for health practitioners to step up and provide evidence-based care," says Dr. Nadia Fairbairn, British Columbia Centre on Substance Use and the University of British Columbia, Vancouver, BC.

Heroin is classified as a Schedule I controlled substance in the United States, making it illegal to prescribe. But pharmaceutical grade heroin (known as diacetylmorphine) is legal in Canada, UK and several other European countries.

Studies have found that heroin-assisted treatment is effective in treating opioid addiction in patients who have failed at other treatment methods, such as methadone.

Under the proposed guideline, injectable heroin (diacetylmorphine) and hydromorphone (Dilaudid) could be used to treat severe opioid addiction in patients who do not respond to oral medication or use illicit injectable opioids.

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It would be up to each Canadian province to decide whether to adopt the guideline.

Pharmaceutical heroin and safe injection sites are controversial issues in the U.S. But a recent analysis by the RAND Corporation advocates their use to combat opioid addiction.

“Given the increasing number of deaths associated with fentanyl and successful use of heroin-assisted treatment abroad, the U.S. should pilot and study this approach in some cities,” said Beau Kilmer, co-director of the RAND Drug Policy Research Center. “This is not a silver bullet or first-line treatment. But there is evidence that it helps stabilize the lives of some people who use heroin.”

What About Pain Patients?

Pain patient advocates in Canada were taken aback by the proposal to liberalize the use of heroin to treat opioid addiction. Opioid pain medication is increasingly difficult to obtain in Canada, as it is in the United States, because of restrictive guidelines.

“It is indeed shocking. Pain patients continue to be marginalized, stigmatized, ignored and left to suffer,” said Barry Ulmer, Executive Director of the Chronic Pain Association of Canada.  “I do think it is ridiculous to say opioid use disorder is a public health emergency. The population they are addressing no doubt has to be addressed, but in terms of numbers it is minuscule to those suffering pain, yet the number of dollars expended for both is just out of whack.

“People suffering pain cannot obtain help or even maintain access to medication they have been stable on for years. Something is sadly wrong. What is a public health emergency is the epidemic of undertreated chronic pain. They should get their blinders off. We have well over 1 million Canadians suffering from high impact pain, yet they are pretty much marginalized.”

One of those Canadians is Dan Wallace, a retired military veteran and police detective who lives with chronic knee and shoulder pain.

“I applaud the efforts made and others that are contemplated for the near future that would allow those who are addicted to obtain legally prescribed heroin that would keep them from the tainted street drug supply,” Wallace said. “Where I have a problem is with the complete dismissal of medical care to the many legacy patients who were previously prescribed opioids to manage their pain.”

Wallace used opioid medication for over 20 years before being tapered. He now has trouble walking and sleeping because of what he calls “a tortuous and cruel degree of pain.”

“I and others like me aren’t looking for a handout of free heroin because we haven’t been able to control ourselves and have become addicts. No one deserves to be treated like throw-away patients yet pain patients are just that. Why is it that their lives matter while simultaneously ours do not?” Wallace asks.

“I have never abused any substance in my life. Does my suffering ever help a single person who will now be getting prescribed heroin so they don’t have to buy illegal street drugs? Health Canada should be deeply ashamed at the needless suffering, disability, and deaths of pain patients they have caused.”

A Survey for Canadian Pain Patients

By Ann Marie Gaudon, PNN Columnist

The last few years have been very difficult for pain patients in Canada. If you are one of the severely pained, you well know that government officials, in a misguided attempt to deal with the problems of addiction and overdose deaths, decided that doctors have been over-prescribing opioid medications and that pain patients taking opioid therapy were the cause of the problems.

The Chronic Pain Association of Canada (CPAC) knows this was never true.

Given the fact that overdose deaths continue to increase as opioid prescriptions have been drastically reduced, government policy has been a total failure while causing tremendous harm to innocent victims.

As a volunteer for CPAC, I want to let you know that our goal is to educate the public, people in medicine, regulatory bodies, and Health Canada on the nature and severity of chronic pain and its treatment. We are working hard behind the scenes to spread awareness with the correct information. No hype, no hysteria – just the facts.

CPAC has created an anonymous survey for Canadians needing opioid medication for pain treatment. We are running out of time and need your help.

The survey is designed to gain a snapshot of how your medical care has unfolded over the past couple of years and how this has affected your overall health. It will take approximately 5 to 10 minutes to complete.

If you are a Canadian pain patient in need of opioid medicines or a caretaker of same, this survey is for you. Please share it widely.

This survey is anonymous: we will not collect personal information, your email address or your computer's IP address.

Once we have collected the data, it will be shared with Health Canada, other government health officials, the media, and all of our allies. If you are not on our emailing list, please join us here.

The time is NOW for your valuable input. Take and/or share the survey by clicking clicking here.

Thank you for helping Canada’s only national advocate for pain patients. We can’t do it without you!

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Ann Marie Gaudon is a registered social worker and psychotherapist in the Waterloo region of Ontario, Canada with a specialty in chronic pain management.  She has been a chronic pain patient for over 30 years and works part-time as her health allows. For more information about Ann Marie's counseling services, visit her website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Would Decriminalization Solve the Overdose Crisis?

By Pat Anson, PNN Editor

Vancouver, British Columbia was the first major North American city to be hit by the overdose crisis. In 2016, after a wave of overdose deaths involving illicit fentanyl and even more deadly synthetic opioids like carfentanil, the western Canadian province declared a public health emergency.

Despite efforts to decrease the supply of prescription opioids in BC, over 3,600 more people have overdosed since the emergency was declared, with fentanyl detected in 87% of the deaths last year.

So when BC’s largest healthcare system recommends some radical solutions to the overdose crisis, it’s worth noting. Vancouver Coastal Health (VCH) released a report last month recommending that illegal drugs be decriminalized and that drug users be given access to prescription opioids as an alternative to the black market.

"Legalization and regulation of all psychoactive substances would reduce people's dependence on the toxic illegal supply, criminal drug trafficking and illegal activities that people with addictions must engage in to finance their drug use," said Dr. Patricia Daly, VCH’s chief medical health officer.  

Some Canadian drug policy experts think the idea makes sense.

"The illegal market is an absolute toxic mess right now," Donald MacPherson, executive director of the Canadian Drug Policy Coalition, told the CBC. "It's really in line with consumer protection strategy ... just like we do with every other substance that we ingest, whether it be food or drugs."

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Also notable about the VCH report is that – unlike most regulators and politicians in Canada and the U.S. – prescription opioids are not singled out as the root cause of the overdose crisis. Instead, opioid medication is seen as part of the solution.

The report recommends pilot programs to see if prescription fentanyl and other opioid medications made available at supervised consumption sites could help high-risk illicit drug users “transition” to legal opioids.

“Piloting legal access to opioids is different from OAT (opioid agonist therapy) as treatment and would be low-barrier and flexible. Initial pilots would include observation of consumption, followed by pilots allowing distribution of opioids for people to take away for later consumption,” the report recommends.

The idea is controversial, but some doctors are warming up to it. A pilot program recently began at a Vancouver clinic, where hydromorphone tablets are given to about 50 patients who ingest them on site under staff supervision. In Ontario, over 400 healthcare providers and researchers recently signed an open letter asking that high dose injectable hydromorphone be made widely available to illicit drug users.

Substance Abuse and Socioeconomic Problems

The primary cause of the opioid crisis, according to the VCH report, is a “complex interaction” of socioeconomic problems, such as unemployment and homelessness, combined with substance abuse and an increasingly dangerous black market supply.

VCH analyzed the deaths of 424 overdose victims from 2017 and found that less than half (45%) even sought treatment for acute or chronic pain. They were far more likely to be unemployed (72%) and have a substance abuse problem (84%). About four out of ten overdose victims used opioids, alcohol or stimulants daily.

“Most of those who died used multiple substances including opioids, alcohol and stimulants such as cocaine and crystal meth. A significant percentage of those who died of opioid overdoses had primary alcohol use disorder and/or stimulant use disorder,” the report found.

Importantly, most of those who died were no strangers to the healthcare system. The vast majority (77%) had seen a healthcare provider in the year before they overdosed and one out of five (21%) had seen a provider a week before their death. Six out of ten (59%) had received Suboxone or methadone to treat opioid addiction, but the medications were either not effective or they dropped out of treatment.

In addition to decriminalization, the VCH report recommends improving access to addiction treatment, better substance abuse training of healthcare providers, and increased access to the overdose reversal drug naloxone.

Task Force: Canada's Chronic Pain Patients ‘Simply Deserve Better’

By Pat Anson, PNN Editor

In March, Health Canada created a new national task force to study how to prevent and treat chronic pain and remove barriers to pain treatment. Health Minister Ginette Petitpas Taylor called it “the first step in addressing the issue of chronic pain in this country.”

One in five Canadians lives with chronic pain and -- like their counterparts in the United States -- many have trouble just finding a doctor willing to treat them. Some patient advocates were skeptical of Health Canada’s task force and its plan to release an initial report this summer, followed by two more reports in 2020 and 2021. It sounded like bureaucratic foot dragging.

“We are happy they are actually acknowledging chronic pain is an issue. However, the time frame is wrong and a little bit too late,” said Barry Ulmer of the Chronic Pain Association of Canada (CPAC).

Four months later, that initial report from the task force has now been released. It calls pain a “significant public health issue” in Canada and admits the nation’s healthcare system often fails to treat pain patients. Efforts to rein in opioid prescribing — such as Canada’s opioid guideline — have made a bad situation worse.

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“Some Canadians have been unable to access opioid medications when needed for pain and function. Others have faced undue barriers to obtaining or filling their opioid prescriptions, and some have had their opioid dose abruptly lowered or discontinued. This has resulted in unnecessary pain and suffering, and has led some Canadians to obtain illegal drugs to treat their pain,” the task force found.

“People living with pain have limited access to the services they require and often face stigma and undue suffering as a result of their condition. This stigma often intersects with other forms of discrimination related to poverty, housing and employment instability, mental illness, race and ethnicity, and other factors further complicating the challenge of living with pain. Canadians living with pain and their loved ones simply deserve better.”

Patients Not Believed

In its short history, the task force completed an ambitious review of pain care in Canada; holding public workshops, meeting with federal and local governments, and consulting with healthcare providers and researchers. Importantly, the panel also reached out to the pain community and invited 12 Canadians living with chronic pain to share their experiences. Many said they had poor access to pain care or were not believed by healthcare providers.

“I was bounced between various outpatient clinics and utilizing the ER multiple times a month and making no progress,” one patent said. “I was consistently questioned whether or not I was making up the pain for attention, or if the pain was due to a mental health condition.” 

“While I am fortunate to be seen periodically by a pain specialist, I do not have access to a multidisciplinary pain clinic where key services, such as physiotherapy and psychology are provided. Many patients in my community have even less (or no) access to a pain specialist and are unduly suffering as a result. They do not know where to turn,” another patient said.

“I found the transition from the pediatric pain clinic to the adult pain clinic very difficult. At the pediatric pain clinic they have a multi-disciplinary team, which include a psychologist, a physiotherapist, a nurse, and a pain specialist. At the adult pain clinic they only have a physician who is amazing but is overstretched, sometimes I can only get an appointment every 6 months,” another patient told the task force. 

Pain Education Lacking

Improving pain education in Canada’s medical schools was one of the first goals identified by the task force. In a review of 10 Canadian universities, the panel found that 68% of the medical programs were not providing any designated hours for pain education.  Incredibly, veterinary students receive 2 to 5 times more pain education than that of health science students.

The panel also found that pain care in Canada is largely dependent on where people live and what type of insurance they have; that pain patients need better access to psychological support, physical therapies and other healthcare services; and that more research and better evidence is needed to help providers make informed decisions on pain care.

“This report makes Health Canada aware of what Canadians with pain have known for too long: that pain care is largely not accessible, many health care providers lack the knowledge and skills to manage pain and breakthroughs in research are hampered by lack of funding,” said Maria Hudspith, co-chair of the task force and Executive Director of Pain BC, a patient advocacy group in British Columbia.

“We hope this report lays the foundation for a national pain strategy that will improve the lives of Canadians who live with pain.”

Not everyone is happy with the direction the task force is taking. CPAC called it a “knee jerk” reaction to the pain crisis that continues to spread stigma about pain patients and their use of opioid medication.

“You see it again in this report,” CPAC’s Ulmer said in a statement. “Pain patients are supposedly often mentally ill—somehow, the need for relief has been recast as mental illness, though it seems pretty sane to me. And patients are repeatedly said to be at high risk of addiction.”

Last month, a federal task force in the U.S. released a final report on recommended best practices for pain management. It found nearly identical problems as the panel in Canada — and called for a balanced approach to pain treatment that focuses on individualized patient care, not rigid prescribing guidelines that have triggered a pain crisis for millions of Americans.

 

Canadian Doctors Prescribe Opioids to Keep Patients Off Street Drugs

By Pat Anson, PNN Editor

So-called “safe injection sites” – supervised clinics where intravenous drug users can inject themselves -- remain controversial in the U.S. Efforts to establish such sites in San Francisco and Philadelphia are mired in political and legal opposition.

But supervised injection sites are already operating in several Canadian cities, where they are seen as an important resource in reducing the risk of overdose and getting drug users into treatment.

Some Canadian doctors, however, believe the injection sites leave out a key population – illicit drug users who don’t normally inject drugs. Rather than run the risk of those patients turning to risky street drugs, they are prescribing opioid medication to them.

“We have to be willing to step outside of our comfort zone and out of the medical establishment comfort zone and say that we need to keep people alive,” Dr. Andrea Sereda, a family physician at the London Intercommunity Health Centre in Ontario told Global News.

Sereda is prescribing hydromorphone tablets to about 100 patients, most of whom were homeless and using street drugs. So far there have been no fatal overdoses, half the patients have found housing, and they have regular contact with healthcare providers.

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“It’s not just a prescription for pills, but it’s a relationship between myself and the patient and a commitment to make things better,” Sereda said. “That involves me taking a risk and giving them a prescription, but it also involves the patient committing to doing things that I recommend about their health and us working together.”

Sereda says her “safer supply” program is only intended for patients who have failed at addiction treatment programs where methadone or Suboxone are usually prescribed.

A similar pilot program recently began at a Vancouver clinic, where hydromorphone tablets are given to about 50 patients, who ingest them on site under staff supervision. At another clinic in Toronto, hydromorphone is prescribed to 10 patients who would normally rely on the black market, where drugs are often tainted with illicit fentanyl or its lethal chemical cousin, carfentanil.

“I’ve had people who, literally, their urine is just all carfentanil,” Dr. Nanky Rai, a physician at Parkdale Queen West Community Health Centre told Global News. “That’s really what terrified me into action.”

Other physicians are warming up to the idea. Last week over 400 healthcare providers and researchers sent an open letter to Ontario Premier Doug Ford asking that high dose injectable hydromorphone be made widely available to illicit drug users.

“We could rapidly implement hydromorphone prescribing,” Jessica Hales, a Toronto nurse practitioner, said in a statement. “Clients want this. Prescribers are eager to deliver it. But it is not covered under the Ontario Public Drug Plan, which is how almost all of my clients access prescription drugs.”

What About Pain Patients?

But patient advocates say the safe supply movement should be expanded to include pain patients who have lost access to opioid medication or had their doses drastically reduced.

“The Chronic Pain Association of Canada fully endorses the safe supply initiative, but asks why we’re helping one group while hurting the other, pointlessly. Safe supply is equally critical for the million or so unfortunate Canadians, including children, who suffer high-impact chronic pain and can no longer obtain the drugs they need,” Barry Ulmer, Executive Director of the Chronic Pain Association of Canada, said in a statement. 

“These patients have long been sustained by the pharmaceuticals and don’t abuse them. But now they’re routinely forced down or completely off their medications, blamed for overdoses they have no part in.”

Some pain patients are turning to street drugs. In PNN’s recent survey of nearly 6,000 chronic pain patients in the United States, eight out of ten said they are being prescribed a lower dose or that their opioid prescriptions were stopped. Many are turning to other substances for pain relief. About 15 percent have obtained opioid medication from family, friends or the black market, or used street drugs such as heroin and fentanyl.

“I know seven people personally that have gone to the streets to get pain relief. Four of them died because it was mixed with fentanyl. Two committed suicide,” one patient told us.

“I have been without a prescription for two years and have been getting medication on the street. I cannot afford this and I have no criminal history whatsoever. I have tried heroin for the first time in my life, out of desperation and thank God, did not like it,” wrote another patient.

Barry Ulmer says these patients need a safe supply too.

“Prescribing opiates safely to those with addiction makes sense. But simultaneously denying legitimate pain patients their medications doesn’t. It’s pointless — and cruel. Let’s give people with pain the same respect and care we give people with addiction,” he said.

Chronic Pain Patients in Alberta Revolt

By Marvin Ross, Guest Columnist

Last week the Chronic Pain Association of Canada issued a press release calling upon the Alberta health minister to investigate the College of Physicians and Surgeons of Alberta (CPSA) for “its unwarranted and secret cautioning and sanctioning” of doctors who prescribe opioid medication.

The press release came after a public meeting of pain patients in Edmonton organized by the group Help Alberta's Pain. Numerous patients showed up to complain about the poor quality of pain care in Alberta.

The meeting was so successful that the organizer, Tracy Fosum, told me that more meetings are being arranged in Edmonton, Calgary, Sherwood Park, Lethbridge and one in Northern Alberta.

An estimated 1.25 million Albertans suffer from chronic pain and 125,000 have long used opiate analgesics in order to function. In March, an Edmonton pain practice shutdown, throwing nearly 1,000 of these patients out of care.  

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“Thousands of Albertans with pain have lost specialist and primary care because the College of Physicians and Surgeons of Alberta has forced doctors to stop prescribing opiates. The province's pain specialists are retiring in large numbers, citing College intimidation,” Barry Ulmer, Executive Director of the Chronic Pain Association of Canada said in a statement.

In response, the CPSA issued a statement from Registrar Dr. Scott McLeod calling such claims “misinformation” and denying there was an exodus of pain physicians from the profession.   

“Many Albertans suffer with severe daily pain and need medical assistance to allow them to live productive lives with their family, friends and in the workplace. We understand the challenges these Albertans face and encourage physicians to work with their patients to find a sustainable solution,” McLeod said. “Responsible prescribing does not include abrupt discontinuation or tapering of opioids or abandoning patients who use opioids.”

McLeod said the CPSA has been successful in reducing overdoses and opioid prescriptions. Accidental overdose deaths in Alberta from prescription opioids have been cut in half, there has been a 20% decline in opioid prescribing since 2016, and 13% fewer patients received an opioid in 2018 compared to 2016.

Patients Denied Treatment

Tracy Fosum recently appeared on the Roy Green syndicated radio show to talk about her personal experiences as a long time chronic pain patient in Alberta. Suffering from what even I recognized as the classic signs of a heart attack, she went to a local Edmonton hospital. Staff were suspicious of Tracy because of her high opioid use and, after a cursory exam, suggested she go home and take some NSAIDs for what they decided were chest muscle spasms.

Later, Tracy went to another hospital emergency room, where she was forced to wait for six hours as, she contends, they mistook her for a drug seeking addict. While trying to convince them to do an EKG, she went into cardiac arrest and collapsed. Fortunately, Tracy survived but ended up with heart damage because she had to wait too long.

Meanwhile, the Ontario College of Physicians and Surgeons is in the process of revising their opioid prescribing guidelines. A new draft policy states: “Physicians must not taper patients inappropriately or arbitrarily. Physicians are reminded that it is not always possible or appropriate to taper below a specific dose, nor is it usually appropriate to suddenly or rapidly taper prescriptions.”

The proposed guideline also states that “arbitrarily refusing to prescribe these drugs in all cases and without consideration for the circumstances of the patient may lead to inadequate patient care.”

While this is a step in the right direction, the problem is that patients have little recourse other than filing a formal complaint if a doctor provides poor treatment. A formal complaint can take months to years to resolve and ruins a doctor/patient relationship.

I am personally familiar with one case where a chronic pain patient was refused care by a doctor unless she agreed not to take any opioid medication. That doctor was sanctioned for refusing a patient on narcotics and refusing to prescribe narcotics, but the sanction was simply “Don't do that. You cannot refuse.” That patient now has no doctor because no one will take her on.

The Colleges can revise their rules and recommendations all they want, but they also need to ensure that doctors adhere to them.

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Marvin Ross is a medical writer and publisher in Dundas, Ontario. He is a regular contributor to the Huffington Post.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Still No Relief in Sight for Canadian Pain Patients

By Marvin Ross, Guest Columnist

Last month the U.S. Centers for Disease Control and Prevention said the agency’s 2016 opioid guideline does not endorse rapid tapering or discontinuation of opioid therapy. The CDC was responding to mounting criticism that its controversial guideline was causing harm to patients, including uncontrolled pain, depression and suicide.

As a Canadian, I am envious and embarrassed, for it is not over for pain patients in Canada. Americans have had active advocates in the American Medical Association and hundreds of doctors signing a public letter of protest, which resulted in the CDC and Food and Drug Administration finally admitting that forcing people to go off opiates is not good practice.

Canadian docs have said little about this, so I decided to ask the main authors of Canada’s opioid guideline, which is pretty much a copy of the CDC’s. They had written in response to me last year in the Canadian Medical Association Journal that they had “concerns” about inappropriate tapering and would “monitor the emerging literature.” Only one replied to me this time, saying that they speak out whenever they can, but no one will listen to them.

One anonymous doctor going by the name of “doc2help” objected to a piece I did in Medium suggesting that Canadian doctors have lost their moral compass. He thinks I am ill informed and doing damage.

I also let the office of the Canadian Minister of Health know what the CDC and FDA have done, as Health Canada has the same regulatory powers for drug approvals as the FDA. The answer was that they are having internal discussions.

Meetings and discussions make the bureaucracy go round-and-round. The Minister of Health did recently announce the formation of a chronic pain task force, but it has a three year time frame for more meetings.

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It is so much easier to blame patients and opioid prescribing, as Canadian authorities continue to do, even when most drug overdoses are the result of illicit fentanyl, not prescription opioids.

In Hamilton, Ontario, a medium sized city southwest of Toronto, opioid deaths are going up, while prescriptions are going down. Much of the illicit drugs in that city are due to pharmacy diversion, according to an excellent article in the Hamilton Spectator that revealed vast amounts of prescription drugs are making it onto our streets.

So far, 15 pharmacists have been caught peddling opioids illegally and Health Canada has found that over 1,400 Ontario pharmacies have reported missing drugs that they cannot account for. 

Dr. Anne Holbrook, director of clinical pharmacology at McMaster University, suggested it is patients who are selling their prescriptions on the street, but provided no studies to back up that claim when she spoke to the Spectator reporter. I have asked her directly and via the media relations department at McMaster University, but did not get a reply.  

Blaming patients is easy when you do not want to confront the fact that most street drugs are coming into the country illegally or being diverted by pharmacies.

A Toronto Star investigation found one Ottawa pharmacy that was responsible for putting at least 5,000 fentanyl patches on the street. The investigation found that between 2013 and 2017, nearly 3.5 million doses of prescription drugs disappeared from Ontario pharmacies. Over 200 Ontario pharmacists were disciplined by their professional body for diverting “massive amounts of deadly opioids.”

Our governments are ignoring all of this and blaming the poor chronic pain patients. Those of us in Canada will have to wait while the bureaucrats hold meetings and write papers before anything will be done.

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Marvin Ross is a medical writer and publisher in Dundas, Ontario. He has been writing on chronic pain for the past year and is a regular contributor to the Huffington Post.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.