High-dose opioid painkillers still prescribed at high rates in Canada

[S.J.B.]

High-dose opioid painkillers still prescribed at high rates in Canada
CBC
September 12th, 2014

Many Canadians are prescribed high-dose painkillers such as OxyContin and morphine, among the most dangerous pills, say researchers, who found differences between dispensing between provinces.

Investigators at the Institute for Clinical Evaluative Sciences in Toronto reviewed retail pharmacy dispensing rates for opioids between 2006 and 2011.

In Friday’s issue of Canadian Family Physician, Dr. David Juurlink, a clinical pharmacologist at Sunnybrook Health Sciences Centre and his co-authors said they found "marked inter-provincial variation" in dispensing of high-dose opioids in Canada.

"What this paper looks at is specifically the high-dose products," said Juurlink, who is also a scientist at ICES. "The doses at the upper limit, where if you took them as prescribed, you would be a watchful or dangerous dose of opioids, and where if a teenager experimented with a single tablet, could easily kill themselves if they took it at a party."

Most of the time, Juurlink said, high-dose opioid drugs are associated with side-effects more than benefits. The risks include:

• Motor vehicle collisions.
• Fractures.
• Confusion.
• Addiction.
• Death.

Read the full story here.

This is misinformation:

The doses at the upper limit, where if you took them as prescribed, you would be a watchful or dangerous dose of opioids, and where if a teenager experimented with a single tablet, could easily kill themselves if they took it at a party.

A single tablet of any pharmaceutical opioid, even at the high-dosage formulations, will not kill a teenager. That is a ridiculous, unsubstantiated claim to make. However, the teenager could die if the tablet were combined with a depressant, such as alcohol or a benzodiazepine. The vast majority of drug poisoning deaths involving opioids occur after consumption of multiple depressants, not a single drug.

 

[Screaming_Skull]

Sooo keep your damn pills locked away from the kids. I'm so tired of these articles, people need these meds, there always have and always be people who abuse opiates/opiods since the begining of time pretty much...its not gonna go away, and cracking down on doctors who prescribe(and went to school for it) have to listen to people who have no goddamn clue what there talking about about how much to prescribe etc etc...it just makes the problem worse, there's always heroin, which if some one who is in chronic pain or is just an addict getting it from a doctor and no longer can, well there gonna do fuckin heroin. I swear...of course they had to mention teens taking it cuz it's about the children. Just grrrrrrrrrr!!!!!

 

[Crankinit]

A single tablet of any pharmaceutical opioid, even at the high-dosage formulations, will not kill a teenager. That is a ridiculous, unsubstantiated claim to make. However, the teenager could die if the tablet were combined with a depressant, such as alcohol or a benzodiazepine. The vast majority of drug poisoning deaths involving opioids occur after consumption of multiple depressants, not a single drug.

There was a case a few years back where two teenage girls bought an oc80 each, ate the whole pill (can't remember if they crushed it or not) and at least one of them died. So yeah, it can happen. A lot of, maybe most of, OD's involve poly-drug use, but not all of them.

Not to mention the risk of vomiting while unconscious and choking, passing out in a bad position and losing breathing/blood flow, etc etc.

 

[S.J.B.]

There was a case a few years back where two teenage girls bought an oc80 each, ate the whole pill (can't remember if they crushed it or not) and at least one of them died. So yeah, it can happen. A lot of, maybe most of, OD's involve poly-drug use, but not all of them.

You can verify that they had not taken any alcohol? Usually this isn't even reported.

There was a study done on all overdose deaths involving oxycodone, between 1999 and 2008, in New South Wales. Every single person had taken at least one other drug.

In Scotland, in 2012, 97.6% of drug overdose deaths occurred after someone had taken more than one substance.

There are clearly a small number of exceptions to what you could call the Polydrug Overdose Rule (2.4%!) but I'm sceptical that a teenager has ever died just from eating (or even sniffing) 80 mg of oxycodone.

 

[Crankinit]

Like I said, it isn't just down to pure respiratory depression. Pass out in the wrong position, or the wrong location, or vomit while doing so - any of those can happen well below 80mg to a non-tolerant teenage girl.

Besides, the article didn't say anything about whether the (hypothetical) pill would be taken by itself. In fact the (hypothetical) situation discussed is a party, probably the situation most prone to poly-drug use that there is. At a minimum, 'party' implies alcohol. A teenager, still with a low alcohol tolerance, knocking back drinks to impress people, someone passes a pill, 8 hours later there's a corpse in a pile of vomit in a bedroom or bathroom. That's the kind of thing they're talking about.

You're overreacting. I like oxy as much as the next opiate user, but that doesn't mean losing sight of the fact that having them around and easily accessible, especially to teenagers, is dangerous.

 

['medicine cabinet']

Well since chronic pain will always be around, until modern medicine builds a better mousetrap so to speak and creates some kind of equally powerful painkiller with no euphoria and addictive qualities these opioids drugs will be abused since they are the gold standard in efficacy for the treatment of severe pain. And also for the fact drs more or less have to take their patients word that they are in pain. Xray and other tests can only reveal so much..

Sucks here in the us BC drs are so reluctant to write opis unless its a chronic pain Dr or the patient is obviously in pain, broken bones burns ext but when someone says they pulled their back and need oxy and ask for it by name, that usually throws up a red flag.