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Opioid abuse problem peaks in London area

By Dan Brown, The London Free Press

Ontario’s opioid drug epidemic has reached staggering levels, the problem worse in parts of Southwestern Ontario than anywhere else, some experts say.

In a new report Wednesday, Health Quality Ontario suggested as many as two million Ontarians — or 14 per cent of the population — filled prescriptions for pain-killing opioids in the year that ended last March.

That’s a jump of 450,000 prescriptions over the same period three years earlier, suggesting patients were still given the potent painkillers despite efforts to curb what’s been called a national epidemic of overuse.

Not only did the number of prescriptions spiral upward, but there was also a trend toward doctors choosing more potent versions of the drugs and a spike in the number of patients receiving them, said Dr. Joshua Tepper, president and chief executive of the provincial agency.

That’s despite the fact that the use and abuse of the powerful painkillers, a common street drug, has been known for years, with growing awareness of the fallout.

In Southwestern Ontario, one county — Oxford — picked up an unflattering nickname, Oxy County, from frequent stories involving abuse of the opiod OxyContin, which took a heavy toll in many small towns and rural areas of Ontario before it was yanked from the market in Canada in 2012 and replaced by a different pill considered harder to abuse, because it can’t be crushed and snorted or dissolved and injected.

Opiod use still looms large in Southwestern Ontario, the new report suggests.

Of 14 geographic areas into which Ontario is divided and overseen by provincial agencies that allocate health dollars, called local health integration networks (LHINs), the Windsor-Chatham-Sarnia area ranked No. 1 in the report for opiod use, with 18 per cent of the population taking the prescribed drugs.

In the LHIN that takes in London and cities nearby, including St. Thomas, Stratford and Woodstock, 14 per cent of the population was using prescribed opiods, the same as the provincial average.

Provincewide, areas covered by five LHINs were below the provincial average.

Central Toronto was the lowest-ranked area, with only 11 per cent of its residents prescribed opioids.

“We don’t know the exact reasons for the variation by LHIN region, but it may be partly related to population differences, differences in prescribing practices, or variation in access to non-opioid options for pain control, such as physical therapy,” says the report.

But Sharon Koivu, a palliative care and addiction physician consultant at London Health Sciences Centre, says overprescription is a “huge” problem in Southwestern Ontario.

“We are different (than the rest of Ontario). We have more prescription opiods as the drug of choice on our streets,” Koivu said.

“Because this problem is different, we need a local solution to our local problem.”

“It’s definitely an issue,” echoed Sonja Burke, director of Counterpoint harm-reduction services at the Regional HIV/AIDS Connection in London.

Burke and Koivu say when Oxy Contin was pulled from the market and replaced with Oxy Neo, those with addictions in London simply switched to any drug they could find.

“So now we have a crystal-meth problem,” said Burke.

“You can pull away the substance, the addiction doesn’t go away,” Burke said. “We left an entire generation without supports.”

Almost all oxy in the region was obtained through prescriptions, Koivu noted. “I think we have to look at the source. And in London, the source is physicians,” she said.

“In spite of us know that there’s a problem with opiods . . . it takes a lot to change culture and understanding,” Koivu added. “I’m worried about the size or prescriptions.”

Tepper, the head of Health Quality Ontario, underlined that point.

“Despite people (being) aware of the significant impact and danger of opioids, we continue to see a steady increase in the number of prescriptions being written,” he said.

Jeff Yurek, the health critic for the Progressive Conservatives at Queen’s Park, and a licensed pharmacist, said he didn’t realize the problem is as severe as it is in the southwest.

“I think overprescribing is a concern. I think the government’s been slow to react to remedy the situation,” said the Elgin-Middlesex-London MPP.

He said rationing of health care also plays a part — patients who can’t get scheduled for surgeries end up using opiods as a long-term pain solution when they can’t get quickly get the operations they need.

The report found there’d been a shift to doctors prescribing stronger opioids over time. For instance, 29 per cent more patients received hydromorphone in 2015-16 than in 2013-14. The drug is five times more potent than morphine, the drug used in prescribing guidelines as a baseline standard for comparing the strengths of different opioids.

“Hydromorphone was a drug that a few years ago was very rarely used and now is being much more commonly prescribed,” Tepper said. “You may see greater dependency over time developing with lower-potency (drugs) and people shifting (to it) to deal with the tolerance that developed.”

Addiction experts say another reason doctors switched to such opioids as hydromorphone, tramadol and morphine relates to the replacement of OxyContin in 2012 with OxyNeo, a tamper-proof version of the drug that Ontario dropped from its drug benefit formulary in a bid to curb excessive prescribing.

Benedikt Fischer, a senior scientist at the Centre for Addiction and Mental Health in Toronto, said it’s been known for well more than a decade that opioids posed risks of dependence or addiction and that prescribing in Canada was disproportionate to their benefits for relieving chronic, non-cancer pain. Canadians are the world’s second-highest per capita opiod consumers, lagging only behind the U.S.

“This report puts a bit of a more refined picture on that state of affairs. It describes a lot of important details,” Fischer said.

“What it doesn’t tell us is: Are the people who are getting these prescriptions — should they be getting these prescriptions or not? That’s the next critical question that we really need to answer.”

While the report points to such measures as greater access to the overdose-reversal drug naloxone and an increased emphasis on providing treatment for opioid use disorders, Fisher said the major driver of the opioid crisis — rampant oversprescribing — continues.

“So we’ve tinkered with prescribing and shifted a little bit from a rock to a hard place, but overall the general problematic situation of a high number of opioids being prescribed to a lot of people — and more often than not for a long term — remain virtually unaddressed,” he said.

Three months ago, public health officials in Windsor-Essex released a report showing that area had an opiod-related overdose death rate double the provincial average.

Koivu said those dependent on the drug need attention. “Nobody chooses to be addicted and we have an obligation to care for the people who are suffering,” she said.

With files from Canadian Press and Windsor Star