The BC opioid crisis

My area of interest in the treatment of chronic noncancer pain and the treatment of addiction to opioids over the past 17 years has afforded me some unique perspectives on the BC opioid crisis that I would like to share.

Addiction is a behavioral diagnosis that is made over time when it becomes obvious that a person is unable to control compulsive behaviors with negative consequences associated with the misuse of a substance or behavior (e.g., substance: heroin; behavior: gambling). Taking opioids does not cause the addiction. To be clear: Taking prescription opioids does not cause the addiction. Addiction is behavioral. Not all patients prescribed opioids will exhibit addictive behavior. However, addicts prescribed opioids will get into trouble.

Taking a course of opioids may certainly cause a physical dependence that is manifested by withdrawal. This is something any mammal will exhibit. It’s a physiological response to the prolonged exposure of the body to opioids. Addicts in withdrawal are merely exhibiting what all of us would experience if we were similarly exposed to opioids for a period and had them withdrawn. Being in withdrawal does not make one an addict.

Most physicians are not trained to identify the behavior of addiction or how to respond to it. The College has a duty to address this deficiency in training in all physicians who are permitted to prescribe opioids. The BC government has an obligation to fund this so that something at a grassroots level can be done about this crisis. Identifying aberrant behavior and knowing how to respond to it requires training. Are the College and government of BC listening? This is their responsibility.

In order to identify high-risk patients prior to deciding if an opioid should be prescribed, sufficient time is required to do an in-depth assessment of these complex chronic pain patients. Until there is a fee code with remuneration that adequately reflects the time and effort needed to do this properly the cursory assessments of chronic pain patients will continue to be done and the resultant poor prescribing practices will remain.

Lower-risk opioids such as trama-dol, the buprenorphine patch, or tapent-adol are not covered by the province. This is another reason for the crisis we are having. Having worked in Australia recently as a locum family physician where far fewer opioid prescriptions are written, I soon realized why there is a problem in BC. Tramadol and the buprenorphine patch are covered in Australia, and these safer opioids were the first-line medications that I used to treat patients with chronic pain. When physicians have safer opioid alternatives to prescribe there are far fewer problems. This is something the government of BC is responsible for. If they are to act and do something concrete to quickly and safely change the opioid landscape this is where they need to be focused. This would greatly assist the opioid prescribers. I know this because I have experienced it firsthand.

I believe that the physicians, the College, and the BC government will all have to work together to tackle this problem. It all starts with responsibility being taken so that those with the power to implement change may be guided to do so. This requires leadership from knowledgeable physicians of which there are quite a number in BC and who are very willing to engage. Will the College, in concert with the government, approach them for guidance?
—Paul Harris, BSc, MBBCh, LMCC, CCFP
Duncan

Paul Harris, BSc, MBBCh, LMCC, CCFP. The BC opioid crisis. BCMJ, Vol. 58, No. 10, December, 2016, Page(s) 551 - Letters.



Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.


For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply