Opiate overdose deaths rising across Canada

Deaths linked to opiate overdoses are rising sharply across Canada owing to an increase in prescription drug use, says a report released Wednesday by the Canadian Drug Policy Coalition.

The report says often these deaths could be prevented and many result from over-prescribing of pain medications.

"It’s a national issue, it’s a growing problem," said Donald MacPherson, executive director of the Canadian Drug Policy Coalition.

"Canada is the No. 2 user of opiates in the world next to the U.S., so there’s a lot of prescription opioids out there in the market."

The report calls for more education of patients taking opiates, appropriate prescribing guidelines for physicians and widespread training and use of naloxone, a drug designed to immediately reverse the effects of an opiate overdose.

"Most overdoses are preventable, they don’t need to happen, they don’t need to result in death. That’s the tragedy here," MacPherson said.

In Ontario, opioid overdoses are now the third leading cause of death, according to the report. In Toronto alone, coroners' statistics show more than 200 people died of overdoses in 2012. Similar increases have also been recorded in Quebec and British Columbia.

MacPherson said the numbers of deaths are likely under-reported, since Canada has a poor system of collecting statistics in this area. As well, it doesn’t include overdoses where death was avoided. "The data is just fragmented. It’s just not there. It’s difficult to get a good picture of the situation at the national level," MacPherson said.

Contrary to popular belief, the deaths and overdoses are not just among street people who use illegal drugs such as heroin, but among the elderly and patients being treated for pain.

"It’s all kinds of people. It’s your grandmother, it’s your husband when he comes out of surgery and his medication isn’t working and his pain isn’t being managed properly and he takes more because the pain is still there," said Holly Kramer, with the Canadian Harm Reduction Network.

Kramer said many people don’t realize the dangerous interaction between opiates and other substances such as alcohol and benzodiazapines such as Valium.

Doctors and pharmacists need to take more responsibility for educating people about the dangers of opioids and what to do in case of an overdose, according to Kramer. "I mean the way we are prescribing now is just a little over the top," she said.

"One of the problems is that doctors, when they prescribe drugs, always assume patients are going to use it as prescribed and that [an overdose] is not going to happen," said Raffi Balian, co-ordinator of Counterfeit, a harm reduction program in east end Toronto that works with drug users.

Balian and Kramer want doctors to prescribe naloxone alongside opiate pain medication and explain to patients and their families how to use it in case of an overdose. She also wants to see police and firefighters carry it since they are often first on the scene of an overdose.

"They all need access to naloxone because it can save lives," she said. She added that injecting naloxone is no different than using an EpiPen, which is commonly carried by many and used to reverse allergic reactions.

For the past three years, Toronto’s public health department has distributed naloxone kits to drug users and trained them how to use it. Similar programs are also in place in British Columbia and Alberta.

Balian said he sees first-hand how naloxone has saved lives in his area. "This morning, one of our workers, I had to give him a new naloxone kit because he had to use it this morning," he said.

Balian said many people who overdose are afraid to call 911 for fear of being arrested by police. The report also calls on governments to set up Good Samaritan laws that would ensure those who call for help are not implicated or penalized for using or possessing drugs.

MacPherson said the new report will be sent to all provincial and federal governments, health ministers, MPs and policy makers in an effort to raise awareness and prevent future deaths.

"You really have to work to raise it up the list of priorities for government. These are often complex, contentious issues and they drift towards the bottom of the agenda," MacPherson said.