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How did we get to this point? Hard lessons about the prescription of opioids



"It only takes a few days for people to become infected with prescription opioids," says Dr. Gary Franklin.

"They may also need opioids days to weeks – especially in teenagers, who are more prone to the substances – to the point where it's hard to break up," said Franklin, a neurologist and occupational health researcher at the University of Washington.

Franklin made general statements after the death of 16-year-old Elliot Eurchuk of Oak Bay. On April 21, he had an overdose of opioid prescriptions for sports injuries and postoperative pain.

Elliot's parents blame his death for the opioid override and a provincial bill that prevents them from being informed about his health

Opioids are commonly prescribed to treat pain, but use can lead to dependence or addiction ,

Canada is the second largest per capita consumption of opioids in the world, behind the United States, with 21

.5 million drug deliveries in 2016, according to a 2017 Canadian Institute for Health Information study.

According to Health Canada and most sufferers, last year a record number of people died of opioid overdoses Fentanyl. In B.C. According to the Coroners Service, a total of 1,422 overdose deaths were registered in 2017. About 70 percent were involved in fentanyl, 18 percent in other opioids such as codeine, oxycodone or morphine.

"If you do not deal with inappropriate acute prescriptions, you will never stop it," said Franklin. He said he had a tendency in the 2000s for a large increase in opioid prescribing and an increase in opioid deaths Overdoses discovered within the state workers compensation system of Washington.

"I reported that in 2005 and here we are 13 years later … Why is it still such a problem? It is ridiculous."

When even a small number of people after a slight injury opioids prescribed, surgical procedures or tooth extractions are addictive, there are too many – especially if non-opioid drugs also work, if not better, he said. [19659002] For dental extractions, for example, non-opioids should be a first prescription line, while "85 percent of dentists in [the U.S.] use opioids on the first line and almost automatically give 20 to 30 pills to a patient," Franklin said. "It's like they're hardwired."

The CIHI report found that the number of opioids received by Canadians dropped as the total number of prescriptions increased.

"While these are very broad indicators, the fact that the total amount of prescribed opioids is decreasing and the number of prescriptions is increasing, let's see," Dr. Robert Strang, Chief Medical Officer for Nova Scotia, when the report was released. [19659002] "Opioid prescriptions for acute pain should only be for a short period of time, with ongoing revaluation for repeated prescriptions."

Rachel Staples, Elliot's mother, is a dentist. She said she had been asked to prescribe opioids 23 years ago, but she declined and believed that non-opioid alternatives – a combination of Tylenol and an anti-inflammatory drug – are sufficient for most dental procedures.

But when it came to this, she asked doctors for non-opioid alternatives for her son, who had four operations over 10 months and prescribed various opioids. She could not convince most doctors. Over time, Elliot's parents said he had become addicted to painkillers, supplemented with street medications.

"There must be another first line of treatment than opioids to cope with pain, especially in the young brain," said Staples

"Opioids should not be given to people under the age of 19, unless they are an extreme situation, "she said. "What's wrong with feeling pain? It's a short-term problem. Our body tells us to stop and heal."

Staples and her husband, Brock Eurchuk, said they were addicted even if their son was known to be resuscitated on February 10 from an overdose in the hospital, they were prevented from receiving any information about their son's condition or treatment because the BC Infant Act gives minors consent and privacy for their own medical treatment with the consent of a physician ,

They say that they were sent home, not knowing what their son had taken and without a treatment plan for him to recover.

"We, as parents of children for whom we are legally responsible, must be able to make health and care decisions for our children who are under the influence of substances or have mental health problems," Staples said.

"It is unreasonably expected that a parent will take a child home from the hospital … and take care of them without knowing the full extent of their medical history and without the ability to make life-saving decisions." [19659002] Staples calls on the provincial government to adopt the BC Infant Act or Acceptance of the BC Liberals & # 39; Safe Care Act to give parents the control they need to take care of their children.

"This must be the parent's decision," said Staples, who wants the legal age of competence to be set at 19. "We are facing a health crisis and more children will die if we do not make that a priority."

Minister of Health Judy Darcy met with Staples and Eurchuk, but is largely silent on the legislation. Darcy has said that she will await the results of an island health review in Elliot's care.

Iceland Health intends to complete the internal review by the middle of the month.

"The review involves several departments, including surgical services and child, youth and family," said a statement by Island Health. "Once the review is completed, our first priority will be to get in touch with Elliot's family and then share what we can."

B.C. President Dr. Trina Larsen Soles said we are in a phase of transition from the prescription of opioids.

"I think it will be a slow change," said Larsen Soles.

"It's Much Easier to Change Our Approach to People I have never taken part in these medications."

The provinces are considering the Canadian Opioid Chronic Non-cancer Pain Policy 2017 and how they will regulate the new rules ,

The BC The College of Physicians and Surgeons, which licenses physicians, has translated the guidelines into a practice standard for physicians, and doctors at BC, representing 14,000 physicians, residents and medical students, have requested feedback from their members.

The national and provincial guidelines that rule out cancer and palliative pain – how much is too much and how much is too much risky behavior related to addiction and how to moderate it, said Larsen Soles

Never prescribe or opioids In the long run, all low-dose opioids for chronic pain are "ideal world," but not a real world, she said.

It is not practical for an elderly patient on low-dose opioid for lifelong debilitating rheumatoid arthritis to take only tylenol and ibuprofen, for example, if she has an ulcer and can not tolerate an anti-inflammatory drug, said Larsen Soles. "This is not someone who will become addicted … it just means she can knit."

Larsen Soles said that opioids that have been prescribed for the past 30 years have changed dramatically. "We've learned a lot in medicine that we use less medication for everything – not just pain relief," she said. The current philosophy is to use the smallest dose for the shortest possible time, "whereas 10 years ago we were told that if you do not treat your patient's pain properly, you are a bad doctor."

-Cindy E. Harnett, Times Colonist

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