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Feverish talk about an opioid crisis ignores the benefits for chronic pain patients

CBC News by Dawn Rae Downton 26 July 2017

The opioid crisis has gone to the dogs, literally. Last month, major news outlets across Canada reported that a seven-month-old Shih Tzu named Wallace — looking ever-so-cute on the TV broadcasts — had nearly died of a fentanyl overdose.

The Maple Ridge, B.C. vet who saved the puppy with Naloxone said the dog could’ve licked up a few grains of powder; that’s all it takes. Maybe it was carfentanil, the vet said: the really strong stuff.

Carfentanil or not, it sounded unlikely to me that a few grains could’ve done Wallace in.

Veterinarians use fentanyl patches all the time. Years ago, for a couple days after being neutered, my own cats wore 25 mcg patches, the lowest-dose patches made at the time. By then, I myself was a veteran user of prescribed fentanyl for severe and intractable pain from sacroiliitis. But even I worried. One of my cats, the runt of her litter, was tiny. Couldn’t even as low a dose as 25 mcg be too much?

My vet told me how, in the days before fentanyl, he hated seeing animals in pain as they recovered from their injuries and surgeries. He hated seeing them cry and writhe and wave their paws around. My little runt would be fine, he said — and he was right.

Normal and necessary usage

We rarely hear about this very normal and necessary use for narcotic pain medication in our feverish talk about the “opioid crisis” and its bedfellow, the “fentanyl epidemic.” We’ve been told that when it comes to opioids, they’re not only bad: they’re fatal.

Now the opioid hysteria has migrated to veterinary medicine. And indeed, because it’s restricted for human use, some Halifax veterinarians report trouble getting ketamine, an anaesthetic they prefer for veterinary surgery, and say the supply is bottlenecked across the country.

Making matters worse are reports suggesting that addicts might start “veterinarian shopping” to get more narcotics for themselves, or to sell to the street. Not that there’s evidence that this is happening or has happened, or ever could, but to suggest it nevertheless feeds the media narrative.

When it comes to painkillers, can we really trust anything we hear?  In a long interview on Corus radio last month, Minister of Health Jane Philpott, herself a physician, failed to provide numbers to show how dangerous and fatal opioids are. She said she didn’t know how we could tease apart casualty statistics to tell which applied to drug addicts and which to people in pain and using opioids under medical supervision. She agreed that chronic pain patients are routinely confused with addicts, and that the conversation over the past year has been too much about painkillers and too little about pain.

What about the medical professionals who recently crafted the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain, which imposes strict conditions on opioid prescribing? They must know, right? Wrong. Not a single medical practitioner who is a dedicated pain specialist voted on the guidelines. Not a single pain specialist who prescribes narcotics for pain was invited to the health minister’s “opioid summit” last November, either.

Studying the benefits

Indeed, most of the opioid news we hear day after day assumes facts not in evidence. So here is some evidence:

“Medical use of opioids does not cause addiction,” says Dr. Mary Lynch, a professor in the Department of Anaesthesia, Pain Management & Perioperative Medicine at Dalhousie University. Lynch has 25 years of expertise in managing pain, and cites numerous studies showing that only 0.4 to 0.9 per cent of patients continue to use an opioid a year after trauma and/or surgery.

But what about the new guideline’s contention that there is little to no evidence that opioids are useful compared to alternatives? Well, a review in the Cochrane Database, which is regarded by clinicians as the leader for systematic reviews in health care, evaluated 26 studies involving nearly 5,000 chronic pain opioid patients, all of which showed the drugs’ benefits. Only 0.27 per cent — a mere 13 patients — of those 5,000 got addicted.

For that cute little Shih Tzu Wallace, one thing’s certain: if it was fentanyl, he’s in no danger of addiction. And for you? Don’t get hurt; don’t age. The meds that might’ve saved you, well — the truth about them has gone to the dogs.

Dawn Rae Downton is a writer who lives in Halifax.