Kingston Whig-Standard article published June 11, 2018
By Steph Crosier, Kingston Whig-Standard
Preventing the problem before it starts was one of the themes at a Monday workshop aimed at creating better strategies for opioid stewardship in Kingston.
“Only prescribing it when it is indicated, thinking about some of the downsides, talking about tapering people,” Dr. Fareen Karachiwalla, associate medical officer of health at Kingston, Frontenac, Lennox and Addington Public Health, said at the event.
“The main reason for that is that we know that opioid load in communities is really tied to the number of overdoses, the number of overdose deaths, which is an ongoing problem across Ontario.”
The event, hosted at Public Health’s Portsmouth Avenue location, was called the Strategies for Opioid De-Implementation in Primary Care Workshop and featured speakers from Kingston Community Health Care, Canadian Addictions and Mental Health, Queen’s Family Health Team and the Association of Family Health Teams of Ontario. The approximately 45 participants in the workshop were health-care providers from family health teams or community centres, including physicians, social workers, nurse practitioners and pharmacists.
“They are all facing the same challenge of how to get people to think really quickly before prescribing an opioid, and how to get some people who are on unsafe doses of opioids to bring down that dose in a safe and thoughtful way,” Karachiwalla said.
She pointed out that a large part of the problem with prescribed opioid is linked to the fact that in the 1990s and early 2000s, opioids were heavily marketed to prescribers. Pharmaceutical companies were misleading when it came to side effects of addiction, resulting in minimal awareness for those prescribing the strong painkillers.
“So a lot of people who end up misusing opioids or get dependent on them long-term started because of a prescription,” Karachiwalla said. “In the medical field particularly, when people have surgeries or dental procedures, there’s often a large amount of painkillers that are given out, and often those can be diverted or can be misused.”
Ironically, opioids aren’t even that effective in treating long-term pain, Karachiwalla explained.
“The studies aren’t great, and are more and more showing that [opioids] can actually increase your pain in some ways and reduce your functioning,” Karachiwalla said. “So [the workshop] is about: We’ve gotten so far into this problem, what can providers do in their settings?”
Rather than prescribing opioids, the group discussed alternatives to treating chronic pain.
“One of the challenges right now in Ontario and many other parts of Canada is that those ancillary pain treatments, things like physio[therapy] and acupuncture and mindfulness, those aren’t as available, and when they are available, they’re often not publicly funded,” Karachiwalla said. “It’s no wonder that this reliance on medication has continued. …
“Those alternative treatments are really important, and the government so far has been pretty committed to funding getting more access to chronic pain treatments, but there’s a long way to go still.”