We don't prescribe oxycodone and hydromorphone.
Virtually all the patients who have joined the clinic taking one of these drugs will be moved over to safer alternatives over the next six months.
Chronic pain is a common problem for primary care doctors - disabling arthritis, back pain, nerve pain. When choosing a medication that will treat long term pain, it is important to choose ones that are effective and continue to work over long periods of time.
The best choices are a combination of acetaminophen, anti-inflammatories, gabapentin (an anti-epileptic), and amitriptylline (an antidepressant). It is also very important to treat depression in chronic pain patients, as virtually all such patients will become depressed over time which makes their pain worse.
The worst choices are hydromorphone and oxycodone. These are extremely dangerous drugs, and a very poor choice for long term pain. The reasons are 1. they produce a 'buzz' or 'high' which is extremely addictive, and 2. patients become rapidly tolerant to them and need higher and higher doses for the same effect.
The street value for these drugs is very high as a result, and they are now the most common drug of addiction in Canada. They now cause far more damage than heroin or cocain and because the dangers are not widely known they are addicting a wide range of people who would not normally be exposed to dangerous drugs. Once exposed to these drugs, the less dangerous drugs are less effective because the 'buzz' is missing.
It is rare to see oxycodone prescribed in Scotland. I've only seen them used in terminal care of dying patients. There are two reasons for this: 1. the heavy marketing of the drug in the US by the manufacturers, and 2. the widespread use of pharmacy advisors who monitor the prescribing of drugs in the UK. Yet, I see far more chronic pain problems here than I do in Scotland. It could be that the use of these drugs is actually increasing the chronic pain problem by addicting patients rather than treating them.
If an opiate drug is required, then it is vital to use one that produces less 'buzz' or 'high' as these are less addictive. For example, tramadol.
Sadly, PEI Medicare currently covers the dangerous opiates but does not cover the less dangerous ones, although the prices are similar. I would encourage the PEI Department of Health to review this decision.
For terminal care patients addiction is obviously not an issue and we will continue to use all the drugs available to us to relieve pain in these patients.
4 comments:
It is exciting to hear from a Dr. who considers his patients long term health! While I'm sure it is difficult for patients who currently use these addictive drugs to consider that other medications could be equally or more effective. I would urge them to have faith in a Dr. who clearly has their best interests at heart.
I agree whole-heartedly with this decision. Although many people cannot see past the negative in the decision to not provide prescriptions for these 2 pain meds, the positive is quite apparent in that Dr. Coull is still providing solutions that, in the end, will have a two-fold benefit to the health of his patients. Cudos for sticking to your beliefs, Robbie.
Personally as a person with disabling arthritis I have taken other route imaginable before turning to narcotic pain medication. Although I understand the dr's remarks on the healthcare system over perscribing the narcotics - for me this is something that helps me get through my day. I take them as prescribed without abusing and in my personal opinion I do not think it is fair, I think every patient has a choice. I understand that this is a drug that is abused but the people that use it as prescribed should not suffer because of the people who choose not to use it as wisely. There are other ways to see who is seeking a drug for misuse and who is seeking the drug for help with their pain. I have been on anti-inflammatories and many other narcotics such as tramadol. But the only thing that has helped for me was oxycodone. So although I can see your point on the matter Dr.Coull I do not agree with it. I do appreciate the contribution you are making to the health care world but I think the choice of taking everyone except terminally ill patients off narcotics is a wrong choice. If you lived with the pain I go through I think you might change your mind.
Thank you for your time.
Anonymous,
We do prescribe narcotic pain killers to patients with chronic pain.
Obviously, it is better if patients can be treated without strong opiates (narcotics). However, where they are needed then we use them as safely as possible.
More info here.
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