A Public Health Hotbed: Canada’s Pain Pill Abuse Problem And The Multi-Faceted Solution
Pain Management Canada is the second largest per capita consumer of opioids in the world and prescription opioids are some of the most commonly abused drugs in Canada.
The treatment of pain is both a public health issue and a societal issue: On one hand, black market sales of diverted medications in Canada and Canadian products showing up on U.S. streets together contribute to all the usual criminal activities of the drug trade. On the other hand, countless patients who have legitimate need for these medications are stigmatized and made to feel like criminals.
“It’s clearly become a public health hotbed,” says Dr. Hance Clarke, Director of Pain Services at the University Health Network. “There is an addiction issue. There are prescribing issues. And there is a greater issue with pain that is often lost in the background.” Roughly 30 percent of Canadians have pain problems at some point in their lives, and it is difficult to find a solution that meets their needs while also addressing concerns about addiction and abuse. An unfortunate societal side effect of opioid abuse is that it can make doctors more reluctant to prescribe these medications to the patients who need them, for fear that the drugs will be misused or diverted.
"In Canada, we are many years behind. Both Emberley and Dr. Clarke agree that a national policy on abuse-deterrent formulations would be a good start towards curbing Canada’s prescription opioid abuse problem."
Making drugs harder to abuse
Research and development of innovative technologies designed to help address these issues has accelerated over the past decade and in particular, the introduction of abuse-deterrent formulations is gaining traction in the opioid space. There are a number of approaches to abuse deterrence, six of which are recognized by the FDA. One approach involves changing the physical characteristics of the tablet to make the medication more difficult to abuse. “Before, the pill could be fairly easily crushed and then either snorted or dissolved in a liquid and injected,” explains Philip Emberley, Director of Pharmacy Innovation at the Canadian Pharmacists Association. “Tamper-resistant technologies apply physical and chemical barriers that can limit drug release following mechanical manipulation, making it very hard to get at the drug and use it for those purposes.” Another form of abuse-deterrence involves adding additional active compounds, known as antagonists, to the analgesic to reduce or defeat the euphoria associated with abuse, while a third approach is the inclusion of aversive agents to produce an unpleasant effect if the tablet is manipulated.
Canada lagging behind
These abuse-deterrent formulations, however, are not currently available in Canada for the majority of opioids. In the United States, the FDA has introduced a major initiative to incentivise pharmaceutical manufacturers to make abuse-deterrent formulations for the full spectrum of abusable opioids. In Canada, we are many years behind. Both Emberley and Dr. Clarke agree that a national policy on abuse-deterrent formulations would be a good start towards curbing Canada’s prescription opioid abuse problem.
“Not only do patients need to be educated about the proper use of their medications and the dangers of misuse, doctors also need additional education on best prescribing practices for these drugs.”
A problem that requires a multi-faceted solution
Of course, any successful program will require a multi-faceted approach. “There is always going to be drug-seeking or abusive behaviour,” says Emberley. “Abuse-deterrent formulations can be part of the solution, but we have to be aware that it’s never going to be the entire solution. There’s a big educational component as well.” Not only do patients need to be educated about the proper use of their medications and the dangers of misuse, doctors also need additional education on best prescribing practices for these drugs.
In the meantime, as more abuse-deterrent formulations make their way to the market, we can be secure in the knowledge that they are laying a solid foundation on which a more comprehensive solution, one that fights abuse without preventing the legitimate use of these important medications, can be built.