Dialogue Volume 12 Issue 3 2016 | Page 9

“ Function is more important than pain ”
Feature

Opioid Use and Abuse

“ Function is more important than pain ”
BY STUART FOXMAN
photo : istockphoto . com

At age 65 , Anne had poorly controlled diabetes , coronary artery disease and back pain . One day last summer , her daughter , worried that she could not reach her mother by phone , went to her home and found her lying on the couch , unresponsive . By the time paramedics arrived , Anne was dead . It was classified as a natural death , with chronic hydromorphone use as a contributing factor . Eight days earlier , Anne had filled a prescription for 640 vials of hydromorphone . Given her daily dosage of six vials , 48 should have been used . Now 160 of them were unaccounted for , the equivalent of 20 vials or 40 mg / day . Were they being overused ? Sold ? Bartered ? Her daughter had no answer . In another home , Katie , 21 , heads for bed , after telling her boyfriend that she feels tired . When he comes to bed hours later , she is dead . Under the futon , police find a box of burnt fentanyl patches in foil . The cases illustrate the devastation wreaked by the opioid crisis and the increase in overdose deaths alarms Dr . Paul Dungey , Regional Supervising Coroner in Kingston . “ Opioid addiction and opioid deaths aren ’ t your stereotypical drug abusers . It could be anybody ,” he says . Dr . Dungey says people like Katie light up portions of their patches and inhale the smoke for the hit . And people like Anne – who last visited her doctor a year before her death – are sometimes prescribed injectables that are ripe for abuse . Too often , he feels , there isn ’ t even good evidence to show the narcotics are beneficial . Dr . Dungey has a slide of opioid toxicity deaths in Ontario from 2002-2014 . Heroin-related deaths have increased fourfold in 12 years . Over that period , deaths from oxycodone have risen 4.5 times , from hydromorphone by 7.5 times , and from fentanyl by 15 times . The deaths reflect a larger health crisis around opioids , which cut across demographics . Dr . Dungey blames a culture that puts too much emphasis on drugs as an automatic solution to pain . “ There should be a multidimensional approach to pain , of which narcotics is just one strategy ,” says Dr .

Issue 3 , 2016 Dialogue 9