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What Are Physicians Doing About Prescription Drug Misuse in Nova Scotia?

Prescription drug misuse is when someone uses a prescription drug for a purpose other than the reason it was prescribed – for example, taking pain medication to get high.

Many different prescription drugs may be misused: the list includes opioid pain medications, such as morphine and oxycodone (familiarly known as Oxy-Contin); tranquilizers, such as Valium and Xanax; stimulants, such as Adderall and Ritalin; and even asthma inhalers. But the misuse of prescription opioids is perhaps the most urgent issue in communities across the country.

Canada is the second-largest consumer of opioid painkillers in the world, says the International Narcotics Control Board. Until about 20 years ago, opioid prescriptions were limited to patients suffering acute, terminal or cancer-related pain.

In the late 1990s, drug companies released long-acting oxycodone and launched aggressive marketing campaigns selling the drug as a treatment for chronic pain. It wasn’t long before physicians were prescribing opioid painkillers in record numbers.

The Canadian Drug Use Monitoring Survey reported that in 2009, approximately 20 per cent of the country’s population – about 6.7 million Canadians – received a prescription opioid. Of those, 4.8 per cent (more than 320,000 people) admitted that they had used the drugs in a non-prescribed way, and 0.4 per cent admitted to using the drugs to get high.

In fact, it appears that prescription drugs are actually replacing illicit drugs in some areas:

“A recent study of prescription opioid abuse in Canada using OPICAN data from seven urban centres across the country found … whereas about 30% of study participants used heroin, 37% used Dilaudid®. Further, other prescription opioids such as morphine, oxycodone, Percocet®/Percodan®, and codeine-based preparations are being actively used.”
Backgrounder: Canada’s prescription opioid crisis

What does prescription drug misuse look like in real life?

It’s tempting to picture the people who misuse prescription drugs as stereotypical drug addicts – like someone you might see on an episode of Law & Order or CSI. But the reality is that anyone can become addicted to prescription drugs.

Studies show that a wide range of people misuse prescription drugs, and that their reasons for doing so vary. Evidence suggests that, generally, adolescents, older adults, women and Aboriginal people have a higher risk of misusing or abusing prescription drugs. Social determinants also play a role: poverty and crime are strongly linked to the disease of addiction. Patients with chronic pain are also at high risk.

Imagine a woman you know who has had a Caesarian section, an elderly person who has had a hip replacement, or a colleague who deals with chronic back pain: it’s possible that they have filled a prescription for an opioid pain medication.

Because of the highly addictive properties of opioids – they flood the brain with dopamine, causing a feeling of euphoria – any one of those people might have been at risk of developing a dependence or misusing the medication.

People who misuse prescription opioids can quickly find themselves locked into a downward spiral: they may change doctors frequently or attend urgent care or emergency clinics as a way of getting new prescriptions, divert drugs from friends and family members, or resort to buying pills on the street – or stealing them.

As this behaviour increases, so does the risk of death as a result of opioid misuse.

The problem is rampant in Nova Scotia: The Office of the Chief Medical Examiner in Nova Scotia identified 295 prescription drug-related deaths between 2007 and 2010. In fact, deaths related to prescription drugs were more than four times more common than deaths related to illicit drugs, and the most commonly cited drugs in those cases were opioids.

What is being done about prescription drug abuse in Nova Scotia?

Health-care providers across the province are working on initiatives to help deal with the problem of prescription drug misuse in Nova Scotia. Some are simple, such as community-based drug drop-off days, when patients can safely disposed of unneeded medications by returning them to the pharmacy or another designated drop-off spot.

Nova Scotia is fairly advanced when it comes to monitoring prescription drugs: the province established the Prescription Drug Monitoring Program in 2005 to reduce the abuse or misuse of prescription drugs.

As of April 2014, the College of Physicians and Surgeons of Nova Scotia (COPSNS) also requires physicians to pre-screen patients’ prescription histories before providing narcotics in urgent care or emergency rooms.

Finally, the province-wide Drug Information System, which rolls out this August, will create a personal profile for every person who fills a prescription, allowing doctors, pharmacists and other health-care providers the opportunity to review a patient’s prescription history.

In addition, campaigns like The Right Tool for the Job and Choosing Wisely Canada are working to educate both patients and doctors about the dangers of prescription drug misuse, and to encourage both parties to discuss different treatment options – recognizing that a prescription opioid might not be (and often isn’t) the best option for pain management.

By encouraging doctors and patients to discuss other pain management options, such as non-opioid drugs, physical activity or mindfulness meditation, the people behind these campaigns hope to see a decline in prescriptions issued for opioid painkillers.

Individual doctors are also making a difference. For example, when Dr. Rhea MacDonald came face-to-face with the devastating effects of prescription drug misuse in her community, she and her colleagues got to work. Between them, they developed the Inverness Model, a multi-disciplinary approach to treating prescription drug misuse that is now being emulated in communities across Canada.

What can you do?

Further reading:
Council on Drug Abuse – FAQs
Coalition on Prescription Drug Misuse – Reports and Resources
First Do No Harm: Responding to Canada’s Prescription Drug Crisis (PDF)
Prescription Drug Overdoses in Nova Scotia Working Group: Recommendations
Nova Scotia Prescription Monitoring Program
Backgrounder: Canada’s prescription opioid crisis