"I think that every doctor who contemplates starting a patient on an opioid for chronic pain should ... realize that they are playing with fire," says Dr. David Juurlink, head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre. Photo: Postmedia News file photo The number of lives lost to opioid overdoses is increasing rapidly, according to a new Ontario study — and the bulk of the deaths are clustered among the young.
Researchers who combed through death records from the Ontario chief coroner’s office found that the overall rate of deaths linked to the narcotic painkillers increased roughly three-fold between 1991 and 2010.
During the 20-year study period, the team identified 5,935 people whose deaths involved opioids. The opioid death rates increased 242 per cent, from 12.2 deaths per million in 1991 (127 deaths annually) to 41.6 deaths per million in 2010 (550 deaths annually.)
There was also a stark jump in the percentage of all deaths attributable to opioids, especially among young adults aged 25 to 34, in whom opioid-related deaths accounted for 12 per cent of all deaths in 2010, up from three per cent of all deaths in 1992.
By 2010, almost one in eight deaths in that age group involved an opioid.
“I think that every doctor who contemplates starting a patient on an opioid for chronic pain should look at that figure and realize that they are playing with fire,” said senior author Dr. David Juurlink, a scientist at the Institute for Clinical Evaluative Sciences in Toronto and head of the division of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre.
Others have warned that opioid-related deaths are increasing in virtually every jurisdiction in North America, but the Toronto team did more than simply add up death statistics. They went further by estimating the magnitude of harm.
Overall, they found that, in 2010, opioid-related deaths led to roughly 22,000 years of potential life lost in Ontario alone.
“That exceeds the years of life lost attributable to alcohol use disorders, pneumonia, HIV/AIDS and the flu,” said lead author Tara Gomes, a scientist at ICES and principal investigator with the Ontario Drug Policy Research Network.
The vast majority were accidental deaths. “There were very few related to suicide,” Gomes said. “This really is an issue of deaths that are occurring unintentionally.”
Opioids include morphine, oxycodone (the active ingredient in OxyContin and its newer formulation, OxyNeo), fentanyl and hydromorphone (marketed under the brand name Dilaudid). They are major pain drugs, the most potent analgesics available. Opioids have been shown to work for unrelenting, “intractable” pain that responds to no other treatments.
But observers say the drugs are being widely abused and misused, and often inappropriately prescribed by doctors. Canadians are among the highest users of prescription opioids in the world, second only to the U.S. in our per capita consumption of the narcotics. Overall, in 2013, Canadian pharmacies filled about 19 million prescriptions for opioids, up from just over 17 million in 2010, according to data provided to Postmedia News by IMS Brogan, a prescription drug-research firm.
“Sure there are people who experiment with drugs that aren’t theirs. But a good number of the people who end up dying of opioids started with well-intentioned prescriptions from a doctor or a dentist,” Juurlink said.
“These are people who don’t intend to end their lives at age 20, 30 or 40. They are often people who simply have the misfortune of taking these drugs at doses that are too high, often in conjunction with other drugs such as alcohol, sleeping pills or certain antidepressants. They go to sleep and they don’t wake up and that’s a story that’s repeated more than 1,000 times a year in Canada.”
Appearing in the journal Addiction, the new study was an attempt “to try and quantify the true burden of mortality in a way other than simply looking at the number of tombstones,” he said.
Doctors have been prescribing the drugs more freely than they used to, and when the response has been “suboptimal”, simply escalating the dose, “which is partly what we were taught to do,” Juurlink said. “And that right there, I think, is a major contributor to this signal of death that we’re seeing,” he said.
“Not only do the drugs not work for a good number of patients who take them, they cause immeasurable harm when we prescribe them as we’ve been doing.”
Gomes said more high school and university-age students are experimenting with opioids, partly out of a misguided belief that, because the painkillers are “prescribed” drugs, they must be inherently safer than other drugs they can buy on the street.
Overall, the proportion of deaths related to opioids rose three-fold, to 0.6 per cent of all deaths over the study period from 0.2 per cent,.
The annual years of lives lost due to premature death increased from just over 7,000 years in 1992, to 21,927 years in 2010.
“This is a catastrophe,” said Benedikt Fischer, a professor in the faculty of health sciences at Simon Fraser University.
Opioids have their place, he said. “There are a lot of people with pain problems, primarily, who need these medications.”
But many patients are receiving opioids in doses that are excessively high “and go beyond good medical practice,” said Fischer.
Medical licensing bodies urgently need to reign in inappropriate prescribing, he said. “This is a massive public health problem.”
skirkey@postmedia.com
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