Medical experts are calling for the creation of a national system to track Canada’s epidemic of opioid-related deaths, as fatalities from popular painkillers continue to mount.
A new study released Monday in the Canadian Medical Association Journal highlights the lack of timely and accurate information on fatal opioid overdoses. Unlike countries such as the United States and Australia, the study says, Canada has no mechanism for collecting and monitoring the number of people who die each year from opioids.
Opioids such as morphine and oxycodone are prescribed as painkillers, but a spike in the illegal use of the drugs, especially fentanyl, is raising alarms with public-health officials across the country.
Against this backdrop, the group of researchers looked for ways to solve what they say is an incomplete picture of the harm done by prescription opioids in Canada.
Tara Gomes, an epidemiologist at Toronto’s St. Michael’s Hospital and one of the researchers on the study, said such information is vital to track and respond to patterns in drug use, which often change quickly.
“As new drugs enter the market, it’s a constantly shifting target, so having up-to-date information on overdose death is a really important surveillance tactic that has been historically quite difficult,” she said in an interview.
In Alberta, the government is under pressure to take immediate steps to respond to a growing problem of fentanyl abuse. Over the first nine months of this year, fentanyl has resulted in 213 deaths in the province, up from 120 in 2014. The powerful opioid is available by prescription, and is also manufactured in clandestine labs and sold on the street.
Donald MacPherson, executive director of the Canadian Drug Policy Coalition at Simon Fraser University, said the number of deaths from fentanyl alone should galvanize policy makers. He called on the federal government to play a leadership role in setting up a national database.
“I would be interested to know if there are other causes of accidental deaths that double annually and are subject to the same level of continuing complacency,” Mr. MacPherson said in an interview.
Dr. John Younes, Manitoba’s acting chief medical examiner, said there should be a national database tracking all classes of drugs that result in fatal intoxications. However, he said, it would take a fair bit of effort to figure out how to create such a database because each province has its own system for conducting death investigations.
The solution proposed by the researchers is to extract numbers from existing Statistics Canada data. Statscan records the cause of death in its vital statistics death database, they note, based on information from a physician, coroner or medical examiner. While the numbers do not exactly match the results that researchers were able to gather through the detailed study of coroners’ records in Ontario, they believe they can provide a reliable indication of trends.
Up until now, Ms. Gomes said, researchers have relied on detailed examinations of coroners’ records – the “gold standard” for this data. She said national numbers are sometimes estimated based on what is happening in Ontario and British Columbia, which publish annual statistics on deaths associated with several classes of opioids.
Neither province, however, has up-to-date statistics available on deaths. In Ontario, the most recent numbers show that opioid-related deaths rose to 652 in 2013 from 344 in 2008.
Dr. Roger Skinner, regional supervising coroner in Ontario’s Office of the Chief Coroner, said it can sometimes take more than a year to complete an investigation, including toxicology testing.
He said he understands that researchers would like more timely information, but he thinks more of the focus should be on drug safety and measures aimed at curbing opioid addiction. To that end, he would like to see the creation of a system to monitor which doctors are prescribing the painkillers.
“By the time folks are dead, the damage is done,” he said in an interview.
Karen Howlett and Elizabeth Church
Follow us them Twitter: Karen Howlett @kahowlett, Elizabeth Church @lizchurchto
Globe and Mail, November 30, 2015
Click here for the story.