Why medical education is key to reducing drug overdose deaths in British Columbia iNFOnews


Photo credit: ADOBE STOCK

February 23, 2022 – 6:00 am

There is no question that there is much pain and suffering in the world.

All too often, when residents of British Columbia turn to healthcare professionals for help in managing physical pain, they consult someone without formal training in the use of opioids.

That’s one of the reasons drug overdose deaths have been four times higher than COVID deaths in BC over the past two years

“I still think opioid prescription is a taboo subject,” said Dr. Seonaid Nolan, an assistant professor at UBC’s Department of Medicine in Vancouver and a clinical scientist at the BC Center on Substance Use, told iNFOnews.ca.

“I definitely haven’t received any training on how to prescribe opioids appropriately, how to optimize non-opioid prescribing for pain management, and so I feel like there are a lot of healthcare providers who prescribe opioids but aren’t sure about it feel about their prescribing practices,” she said. “Often we see, particularly where I work, that people continue to be abruptly weaned or tapered because doctors and other prescribers are genuinely concerned that they will be reviewed and criticized for their prescription.”

In medical school, it is not necessary to take an addiction elective to learn how to recognize and treat substance use disorders.

“We’re seeing a huge subset of people who have been recipients of healthcare providers overprescribing opioids with this strong push that came a few years ago from the pharmaceutical industry and the college cracking down on prescribing,” Nolan said.

This is not something that only happened in the past. It’s still all too common today.

“Many patients are discontinued from opioid prescriptions altogether, leaving them with no choice but to turn to the illicit drug market to meet either their pain or withdrawal treatment needs,” Nolan said.

She estimates that the majority of people she sees started using opioids this way. The others come more from the leisure sector and then became addicted.

This is despite the widely publicized fact that illegal drugs are often laced with deadly fentanyl.

CONTINUE READING: Illicit deaths from toxic drugs hit the Thompson-Okanagan region hard in 2021

“Young people are a prime demographic that are really risk-taking,” Nolan said. “When we were younger, we all did that to push the boundaries and almost have that sense of invincibility. As you get older and your brain is fully developed, I think the risky behaviors decrease.

“But a lot of people don’t have the coping skills necessary to deal with things like depression, anxiety, stress, and so a very common thing that they turn to to help with that is substances. Certainly the turn to recreational drugs is one aspect. If you look at smoking or alcohol, which are far more common in relation to substance use disorders, people often use those substances for exactly the same purpose.”

And it’s not like opioids are necessarily the drug of choice. Many unintentionally fall into the deadly fentanyl side of the drug trade.

CONTINUE READING: Why you need to update your perception of who dies from an overdose in BC

“There’s a huge segment of people, I’d say the vast majority, who really aren’t interested in accessing fentanyl, but because it’s so prevalent in the illicit drug market, they’re exposed to it anyway,” Nolan said . ”

Fentanyl is attractive to distributors for two reasons. For one, it is not derived from opium, so does not need to be imported from overseas. It can be made cheaply in drug labs, and second, it’s so potent that a little goes a long way.

It’s so good that some users are actually looking for it. They have often developed a general tolerance to opioids, but can still die from poorly mixed medications that contain too much fentanyl.

Drug companies do not intend to kill people who have access to illegal drugs,” Nolan said. “But as you can imagine, a manufacturing facility or laboratory is not a sterile environment. They may make fentanyl, but they also make crystal meth, and there will be some cross-contamination.”

It can take a grain of sand-sized fentanyl to get a user high, but that can also kill someone who thinks they’re buying crystal meth and don’t have an opioid tolerance, Nolan said.

And it’s not just crystal meth that can be dangerous. Fentanyl grains can find their way into other illegal drugs like cocaine or ecstasy.

Since all of these drugs are illegal, there is no way to tell how prevalent any of them are in the recreational market at any given time.

“We’re seeing a shift in the illicit drug market where I practice in Vancouver,” Nolan said. “When I first started the practice five or six years ago, it was mostly heroin and there was a lot of crack cocaine use. Today, fentanyl and crystal meth are the more prominent drugs of choice on the recreational drug scene. The illicit drug market is an ever-changing drug market, so keeping track of treatment can be particularly difficult.”

She’s sure things like magic mushrooms, LSD and ecstasy are widely used in some circles, but she doesn’t see much of it in her practice.

“We just have a biased population around those who present to management in either the ER or our clinic,” Nolan said.

Nor does she see people substituting legal cannabis for opioids. It just doesn’t have the same type of high or pain-killing properties.

“It’s really about the fact that people with an opioid use disorder have developed this level of physical dependence,” Nolan said. “Often they don’t use opioids to get high. They just use it to ease their withdrawal symptoms and fill up normally.”

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