It’s easier for Sue to buy Oxy on the street than to get treatment for the addiction that took over her life.
She knows: She’s tried. Spent five months on Suboxone treatment (an alternative to methadone) but couldn’t stand the shame of picking up her dose at the pharmacy daily because they didn’t trust her to take doses home, missing work weekly for appointments, spending hours in waiting rooms feeling like a junky.
“I started buying Suboxone under the table and then I ended up going back to the opiates,” she said.
“It’s terrible. …If it’s that easy to get an opiate, make it that easy to get the treatment.”
Sue lives in Toronto. She wouldn’t give her last name because most people in her life don’t know about the addiction she’s struggled with for half-a-dozen years, that grew from the occasional pill palmed from co-workers to a back-pain prescription until she was raiding her RRSP to keep the gnawing withdrawal at bay.
She had to tell her husband when he wondered why she needed a loan.
Now things are manageable, but barely: Sue’s on a lower dose and she gets her husband to administer it so she doesn’t go through a month’s prescription in a matter of days.
She still hopes with her doctor’s help she can wean herself off.
“I don’t want to live this life forever. …
“You lose hope for your future.”
Sue was one of dozens of people who got in touch with us following our story on skyrocketing opioid prescriptions in the face of fatal drug abuse and addiction across Canada. They wrote about the struggle to seek treatment for excruciating pain while also battling a burgeoning addiction to pills a doctor prescribed.
READ MORE: What actually works in the war on drugs?
A prescription for safer opioid use
Canada’s health establishment, meanwhile, is trying to tackle the country’s pill problem.
The Michael G. DeGroote National Pain Centre at McMaster University has just begun a two-year process of updating its guidelines on opioid prescribing.
Easier said than done: The people behind the guidelines still aren’t sure the original guidelines were effective, or even how best to measure that efficacy.
And the drug landscape is changing under their feet. OxyContin has been replaced with a “tamper-resistant” formula, raising questions as to whether making a drug tougher to crush, snort and inject actually makes it safer to prescribe. In the meantime, OxyContin’s replacement, OxyNEO, has been supplanted by more accessible, more powerful and potentially deadlier drugs such as Hydromorph Contin and Fentanyl.
The latter, especially, is causing overdose deaths as it’s cut into street drugs whose users underestimate its potency.
“It’s a little disturbing to think that whether it’s practice changes or changes in the manner of abuse, we hear quite a bit about rising numbers of emergency room admissions relating to use of opioids,” said Norm Buckley, the pain centre’s director.
The new guidelines will try to be more explicit about who should and shouldn’t be prescribed opioids, said Jason Busse, an epidemiologist and biostatistician at McMaster.
“A patient comes in with chronic, non-cancer pain … are they a good candidate?”
But imposing stricter rules on prescribing is tricky: Washington state now requires anyone prescribing a daily dose of more than 100mg of morphine equivalent to consult with a pain specialist. But in Canada, “we don’t have a formal definition of what constitutes a pain specialist,” Buckley said. “That’s one problem.”
Then there’s the challenge of treating people in pain: Many of the alternatives to opioids are off the table for anyone relying on public health care coverage, Buckley said.
“As a physician, you’re going to opt for the treatment available, which is medications.”
“I knew I had to get off this drug”
Nancy was prescribed OxyContin for her daily migraines. For seven years she took them faithfully, as prescribed. Then she found herself biting the pills to get the rush in her system more quickly.
“At this point, I knew I had to get off this drug,” she wrote.
She went to her doctor and got admitted to a residential drug treatment program.
“I spent the next four months slowly detoxing off this nasty medication.”
Nancy still gets migraines. But she’s off the opioids for good.
“I would … hurt myself to get prescriptions”
Michael was started on prescription narcotics three decades ago, on an opioid-containing medicine to combat his wracking coughing fits.
It wasn’t long before “it had taken control of everything in my life,” he wrote in an email.
“I would even go so far as to hurt myself to get prescriptions. …
“It got to the point that I started doctor shopping or double doctoring and even stealing doctors’ pads” and writing scrips on them.
He spent a decade in and out of jail.
“I lost family. I lost friends. I lost respect for myself.”
After attempting treatment and then relapsing, Michael has spent the past 10 years “back on track.”
“But in the end it took a lot of my life and [the lives of] those around me,” he wrote. “That’s something I will never get back.”