Ask Your Pharmacist

November 22, 2017
Q:

I’ve seen several news reports on the “opioid crisis” in Canada. What is an opioid and is this a problem in New Brunswick?

A:

Opioids are substances that act on opioid receptors in our bodies to produce morphine-like effects. In Canada, they are common medications for pain relief and other uses such as anesthesia and diarrhea relief. Medications such as morphine, codeine, hydromorphone (Dilaudid), oxycodone (Percocet, Oxyneo) and fentanyl are commonly used opioids in our area. The street drug Heroin is also an opioid.

Prescription opioids are effective in the treatment of severe pain and useful medications when used properly. However, as a side effect, they can produce a euphoria or “high” and have the potential for abuse. The human body can quickly become dependent on opioids which means that individuals feel sick when the levels in their blood stream drop. This is referred to as a physical dependence. This is compounded by the fact that the body also develops a tolerance to opioids meaning that more drug is required over time to get the same results. 

Addiction to opiates typically consists of psychological dependence as well. This refers to a change in a patient’s emotional state following an extended period of opiate abuse. When an individual who has developed a psychological dependence is not using the drug, he or she can experience obsessive thoughts or cravings for it and can often become irritable and extremely motivated to obtain the drug. Opioids can be expensive to obtain on the street which often leads to high risk behaviors including criminal activity to maintain an addiction.

Opioid abuse and addiction have been issues in many Canadian communities for several decades but the rise in overdose deaths as a result of the proliferation of the drug fentanyl led to the declaration of a public health crisis in Canada in the fall of 2015 and continues to be an issue today. Fentanyl is a synthetic opioid that is tremendously more potent than morphine and can easily cause harm to those abusing it. It is not uncommon for community pharmacies to dispense fentanyl patches to individuals with chronic pain syndromes. The patches that we dispense are dosed by the microgram. All other opioid tablets that we dispense are dosed by the milligram. There are 1000 micrograms in a milligram. This means that fentanyl is hundreds of times more potent than the average opioid used in Canada. As a result, there is a very small margin of error for those abusing the medication to experience an accidental overdose which may lead to respiratory depression and death.

It is not believed the fentanyl crisis has reached New Brunswick yet, but we are already dealing with significant issues related to opioid abuse. Data from 2016 shows that New Brunswick experienced 7.8 illicit drug overdose deaths per 100,000 population aged 10 and over. Saint John County experienced a rate of 18.04 deaths per 100,000 during this period. This is surprisingly high given that British Columbia experienced a rate of 20.6 in the same period. This already high number will only increase when street fentanyl reaches our province.

Furthermore, social issues and comorbidities surrounding opioid abuse have a tremendous financial impact on New Brunswick taxpayers. Canadian data from 2000 estimated the cost of untreated or ineffectually treated substance use disorder to be over $46,000 per year, per substance user when social assistance, criminal activity and healthcare utilization were considered. It has been estimated that the average user requires 2.64 ER visits, 5.94 days in the hospital from complications and 18.64 physician visits per year. Furthermore, it has been estimated that between 40-70 per cent of those injecting medications will become infected with Hepatitis C, a complex and expensive condition to treat.

Considering these factors, all New Brunswick residents should be concerned about the impact that the opioid crisis could have on our province. We should be proactive, learn from provinces such as British Columbia that have already been dealing with the issue on a greater scale, and find innovative solutions to these problems before they reach crisis level here.

Ryan Kennedy (BSc., Doctorate of Pharmacy, MBA) is a pharmacist/owner at Jean Coutu in Saint John. His opinions expressed in this newspaper are published for educational and informational purposes only and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com.