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CanadaMore doctors are prescribing opioids to prevent their patients from dying of overdoses

15:00  21 june  2019
15:00  21 june  2019 Source:   globalnews.ca

Canada's health care system is hopelessly sclerotic. We need to wake up: Neil Macdonald

Canada's health care system is hopelessly sclerotic. We need to wake up: Neil Macdonald Either we fund it all properly, which means more taxes, or we allow people to spend their money on their own care, which is un-Canadian, but is what the rest of the world does. Even in Scandinavia. Editor’s note: The opinions in this article are the author’s, as published by our content partner, and do not necessarily represent the views of MSN or Microsoft. Abruptly, last week, I wound up in an ambulance. Something in my hip had gone sideways, and was delivering a lesson on pain. As we rolled up to the emergency ward, one of the paramedics leaned in: "They might not get to you until tomorrow morning, man. That's the way it is now.

Doctors across Ontario are prescribing potent opioids to patients who may otherwise overdose and die on the street supply — and they are “But we can’t wait in order for more research to be done in order to stop people from dying .” Addiction experts say that primary care providers have an important

The more money a physician receives from an opioid manufacturer, the more likely he or she is to prescribe opioids , according to an exclusive analysis by CNN and researchers at Harvard University's schools of medicine and public health.

More doctors are prescribing opioids to prevent their patients from dying of overdoses © Global News The safe supply movement calls for access to pharmaceutical-grade opioids as an alternative to the illicit market.

Doctors across Ontario are prescribing potent opioids to patients who may otherwise overdose and die on the street supply — and they are calling on other clinicians to do the same.

They’re part of the growing safe supply movement, made up of prescribers and harm reduction advocates in Canada who are calling for access to pharmaceutical opioids as an alternative to the illicit market that has become tainted with bootleg fentanyl and carfentanil.

“We have to be willing to step outside of our comfort zone and out of the medical establishment comfort zone and say that we need to keep people alive,” said Dr. Andrea Sereda, a family physician at the London Intercommunity Health Centre in Ontario.

Opioid-related death count up to more than 11,500 nationally: government data

Opioid-related death count up to more than 11,500 nationally: government data OTTAWA — Canada's opioid crisis claimed the lives of more than 11,500 people between January 2016 and December 2018, the Public Health Agency of Canada reported Thursday. New data shows that 4,460 people died in 2018 alone and many of these deaths were related to the contamination of the illegal drug supply, the agency said. The federal health agency said an analysis of national trends suggests there was a significant increase in death rates between January 2016 and June 2017, noting the rates then stayed high from July 2017 to December 2018. It also said Western Canada remains the most affected region of the country.

“If a prescriber’s patient ultimately loses their life to a drug overdose , that prescriber should be notified — there Many became addicted by using prescribed drugs — either their own or those diverted from Top-down recommendations sometimes meet resistance from patients as well as prescribers

Is prosecuting doctors whose patients die of prescription medication overdoses an effective way to combat opioid addiction? Drug-dealing doctors are often prescribing to patients who are already addicted. It's the well-meaning medical community that must prescribe more cautiously.

For the last three years, Sereda has been prescribing take-home hydromorphone tablets to select patients who are currently relying on the illicit market, most of whom are homeless and inject drugs. The effort, which she refers to as “emergency safer supply,” started with three people and has since grown to 100.

Sereda says the results have been positive. None of the patients have fatally overdosed, half of them have found housing, and they have weekly contact with healthcare providers.

“It's not just a prescription for pills, but it's a relationship between myself and the patient and a commitment to make things better,” Sereda told Global News. “That involves me taking a risk and giving them a prescription, but it also involves the patient committing to doing things that I recommend about their health and us working together.”

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Prescription Opioid Data. Related Pages. Prescription opioids are often used to treat chronic and acute pain and, when used appropriately, can However, serious risks are associated with their use, and it is essential to carefully consider the risks of using prescription opioids alongside their benefits.

Prescription opioids can be prescribed by doctors to treat moderate to severe pain, but can also have serious risks and side effects. Wilson N, Kariisa M, Seth P, et al. Drug and Opioid -Involved Overdose Deaths—United States Improve Opioid Prescribing . Prevent Opioid Use Disorder.

Safer supply is not a replacement for methadone or suboxone, said Sereda. It's an option for the subset people for whom methadone and suboxone don't work, and it serves as a bridge for people who may not be ready for those treatments.

Hers is one of the only programs of its kind in Ontario, and she hopes to see more like it. Similar efforts include prescription injectable opioid programs in Vancouver for a subset of patients for whom opioid substitution therapies such as methadone and suboxone are ineffective. Last year, another Vancouver clinic began prescribing hydromorphone tablets for patients who consume them on site with medical supervision.

Dr. Nanky Rai is one of two physicians at the Parkdale Queen West Community Health Centre in Toronto who began prescribing hydromorphone tablets last November to patients who rely on the illicit opioid market. She now prescribes to around 10 patients and she has seen an improvement in their quality of life.

Teens have privacy rights, doctor tells inquest into 16-year-old's opioid death

Teens have privacy rights, doctor tells inquest into 16-year-old's opioid death VICTORIA — Two family doctors and an orthopedic surgeon told a British Columbia coroner's inquest Thursday about the dilemmas they faced treating a 16-year-old patient who denied he was abusing drugs but showed signs of a growing opioid addiction. 

Prescription opioid overdose deaths also often involve benzodiazepines. Benzodiazepines are central nervous system depressants used to sedate, induce sleep, prevent seizures, and relieve anxiety. Examples include alprazolam (Xanax®), diazepam (Valium®), and lorazepam (Ativan®)

Millions of Americans suffer from pain and are often prescribed opioids to treat their conditions. Since the 1990s, when the amount of opioids prescribed to patients began to grow, the number of Overdose deaths involving prescription opioids were more than four times higher in 2018 than in

Rai said she was spurred to ramp up this type of prescribing in part because of the number of people she knew who were dying from opioid overdoses linked to the contaminated drug supply.

“I’ve had people who, literally, their urine is just all carfentanil,” said Rai in an interview. “That's really what terrified me into action. Before that, I was doing it slowly building things up. If we don’t catch this, we’re never going to be able to prescribe any drugs that are meant for human consumption that could actually compete with and address what carfentanil is doing to peoples’ bodies — for those who stay alive.”

Rai also said that the focus on slashing opioid prescriptions as a solution to the overdose crisis has been harmful for some. Not only has cutting people off of their prescriptions forced many patients to turn to the dangerous street supply, it has also impacted those who need pain control for things like medical procedures, who now have more difficulty accessing them.

READ MORE: Opioid overdose deaths continue to increase in Canada: PHAC

Rai said that she looks forward to having her prescribing program evaluated in the future. “We recognize that we're building as we go," she said. "But we can't wait in order for more research to be done in order to stop people from dying.”

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This includes more judiciously prescribing opioids , warning patients they should expect some pain rather than rely on medications, and to better inform patients of the risks of taking opioids . Even people who don’t work in the healthcare settings can train themselves to take steps to help someone

Patients with terminal illnesses started being treated more with prescription opioids , and Medical centers and their doctors were required to examine their patients ' pain levels -- and the Joint One out of every 550 patients started on opioid therapy died of opioid -related causes a median of 2.6

Addiction experts say that primary care providers have an important role to play in the face of governments that are slow-moving or unwilling to embrace certain harm reduction measures. Sanctioned supervised consumption sites exist only in B.C., Alberta, Ontario, and Quebec. And Alberta and Ontario have recently frozen or withdrawn funding for a number of sites.

But the overdose crisis has become even more urgent as death rates continue to rise across Canada. Nationwide overdose data released earlier this week by the federal government show there were at least 4,460 opioid overdoses in Canada in 2018, up 10 per cent from the year before.

New figures released this week from Ontario’s public health agency show that 388 people in the province died of an opioid overdose last summer, down slightly from the 414 deaths during the same time the year before.

If 11 people a day were dying of any other reason, whether it was tainted lettuce or Ebola or a virus like SARS, I think we would be mobilizing at the community to do things differently to stop that epidemic,” said Sereda. “And I think just because it's affecting a highly-stigmatized group like drug users doesn't mean that doctors shouldn't come together for that collective action on this issue.”

READ MORE: A prison is opening the first overdose prevention site for inmates in Canada

Fertility doc used own sperm to inseminate patients: medical regulator

Fertility doc used own sperm to inseminate patients: medical regulator TORONTO — An Ottawa fertility doctor irreversibly violated vulnerable patients by using his own sperm, or that of the wrong donor, to artificially inseminate several women over three decades, a discipline committee heard Tuesday. Lawyers for the College of Physicians and Surgeons of Ontario are asking the regulator's discipline committee to revoke Dr. Bernard Norman Barwin's medical licence, saying it is the only appropriate penalty for such a

The federal government has expressed openness to safe supply measures. In May, Health Minister Ginette Petitpas Taylor said it had approved injectable hydromorphone to treat opioid addiction. However, it is not covered under the Ontario Public Drug Plan, as it is under the equivalent program in B.C.

On Thursday, a group of more than 400 healthcare providers and researchers released an open letter to Ontario Premier Doug Ford to add high dose injectable hydromorphone to the plan so that it can be prescribed in a cost-effective way. The letter also called for the implementation of programs that provide safer drugs.

A spokesperson for the Ontario health ministry told Global News in an email that the province "takes the ongoing opioid crisis very seriously and is committed to helping people struggling with addiction to get the help that they need, when they need it."

The province is also reviewing the federal injectable hydromorphone announcement, but that "no decisions have been made with respect to Ontario’s support for hydromorphone treatment."

READ MORE: Amid opioid crisis, supervised consumption sites face uncertain future in Alberta, Ontario

Former Liberal health minister Jane Philpott, who is currently an independent MP, was instrumental in implementing a number of federal measures to address the opioid crisis in Canada such as easing restrictions around opening supervised consumption sites.

Although health care is under provincial jurisdiction, Philpott told Global News in an interview that the federal government can be a champion for certain harm reduction approaches.

"As physicians and this entire system becomes more comfortable with the concept of safe supply," said Philpott, "one of the things the federal government has already done and can do even more is make sure that the work that's being done is well-documented and well-researched so that we can start to understand what best practice looks like."

Read more

Employers should have to foot the bill for mandatory sick notes.
Doctors send invoices to insurance companies or lawyers all the time for things not covered by provincial health care plans. This would be no different. Editor’s note: The opinions in this article are the author’s, as published by our content partner, and do not necessarily represent the views of MSN or Microsoft. The issue of employers requiring doctors' notes for minor illnesses has been hotly debated for years. Medical associations are strongly opposed to the practice, and according to a recent Ipsos poll, 70 per cent of Canadians agree.

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