‘Public health like it’s 1999’: doctors say restrictions on opioid advertising won’t save lives right now

‘Public health like it’s 1999’: doctors say restrictions on opioid advertising won’t save lives right now
“The dots don’t connect,” said Dr. Hakique Virani, a public health and addictions specialist at the University of Alberta. Prescriptions for opioids are already going down, government statistics show.

“It’s public health like it’s 1999. This is maybe something that might have had an impact when we were calling for government to address increasing prescribing of opioids at the beginning of the 2000s or late ’90s.”

The government is planning to restrict most forms of advertising on prescription opioids and has opened consultations on what exactly the advertising restrictions might entail.

Given that most deaths are due to fentanyl and its analogues – which are generally illegally obtained on the street, not through prescriptions, Virani says the timing of the announcement doesn’t make sense.

“Does it mean that we don’t have a problem with prescription opioids? No, it doesn’t mean that,” he said.

“We may still have people who develop addiction, dependency, functional impairment due to prescription opioids. But in terms of what’s causing the most acute public health risk right now, it’s the illicits.”

The government said that advertising restrictions are just one of many ways they’re working to help the opioid crisis. “I, certainly as health minister, certainly want to make sure that I can use all the tools that I have at my disposal,” said federal Health Minister Ginette Petitpas Taylor on Tuesday.

“And we certainly recognize that the over-prescription of opioids is not the problem but is certainly, it contributes to the problem. So therefore, we certainly feel that limiting marketing with respect to opioids is a step in the right direction.”

Dr. Keith Ahamad, an addictions physician at Vancouver’s St. Paul’s Hospital and clinician-scientist at the B.C. Centre on Substance Use, says he does support the advertising restrictions.

“We need to keep pharmaceutical companies out of advertising to doctors,” he said.

“There is no question that when we look at the disproportionate number of opioids that are prescribed in North America and the issue that we’ve got here, that pharmaceutical influences have changed physician-prescribing practices over the last couple of decades.”

But although he believes that these initiatives could help protect patients in the future by ensuring that fewer people eventually become dependent on opioids through prescriptions, he thinks the problem right now is that people who are already dependent can’t get treatment.

“The majority of people that want treatment can’t get evidence-based treatment when they want it,” he said, so this initiative isn’t going to “turn the tide” on overdose deaths.

There are other programs. According to Health Canada, the government has over the past two years made the overdose emergency drug naloxone available without a prescription, increased inspections for opioids entering the Canadian border, and provided funding to provinces and territories for mental health and addictions services.

They also announced on Tuesday some funding for peer training, professional education and drug-surveillance programs.

Doctors say there’s still much more to be done. Ahamad would like to see treatment for overdose look more like treatment for a heart attack.

When someone goes to the emergency room with chest pain, they follow a defined path through the emergency room, into the cardiology department, where they’re treated with proven medications or surgery if necessary, he said. Then they go home, have access to cardiac rehab, and their family doctor knows how to monitor their condition.

For someone with a drug overdose, “we’re treating their overdose and they’re getting released back out into the street.”

More primary-care physicians also need to be trained to recognize the signs of drug and alcohol dependence early, he said, and then how to treat it before it becomes a massive problem.

Virani isn’t even sure that Canada’s growing death toll is because more people are addicted to opioids. It could just be that illicit street opioids have become more toxic, leading to a higher risk of death for anyone who takes them, he said, though he doesn’t know for sure.

He also wonders whether people whose doctors cut down their opioid prescriptions in response to the restrictions on advertising might turn to the streets to get their drugs.

“The influence of pharmaceutical companies has played a big role in changing the prescribing habits of physicians,” said Ahamad, through ads in medical journals, sponsored conferences, continuing medical education and other means.

Dr. Brian Knight, facility chief for anaesthesiology at Covenant Health Misericordia Hospital in Edmonton, says he’s also in favour of the advertising restrictions. “I don’t think it goes far enough though. I think they should be banning pharmaceutical education for all drugs.”

“I think most of the drugs are, the new ones, are heavily promoted by big pharma by CME (continuing medical education) events, trips, advertisements in journals, booths at meetings. I think that does influence how doctors prescribe drugs.”

He would be in favour of governments funding more medical education so that less comes from pharmaceutical companies.

“I think if you’re going to target one class of drugs, you’ve got to target all classes of drugs.”
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