New Strategy for Canada! First Do No Harm: Responding to Canada’s Prescription Drug Crisis
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Prescription drug misuse has emerged as one of the leading public health and safety concerns across North America and Australia. This growing trend involves numerous psychotherapeutic drugs, including prescription opioids. See the types of prescription medication that have the potential for misuse.
Recent years have seen Canada become the second largest per capita consumer of prescription opioids (INCB, 2010). This is accompanied by dramatic increases in opioid-related harms, including overdose deaths and addictions (Dhalla et. al., 2009).
Canada-wide consultations, undertaken in 2003–2004 by Health Canada and the Canadian Centre on Substance Abuse (CCSA), identified the non-medical use of pharmaceuticals as a priority issue. (These consultations were held to inform the National Framework for Action to Reduce the Harms Associated with Alcohol and Other Drugs and Substances in Canada.) Since then, while there are regional product-specific differences, the need has remained the same—a comprehensive, pan-Canadian approach that requires coordinated action between governments, healthcare professionals, stakeholders, the criminal justice system, industry and provincial licensing authorities.
A key challenge to addressing prescription drug misuse is to find the balance between ensuring timely and appropriate access to prescription medication for pain management is not negatively affected, while minimizing the harms associated with diversion, misuse and abuse. There is also a need to better understand pain, addictions and co-morbidities (i.e., mental health issues) within the context of prescription drug abuse, misuse and diversion.
Whereas the responses and interventions regarding illicit substances are vast and varied, prescription medications find themselves in a "grey zone" given their legal status and therapeutic necessity coupled with their high potential for addiction, diversion and abuse.
In many respects, our collective understanding of the non-medical use of prescription drugs in Canada remains in its infancy. Nevertheless, there is an urgent need to implement policies and practices to deal effectively with pain management and addictions to prevent our current situation from becoming worse.
See what is currently happening to address prescription drug misuse in Canada.
What types of prescription medication have the potential for misuse?
Commonly abused prescription medication includes: opioid pain relievers (such as fentanyl, Percodan®, Demerol® and OxyNEO®); stimulants (such as Ritalin®, Concerta®, Adderall® and Dexedrine®); and tranquillizers and sedatives (such as benzodiazepine, Valium®, Ativan® and Xanax®).
What do we mean by prescription drug misuse, abuse, addiction and dependence? View Defining Prescription Drug Abuse.
Prescription drug misuse facts for Canada
- Canada is the second largest consumer of prescription opioids, according to the International Narcotics Control Board (2010). Globally, North America consumes approximately 80% of the world's opioids.
- About 19% of Canadians aged 15 years and older used prescribed pain relievers in the 12 months preceding the 2009 Canadian Alcohol and Drug Use Monitoring Survey (CADUMS).
- According to the 2008–2009 Youth Smoking Survey, 6.7% of Canadian youth in Grades 7–12 reported using prescription drugs in the past year to get high.
- Prescription opioid-related deaths doubled in just over 10 years in Ontario, from 13.7 deaths per million people in 1991 to 27.2 deaths per million people in 2004.*
* Reference:
Dhalla, I., Mamdani, M., Sivilotti, M., Kopp, A., Qureshi, O., & Juurlink, D.(2009). Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone. Canadian Medical Association Journal. Retrieved from www.ecmaj.ca/content/181/12/891.full.
Prescription drug misuse facts for First Nations communities in Canada
- In the 2002–2003 Regional Health Survey, the non-medical use of psychoactive pharmaceuticals (including codeine, morphine and opiates) ranked second, after marijuana.
- 12.2% of the population reported the use of psychoactive pharmaceuticals over the past year.
Source:
First Nations Information Governance Committee (FNIGC). (2007). First Nations Regional Longitudinal Health Survey 2002/03. Ottawa: Assembly of First Nations/FNIGC.
A pan-Canadian strategy to address prescription drug misuse
In February 2012, CCSA hosted a National Dialogue on Prescription Drug Misuse, bringing together stakeholders and decision makers—including regulatory bodies, policy makers, industry, researchers, federal, provincial and territorial governments, primary care professionals, pharmacists, First Nations and Inuit providers, enforcement officers, and addiction and pain specialists—to collectively identify issues and generate possible solutions to address prescription drug misuse in Canada.
Outcomes from this meeting included support for CCSA to lead the development of a national strategy to address prescription drug misuse. This strategy will take a balanced approach, recognizing the multiple perspectives and stakeholders involved in this complex issue. We encourage safer use and greater awareness of pharmaceutical medicines to maximize therapeutic benefits while also minimizing harms.
Initiatives to address pharmaceutical misuse
Next steps
For more information on the national strategy, please contact Robert Eves at reves@ccsa.ca.