Executive Director - Euthanasia Prevention Coalition
On June 17, the Canadian government legalized euthanasia and assisted suicide. Since only a minority of Canadians have access to effective pain and symptom management, will legalizing euthanasia drive people to a state sanctioned death rather than receiving proper care? During the Bill C-14 debate the government was urged to increase access to palliative care.
Last week the Ontario government announced that on January 1, 2017; the government will stop covering the cost of certain high-dose pain killing drugs.
Even though the government's concern with opioid addiction is important, will the new blanket policy drive people with chronic pain or other painful medical conditions to euthanasia?
According to a CBC news report:
Ontario will stop paying for higher-strength opioid medications through its Ontario Drug Benefit (ODB) program next January as part of its strategy to address the growing problem of addiction to the painkillers.
To help fight what it calls the "growing problem of opioid addiction in Ontario," the province's Ministry of Health and Long-Term Care announced last week that it would stop paying for the following higher-strength long-acting opioids from its ODB drug formulary as of January 2017:
- Morphine, 200 mg tablets.
- Hydromorphone, 24 mg and 30 mg capsules.
- Fentanyl, 75 mcg/hr and 100 mcg/hr patches.
There is a real concern with opioid addiction, according to the CBC news report:
- The province will also delist 50 mg tablets of Meperidine, also known as Demerol.
Deaths linked to opioid use in Canada have soared in recent years.
A 2014 study found that opioids were related to one in eight deaths among young people in Ontario.
Rates of opioid-related death in the province increased by 242 per cent between 1991 and 2010, rising from 12.2 deaths per million in 1991 (127 deaths annually) to 41.6 deaths per million in 2010 (550 deaths annually).
Opioid overdose is a serious health problem, but people with chronic pain management issues and the terminally ill who live with painful symptoms require effective pain control.
Now that euthanasia is legal, not providing effectively controling pain will lead some people to ask their physician for a lethal injection.
Palliative care expert, Dr Darren Cargill, expressed concern for his patients in a letter published in the Windsor Star. Cargill argues that the Ontario government did not communicate with frontline caregivers when they made this decision. He wrote:
In their zeal to curb drug abuse, the government has acted rashly and without the proper input from frontline healthcare providers.
Palliative care patients rely on many of the medications removed from this formulary every day to manage their pain from cancer and other serious medical conditions.
Barriers already exist for patients trying to access high-quality pain management in Ontario, and this move by the government will further hurt patients. These barriers include the Palliative Care Facilitated Access (PCFA) program which requires updating and alterations to return the program to its intended purpose: to improve patient access to palliative care medications.
No one will argue that more needs to be done to prevent prescription drugs from getting into the hands of children and those who would abuse these drugs as a result of an addiction disorder.
However, unilaterally removing these drugs without considering the unintended consequences is irresponsible.
An article published in the Huffington Post suggests that most of the drug overdose deaths are from illegal drugs that are produced in China and Mexico. The article states:
The Drug Enforcement Agency in the U.S. also points out that the increase in fentanyl deaths is largely the result of clandestinely produced supplies rather than legal prescriptions having been diverted. The illegal fentanyl is mostly manufactured in China and Mexico.
The Huffington Post article then quotes from two doctors who explain why the Ontario government drug enforcement policy will not work.
Dr Chris Giorshev of Barrie wrote that "There is no evidence that the recent measures will do anything meaningful other than torture legitimate pain/palliative patients" and "most of the problems arise from the illegal fentanyl coming from China -- not from the patches prescribed by us. And the smaller strength pills are actually easier to move on the streets -- so reducing the pill size will have no effect."
Dr Geoffrey Purdell-Lewis of Burlington, Ontario said that "Not every patient prescribed opioids gets addicted" and that "Some patients appear to need more than a morphine equivalent dosage of 200mg per day and these patients can do well on somewhat bigger doses, especially with careful and strict monitoring and support. Much more thought is needed before the '200mg portcullis' is brought down."
Whether or not the Ontario government's drug policy will deter drug addiction, it will also limit palliative and chronic care specialists from providing effective pain control and it may drive some people to seek death by lethal injection now that euthanasia has been legalized.