Canada’s Dark Little Secret

On Jan. 22, 2008, Academy Award-winning actor Heath Ledger was found dead in his New York apartment. He was only 28.

Rumours quickly swirled about the circumstances surrounding his death. Was he just another victim of the celebrity party scene? Did he take his own life?

But, according to the New York City chief medical examiner’s office, Ledger died from another, less obvious cause: an accidental overdose of prescription medications. Those meds were a potent mix of painkillers, sleeping pills and anti-anxiety drugs, including the opioid oxycodone.

Ledger’s death was big news, but the reason behind it? Not so much. “There are literally thousands of people like this,” said Dr. David Juurlink, general internist and clinical pharmacologist at Sunnybrook Health Sciences Centre, and Professor of Medicine and Pediatrics at the University of Toronto, at a recent ISCEBS breakfast seminar.

Opioids have been around for a long time, he explained—dating back to 3,600 BC, in fact. But the scope of how they’re used has expanded significantly over time.

Morphine was first marketed commercially in 1827, and heroin was introduced by Bayer in 1898. By the 1970s and ‘80s, many doctors were comfortable prescribing opioids for pain management in cancer patients, Juurlink said. By the ‘90s, opioids were commonly used to manage chronic pain.

All of these developments have resulted in what he and others refer to as the “public health crisis” of opioid addiction.

“[Canadians] now face a public health crisis of exceptional scale – an epidemic fueled by well-meaning doctors, expectant patients and corporate interests, and perpetuated by governmental inertia.”

–       David Juurlink, Canada slow to respond to opioid addiction crisis, The Globe and Mail

But, hold on…managing pain effectively is a good thing, right? Isn’t improving quality of life, as well as quantity of life, what drugs are meant to do?

Yes. But the statistics on opioid abuse reveal a bigger issue than a single celebrity overdose.

Did you know that, in Ontario, about 10 people die accidentally from prescription opioids every week? That more years of potential life are lost to opioid use than to alcohol abuse, HIV/AIDS, pneumonia or influenza? Or that it’s possible to become dependent on an opioid after just one week of taking it?

I sure didn’t. I understood there are people who abuse painkillers, just as some abuse alcohol. But I had no idea the problem was so big—that opioid addiction leads to so many preventable deaths.

So my question is, Why aren’t more people talking about it? My generation grew up with the “Say No to Drugs” campaign…but no one really made a connection to the pill bottles in our parents’ medicine cabinets.

I think it’s partly a stigma issue. We’d like to think that only heroin addicts living on the street die from drug abuse. But evidence suggests it happens to people just like you and me, every day.

Maybe it takes a visible, public death like Ledger’s to bring the problem to light. But it won’t stay in the dark for much longer.






2 thoughts on “Canada’s Dark Little Secret

  1. Johanne Brosseau December 10, 2015 - Reply

    Problem is known and I found evidence of narcotics abuse in most drug plans claims audits. Carriers invoke limits that are vague and refuse to intervene with prescribing doctors, especially when there is only one and all prescriptions are dispensed in the same pharmacy, which to my surprise is often the case. Even when presented with evidence of quantities and duration of therapy in excess of manufacturers’ guidelines, it is hard to get carriers to be part of the solution. As a consequence, for years, this “Canada’s dark little secret” has been “financed” by group insurance. Problem is not handled and help may cost over $15,000 because oxycodone dependents have a hard time finding support within the public health system: I know, a friend is faced with the problem!

  2. Please take the time to recognize the difference between dependence and addiction. Diabetics are dependent on insulin. They are not addicted to it. They do not crave it. Addiction is psychological.

    The vast majority of people (~90%) who are prescribed pain pills will take them as directed. Many people actually only take one or two, dislike the feeling (dizziness, nausea, tiredness) and decide to switch to a non-opioid pain reliever.

    There are others (~10%) who upon taking their first pain pill know that this is the feeling that they have been looking for all their lives. It is the missing piece. They fill a gap in their brain chemistry. They make depression go away. These people become self-medicators (AKA “addicts”).

    Understand that most people will never, ever become addicted to pain pills — they can be in a terrible accident, be on morphine for months, but as soon as the healing takes place and pain goes away, they are weaned off the morphine and they get on with their lives.

    My point? Addiction is a medical issue. Predisposition is most likely genetic. Treatment is available. There are medications out there that fill that gap in the brain chemistry without the side effects of stupor. One is called buprenorphine.

    Another important medication in combating opiate addiction is naloxone. This is an “antidote” to opiate overdose.

    Expanding the availability of these medications and other treatment will help people get off the treadmill that is opiate addiction and protect society from the collateral damage that comes with it.


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