Since the early 2000s, the opioid crisis has caused widespread devastation to families across Canada and the United States. Painkiller addiction has led to the deaths of 500,000 people in the United States and kills approximately 19 Canadians each day. The deceitful marketing practices used by Oxycontin creator Purdue Pharma and its owners, the Sackler Family, have left them justifiably vilified at the centre of the crisis.
While the culpability of opioid producers is well-established, another question remains unanswered: who else should shoulder the responsibility for opioid addiction? The rhetoric around prescription painkiller liability – most often in the U.S. – understandably focuses on doctors who allowed pharmaceutical marketing incentives to inform their indiscriminate over-prescription of opioids. But what amount of accountability should Canadian doctors bear where their routine prescription habits leave a patient grappling with the effects of long-term addiction?
Alberta Amongst Provinces with Highest Opioid-Related Death Rate
In December 2021, the federal government reported that Canada’s opioid toxicity deaths from April to June 2021 represented a 66% increase compared to the same period in 2019. Health Canada attributes the jump in fatal overdoses to the impacts of COVID-19, including stress and anxiety, isolation, and decreased accessibility to addictions services.
Equally concerning is the geographical trend of opioid overdose deaths in Canada. Health Canada states that 90% of opioid deaths between January and June 2021 occurred in British Columbia, Alberta, or Ontario.
B.C. Man Files Lawsuit Against Doctor, Pharmacist for Opioid Prescriptions
A British Columbia man has recently filed a medical malpractice lawsuit against his former doctor and pharmacist, alleging that their negligent prescription and provision of opioids has ravaged his life. The plaintiff, Warren Homan, states that he became addicted to Oxycodone after being prescribed the drug for severe back pain from 2013 to 2016. He continues to use the drugs – obtained both on the street and through prescriptions – and has suffered physical and mental health impacts.
The case, which remains before the courts, raises the question of the level of accountability doctors should be held to for their prescription practices. Homan’s lawyer contends that as the risk posed by prescription painkillers has been well-documented for several years, doctors should be offering alternative pain management treatments and warning patients of the dangers of opioid addiction.
Risk Management for Opioid Prescription
In its publication, “Opioids: We Can Do Better”, the Canadian Medical Protective Association provides the following risk management practices for physicians prescribing opioids for chronic non-cancer pain:
- Regularly updating their knowledge about medication and non-medication pain relief treatment options. This includes learning the contra-indications, interactions, and adverse effects of medications.
- Assessing whether non-medication or non-opioid medication pain treatment is appropriate for the patient’s symptoms.
- Considering the patient’s history, if any, of substance abuse or mental health conditions.
- Obtaining the patient’s informed consent by explaining all ongoing risks and any prescription changes.
- Managing patient expectations for their pain relief, considering the nature of the pain.
- Offering opioids on a trial basis, where appropriate, and discontinuing treatment where the patient’s pain does not include.
- Monitoring patients undergoing opioid treatment, including increased appointment frequency and periodic reassessment of the benefits and risks of continuing treatment.
- Prescribing exact amounts of the medication needed until the patient’s next appointment.
Opioids can effectively manage pain when appropriately prescribed and used, and we have previously acknowledged the challenges faced by doctors when prescribing painkillers. However, doctors still owe a duty to diligently incorporate risk management considerations in patients’ pain management treatment plans. Physicians who fail to meet this standard of care can face liability for the catastrophic effects opioid addiction has on patients and their families.
Regulatory Hesitance to Discipline Doctors for Opioid Prescription Practices
It is rare for physicians to face significant disciplinary consequences from their provincial regulatory bodies for opioid prescription practices. In Alberta, a doctor was found to have prescribed the equivalent of 240 mg a day, in combination with benzodiazepines, to a young mother who died of an overdose. By agreeing to undergo training and fulfilling other conditions, the doctor escaped a three-month license suspension.
The doctor at issue in the Homan case, Dr. Gerald Nemanishen, was reportedly investigated by his provincial regulatory college in 2014 for his opioid prescription practices. While the college noted “various deficiencies” in the doctor’s practice and ordered him to take remedial courses, the investigation was abruptly ended when the doctor retired.
Expanded Culpability for Painkiller Addiction in the 2020s?
Today, much of the news surrounding liability for painkiller addiction centres on the financial and legal fallout faced by pharmaceutical companies. However, it can be expected that patients suffering from painkiller addiction will continue to look further down the supply chain for answers. Should the Homan case proceed, it may prompt legal action from those seeking accountability from physicians who have largely been shielded from public scrutiny for their role in the opioid crisis.
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