Mr. Chair, members of the committee, and staff, the Institute for Safe Medication Practices Canada expresses a great appreciation and honour at being asked to present before you.
ISMP Canada is an independent, not-for-profit organization established to analyze incidents of preventable harm from medications, to identify system improvements, and to advance medication safety. We value opportunities that allow us to share our learning and expertise, and we recognize the benefit of partnership.
Medications have brought forth tremendous benefits to the health of Canadians. Lifespan and life quality have all increased in the past century, due in part to medications that are effective against acute and chronic illness. Over this period, however, there has been increasing awareness that medications can also cause harm. Prescription drug abuse—in particular of opioids, but also stimulants and sedatives—has become a serious issue that threatens some of the most vulnerable citizens.
ISMP Canada recently completed a study, in collaboration with coroners and medical examiners' offices across the country, on preventable medication errors causing death. The results confirm the caution with which opioids should be viewed. Nearly half of all inadvertent deaths in the study were associated with opioids. Even in the context of therapeutic care and without any evidence of purposeful abuse, this class of medications can be harmful.
Our organization also maintains a number of databases whereby practitioners and consumers can report medication errors. Again, the drug class most often reported as causing harm is opioids.
ISMP Canada has traditionally focused our work on medication use in the environment of formalized health care—in hospitals, in clinics, in pharmacies. However, we are becoming more aware that the safe use of medications extends beyond that sphere. We are increasingly conscious that drug safety also implies the prevention of prescription medication abuse and dependence, and the reduction in both intentional and unintentional misuse. To that end, we present to the committee for their consideration three strategies directed toward the reduction of prescription drug misuse, abuse, and dependence.
First, we recognize that prescription drugs are only available from a prescriber and that an improvement in prescribing practices is needed. The findings from our death investigations reveal that patients are often initiated opioids at too high a dose, with inadequate education about side effects and dependence potential, and with insufficient monitoring and review.
According to the U.S. Centers for Disease Control and Prevention, the excessive prescribing of opioid analgesics is fuelling an epidemic of addiction and death. Opioid addiction can and does occur with typical doses that are prescribed for approved indications. Dependence and addiction are relatively common consequences of long-term opioid therapy, occurring in up to one-third of patients in some studies.
Prescribers and patients need a more balanced approach to the treatment of pain, but prescribers do not always have the expertise or resources to institute non-opioid options for pain control. A coordinated effort needs to be undertaken by medical schools, regulatory bodies, professional organizations, and expert panels to enhance prescribing skills and develop expertise in pain management, not only in the general prescribing population but also in specialist pain management centres. This strategy increases awareness of the risk of opioid use and provides tools to prescribers to prevent the harms associated with opioid use.
Second, ISMP Canada uses reporting and surveillance to analyze medication incidents and to develop strategies for safety. Our organization leads the Canadian medication incident reporting and prevention system, a medication error reporting program that shares learning from incidents through safety bulletins and informs standards development.
Canada has shown global leadership and has made adverse drug reaction report information freely available to health care workers and the public. All of these programs benefit heavily from concerned reporting. We cannot overstate the value of this surveillance. Our experience shows that reporters tend to report the severe and unexpected cases of harm from medications, and this helps to detect new signals.
Opioid addiction resulting from the escalated use of prescribed drugs should be viewed as an adverse drug reaction or a preventable event. The acknowledgment of opioid addiction as an adverse event or error will stimulate the increased recognition of the problem, and will enhance reporting.
In turn, interpreting this data will detect contributing factors to harm and inform safe use recommendations. Ultimately, the prudent use of opioids includes ensuring practitioners, together with patients, have enough information to make an educated decision about drug treatment.
Our third strategy relates to the recruitment of patients, families, and caregivers in helping ensure safe medication use. Regulated health-care workers can and do provide a level of protection and care, but it is often the patients themselves and those around the patients who are first able to detect the signs and symptoms of increasing and alarming medication use.
Furthermore, they are frequently in the best position to intervene in the case of a serious adverse event. Findings from both our death investigation study as well as our continuous surveillance analysis has determined that in some cases, signs and symptoms of opioid overdose were noted by family members but tragically these intervention opportunities were not recognized. Patients and families need to be an active part of the opioid use process. They need to be aware of the signs and symptoms of overdose and also the risk factors and indicators of dependence and addiction. But awareness is not enough. All parties in the process—prescribers, pharmacists, home care practitioners, families, and friends—must have a plan, the resources, and the support to intervene when they detect and recognize alarming signs or behaviours.
ISMP Canada has created patient and family-oriented products to educate consumers about the safe use of opioids. A video and patient handout emphasize that opioids can be used safely and effectively but they can also carry risks of serious injury. These products offer information on steps consumers can take to minimize the risk of being harmed by opioids. Importantly, education is provided on the recognition of opioid overdose and actions that can be taken to prevent harm.
In summation to this committee, ISMP Canada recognizes the problems associated with prescription drug misuse, abuse, and dependence and submits that addressing these difficulties will require multiple perspectives, approaches, targets, and strategies. To that end we have proposed three directions: one, improvement in prescribing skills in pain management in opioids; two, defining the opioid dependence or abuse as an adverse event or a medication error, and enhancing associated surveillance and analysis systems; and three, recruiting patients and caregivers as both active monitors and active intervenors in opioid use.
Thank you again.