Education should focus on the fact that the goals of a drug are to impart more benefit than harm, and opioids very frequently don't do that. They can be beneficial to some patients in the long term, but the higher the dose goes the less likely that will happen. That's why I think doctors shouldn't be allowed to prescribe ridiculous doses of 200 milligrams or 300 milligrams. It's inconceivable that someone is benefiting from that.
I also think that when these high-dose formulations are used as directed, like the OxyNEO 80 and the high-dose fentanyl patches, you are exceeding the threshold dose from the old Canadian guidelines—a dose above which it's very likely that harms exceed benefits. It shouldn't be happening, yet it still is. It's a cultural thing now. We've been doing it for 20 years, and we have to stop doing it.