A representative from HELP_Alberta, an advocacy group for chronic pain sufferers in the province, is raising concerns about accessibility to medications that manage the day-to-day physical suffering of those dealing with pain.
“As they lose their medication, they lose their life in all kinds of ways,” said Penny Kowalchuk, the southern Alberta representative for HELP_Alberta.
The Lethbridge resident has been involved with patient advocacy for nearly 20 years and got involved with the group earlier this year.
Kowalchuk began helping others with chronic pain after seeing the effects of a disease that has affected her and many of her family members.
“I have a condition called Ehlers-Danlos syndrome, hypermobility type,” she said. “It causes extreme chronic pain in most joints and tissues.”
Kowalchuk manages her own pain with opioid medication that is prescribed by one of the last remaining pain doctors in the area. A lack of doctors is just one of the issues that she’s experienced firsthand while trying to manage her pain.
“What I’m seeing — it started with my family and now especially as part of HELP_Alberta in southern Alberta — is a lot of patients that are being de-prescribed from their medications for no reason,” she said.
And Kowalchuk believes that the stigma attached to opioids is one of the root causes.
“Not because of an issue, just because of fear of opioids… especially since the opioid crisis made the news.”
Kowalchuk is not alone in her observation. Local pharmacist and pharmacy owner Zak Murakami has also seen the effects of doctors trending away from opioid prescriptions.
“The people that really do need it, I think that it’s too bad,” Murakami said.
“I really empathize with them and what they’re going through, and just because of everything that’s going on with current events and in society… that they have to suffer when they were using their medications properly before.”
The trend has also been noticed by the College of Physicians and Surgeons of Alberta (CPSA), who have been dealing with the issue for a few years now.
“There has been a perception that family physicians have been reluctant to continue to provide the medications that they feel are important for the management of chronic pain conditions,” said Dr. Monica Wickland-Weller, a senior medical adviser with the CPSA.
“My understanding, from speaking with many chronic pain patients over the last several months, is that they are having accessing care,” Wickland-Weller said. “And certainly not all of them, you know, I’ve had some very positive interactions with patients with chronic pain.”
Wickland-Weller said over the last five to seven years, stricter national guidelines have led to less doctors feeling comfortable prescribing opioids.
The biggest fear for many is the possibility of addiction that these medications present.
“Certainly there is some evidence that does suggest that there can be an overlap, that patients who do take opioid medications for a long period of time may develop difficulties with opioid use disorder, but that’s not to say everybody does,” she said.
For Murakami, a lack of education on how to properly administer and use opioid medications is the issue, with few people understanding that the goal is to manage 70 to 80 per cent of a patient’s pain.
“The risk happens when either they intentionally overuse — that can happen — but sometimes people think that they are trying to get to that zero out of 10,” said Murakami, “ be completely pain free, and that leads to an accidental overdose, which could lead to the addiction.”
Murakami believes that increasing pharmacists’ roles in pain management could take some of the burden off doctors.
“I think we might be able to play a bigger role in the management,” he said. “Work with doctors to get patients on the right dose and the safe doses for them that give the right balance between pain relief and avoiding any addictions.”
For now, doctors will continue to follow national guidelines.
“Nowhere in the guidelines does it say that everybody has to be at x amount of opioid medication,” said Wickland-Weller.
“What we really hope is that patients and physicians will work together to find what is… the safest, the most responsible medication that will be most helpful for that patient in the long run,” she said.
And for chronic pain sufferers like Kowalchuk, understanding is really the top desire.
“Part of it is the public stigma, and the lack of education among medical professionals and the general public in particular, and actually, even pain patients need to be educated because I was afraid of medications before my family ended up with chronic pain and had to find ways to deal with it,” Kowalchuk said.
“People that call us are just begging for somebody to respect them and believe them when they talk about what they’re experiencing,” she said.
“We should all be given the benefit of the doubt rather than being penalized for the few people that do break the law by abusing medications.”
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