Rotarian Dr Stephen Holland gave his perspective on the Opioid Crisis: how we got here and what we can do. 
Steve began by showing us a newspaper clipping in which Dr. Ian Scott is quoted as saying " Every decision we make in medicine has both benefits and risks.  .............As we address the opioid crisis all of us need to remember this." 
This led to an explanation of the role of the medical community.  Steve recalled a widely publicized case in 2015 in which a young couple was found dead in their North Vancouver home.  They were not known to be recreational drug users but they both had a variety of drugs in their systems.  Harvey was an apprentice carpenter who injured his shoulder and was then treated at a series of walk in clinics. He became addicted to pain killers.  His wife had postpartum depression and she used some of his meds.  When a physician tried to get them into treatment they shopped on the streets and eventually overdosed. 
How did we get here?   In the 90's the big pharmaceutical companies started pushing certain drugs.  Their aggressive marketing made these drugs appear to be safe. In 2002, guidelines from the Pain society included statements such as:
“There are very few types of pain that would absolutely preclude a trial of opioid therapy.”
“A patient with a past history of or risk factors for addiction should not
necessarily be precluded from a carefully monitored trial of opioid therapy.”  and

“Opioid analgesics are generally safe medications when prescribed with
appropriate monitoring.”
From 199 to 2010, opioid sales quadrupled.  At the same time, Deaths from overdose and addictions also increased significantly. 
History of Narcotics 
Opium is centuries old

In 1800, three chemical compounds – morphine, codeine and ”thebaine” were extracted from opium and the hypodermic needle was invented.
From 1898 heroin was marketed as a non-addictive morphine substitute for coughs.  In 1913 it was pulled from the market when it was discovered to be addictive. 
In 1996 Oxycodone was refined from thebaine.  Purdue began aggressively marketing oxycontin, a slow release form, to treat chronic pain. As physicians were prescribing it they found that the pain of withdrawal was worse than the chronic pain and overdose deaths soared. 
In 2007 Purdue was sued for misbranding it as "non-addictive" and in 2012 it was pulled from the market because it was being diverted to the street and injected.  It was replaced by oxyneo which cannot be injected. 
In the 1980’s the synthetic narcotic, Fentanyl, began being used in cardiac anesthesia.  Now it is used in endoscopic procedures for
sedation and pain relief.
Last year there was a huge spike in overdose cases presenting at Emergency.
What is the college of Physicians and Surgeons doing?
The Professional Standards and Guidelines now require physicians to review all current meds on Pharmanet.  These meds are not to be used for headache disorders, fibromyalgia or back pain.  When they are used, they must be prescribed in small frequent dipenses and not combined with sedation.
Harm Reduction Strategies
There are 3 proposed safe injection sites for Victoria.  Supervised consumption is the only strategy that effectively reduces HIV, reduces risk behaviour, prevents overdose and leads to referral for treatment. 
The newest idea is prescribed heroin.  This is very expensive, complex and controversial. 
In the Q & A  we learned:
Fentanyl can be shipped in very small packages from China. Just recently, the Border Patrol was authorized to open and inspect packages under 30 grams. 
Methadone is not a great drug.  It is often found in OD deaths along with other drugs.  Suboxone is now being used. 
Cannabis is not a complete solution.  As Marijuana is legalized the traffickers concentrate on Fentanyl to make money. 
Patrick Morris thanked Steve on behalf of the club.