Two Guys Hooked - Part III of a series by London Free Press - and in which reporter Randy Richmond asks Dr. Roman Jovey - a past president of the Canadian Pain Society - to comment on the ready availability of oxycodone tablets to London addicts:

Family doctors can hardly be blamed for the proliferation of OxyContin, said Dr. Jovey - They are doing the best job they can.

The doctor shortage means family practitioners are busier than ever, he notes - Its rush, rush, rush.

Relatively few have proper training in assessing pain and monitoring pain treatment, Jovey adds. Doctors must have faith in their patients.

Pain itself is difficult to gauge, Jovey notes - It is totally subjective. There are no tools to gauge pain.

Many addicts told the London Free Press they received OxyContin prescriptions from pain specialists.

But pain specialists in Ontario have no official credentials or prefessional body overseeing their training or procedures, Jovey says.

I am self taught. There is no standard training - no official credentials, Jovey states.

SupportNet Note - Dr. Jovey knows of what he speaks . . .

In a September 2006 Corporate Profile funded for publication in The Medical Post by Prix Galen / Purdue Pharma - Dr. Jovey is credited as one of the country's leading experts on pain - and as then President of the Canadian Pain Society - and was interviewed to dispel the myths surrounding medical opioid use . . .

SupportNet has excerpted some of Dr. Jovey's 2006 interview:

Much of the apprehension about opioids stems from concerns about addiction and abuse. How can physicians limit opioid addiction?
There are many sources of opioids on the street. The assumption has been that it is simply a result of poor prescribing by doctors - but there is evidence from U.S. research that a significant part of street opioids are stolen - stolen from pharmacies - stolen from warehouses - etc.

If we discount that and look at just the physician contribution - physicians have to screen patients for risk factors for addiction any time they are considering an opioid for the treatment of chronic pain. There are short questions and answer tools that only take five minutes but will give physicians some idea of the risk level of a patient being considered for opioid therapy.

Are some opioids more ‘abusable’ than others?
All opioids can be abused by people determined to do so. The exception may be methadone given in a witnessed daily administration program. There seems to be some regional variation that favors one molecule over the other - but it has little to do with the addictive potential of the particular opioid. I have treated many people for codeine addiction - in spite of it being a weaker opioid.

Are there data regarding the amount of prescription opioid abuse in Canada?
Health Canada - which is responsible for controlled substances - doesn’t have an organized system for monitoring abuse. They know how many opioids are prescribed - but they don’t have any idea of what percentages of these prescriptions are abused.

While the numbers are growing - it is a very small percentage of all patients who are admitted for treatment of addiction that are admitted for prescription opioid addiction.

How has widespread media publicity and negative media attention affected pain management in Canada?
Negative publicity focusing on the small group of people in our society who choose to misuse prescribed opioids has resulted in a degree of professional opiophobia – which penalizes legitimate patients with pain.

What causes physicians to under treat pain?
Fear is the number one barrier to better pain management. Physicians are afraid of contributing to addiction and to the diversion of drugs. And they fear having their College review their entire practice - possibly causing them to lose their livelihood or restricting their capacity to practice in some way. Right across the country - this is the single biggest barrier.

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