CANADA

Hidden addictions

The increasing abuse of prescription drugs

RIC DOLPHIN December 12 1988
CANADA

Hidden addictions

The increasing abuse of prescription drugs

RIC DOLPHIN December 12 1988

Hidden addictions

CANADA

The increasing abuse of prescription drugs

The elderly woman tells a friend in the nursing home that she watched a TV report about drug pushers preying on young people. “What about us old ladies?” replies the friend. “We go to our bingo and sell our Valium pills.” Chimes in a third woman: “How about doctors? They give us drugs we don’t need.”

The dialogue is contained in Les Vieux (the old people), a play currently being performed at schools and seniors’ homes in the Ottawa area and parts of Quebec by a troupe of actors who are retired on pensions. And according to Sister Gisèle Richard, 66, the Holy Cross nun who produced the play and who is chairman of the Ottawa-Carleton Council on Aging, some seniors do sell their sedatives at bingo halls and many are drugged to the point of dependency by impatient doctors. “It’s too easy,” said Richard, “to get rid of a senior by prescribing a drug.”

Drug dependence among the elderly is a significant part of a growing financial and health problem across Canada: the soaring costs and use—many authorities call it abuse—of prescription drugs by all levels of society. In Ontario, the health ministry spends $3 million a day—roughly twice the per capita spending in other provinces—on free drugs to seniors and the poor and on some drugs used in hospitals. Ministry statistics show that under the Ontario Drug Benefit Plan, pharmacies fill 23 prescriptions a year for the average beneficiary. And the eight-member Lowy commission in Ontario investigating the possible overprescribing of drugs has heard testimony suggesting that the problem may be widespread. The commission concluded its public hearings last week with a stop in Ottawa.

There, Susan Harrison, executive director of the Amethyst Women’s Addiction Centre, testified that half of the 194 women assessed by her staff between April and November were addicted to prescription drugs.

In British Columbia, the

government last year introduced a prescription-drug user fee for seniors as a way to stem the escalating costs of the provincial pharmacare plan—which provides subsidized pharmaceuticals to seniors and the poor. And currently, five unnamed doctors are being investigated

for allegedly prescribing unusually large quantities of drugs to addicts. The drugs include the pain-killer Talwin and the adult stimulant Ritalin, both of which are now part of the illicit street trade. A Vancouver police department spokesman said that one of the doctors under investigation prescribed 680 Talwin tablets to one patient in two months. The normal prescription for chronic pain averages between 40 and 100 tablets a month.

Officials in other provinces have also expressed concern about the strain on their drug-plan budgets. In Manitoba, where everyone is entitled to an 80-per-cent drug reimbursement after an initial expenditure of between $85 per individual and $150 per family, provincial spending on prescription drugs rose to $34.7 million in 1987 from $6.7 million in 1977. Kenneth Brown, pharmaceutical consultant to the Manitoba health department, said that the rise was mostly at-

tributable to an annual increase in the price of drugs of between 10 per cent and 15 per cent—up to three times the rate of the consumer price index. But figures released last spring by the federal government’s Canadian Centre for Justice Statistics in Ottawa show that Manitobans, especially rural residents, abuse prescription and hallucinogenic drugs to a greater degree than people in any other province. According to the centre’s statistics, the number of charges laid in connection with controlled drugs in Manitoba rose to 56 in 1987 from only three in 1977.

Meanwhile, critics say that the incidence of overprescribing is most prevalent among se-

niors. Because the elderly generally receive subsidized drug care, it is impossible to statistically pinpoint how much their drug use may have increased nationally. But between 1976 and 1986, the number of Canadians 60 and older increased to 15.1 per cent of the population from 12.6. And there have been clear danger signals of drug abuse among the older population. Among them: a study by the drug quality and therapeutics committee of the Ontario health ministry last year showed that of the geriatric patients admitted to hospital, as many as 20 per cent were treated for adverse drug reactions or for taking the wrong dosage. For his part, Louis Pagliaro, a professor of pharmacy at the University of Alberta in Edmonton, also says that the

problem is becoming acute. In 1987, Pagliaro and his wife, Ann, a nursing professor, began a study of drug abuse among the elderly. Now, he estimates that 20 per cent of elderly people misuse alcohol and drugs—usually sleeping pills and such sedatives as Valium. Lonely old people may visit their doctors as much for social contact as for medical problems, said Pagliaro. “The quickest way to get these people out of the office is to give them a prescription,” he said. “Doctors are often unaware of any dependency.”

In an effort to reduce the cost and abuse of drugs, several provinces have modified their regulations. British Columbia’s introduction of a user-pay system for seniors—excluding the very poor—saved the government $34 million and reduced the number of prescriptions by one million in the year before April, 1988. To guard against overprescription, the colleges of physicians and surgeons in Alberta and Saskatchewan recently introduced triplicate prescription forms. The doctor keeps one copy, and the others go to the pharmacist and the college, the doctors’ regulatory body, which stores the information in a computer. In cases where abuse is suspected or alleged, the records can be used to trace the transactions. To further streamline its drug plan and cut down on paper work, the health ministry in Saskatchewan, under Health Minister George McLeod, has computerized all of the province’s 320 pharmacies. That initiative has earned praise from Peter Pereverzoff, president of the Saskatchewan Pharmaceutical Association. Starting on Jan. 1, beneficiaries of the Saskatchewan Drug Plan will present a blue-andgrey plastic card to their pharmacists. The card’s magnetic strip will contain the customer’s health care number. The pharmacist will slide the health care card through a slot in a machine linked to a central government computer, which establishes how much of the beneficiary’s deductible has been used. But the computer will also give the pharmacist an alert signal if within the past seven days the same prescription has been filled. Associate deputy health minister Michael Shaw said that the card—which will later be used for doctors’ services as well—is largely intended to streamline record-keeping, although critics have said that the system may compromise patient confidentiality. The proponents argue that the new system will make it possible to monitor overprescribing doctors and patients who visit more than one physician in order to get the same drug several times.

Dr. George Carruthers, chairman of the department of medicine at Dalhousie University in Halifax, said that he thinks this so-called smart-card system—also being tested in North Bay, Ont.—is a step toward reducing the abuse of prescription drugs. But it would be better, he said, to educate doctors about the drugs they are prescribing. He estimates that by the time a doctor has been out of medical school for 10 years, half the drugs he prescribes have been developed since his graduation. And often the only information provided the doctor about the new drugs comes from the manufacturer.

Carruthers resigned as chairman of the Ontario government’s drug advisory committee last January, citing the health ministry’s “squandering” of money on unproven drugs. He now recommends the establishment of provincial panels of professional drug evaluators, which would recommend cheaper proven drugs over the more expensive and largely unproven ones. The Ontario Medical Association, while denying that its members are prone to overprescribing, also recommended such a system to the Lowy Commission last week.

But often, the problem is not with the doctor but with patients who feel that their office visits are incomplete unless they leave with a prescription. Sister Richard in Ottawa said that prescription-drug users, especially the elderly, must be weaned from drugs by doctors willing to provide alternatives, including exercise and diet. Said she: “Eighty-seven per cent of seniors are in good health, and we should try to keep them in good health instead of keeping them stoned.” Few would disagree with that objective, but how to achieve it is the question that plagues the health care industry.

RIC DOLPHIN with DEAN A DRIVER in Regina

DEAN A DRIVER