PRESCRIPTION DRUG ABUSE IN CANADA A Clinicians Perspective

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PRESCRIPTION DRUG ABUSE IN CANADA A Clinicians
Perspective

• Dr. Joel Bordman, M.D.
• C.I.S.A.M., D.A.A.P.M., D.C.A.P.M.
• Medical Director, Complex Pain Program,
• First Step Medical Clinics

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Dr. J. Bordman Conflict of Interest

• I have participated in Advisory Boards or been on
  Speakers Bureaus for the following Pharmaceutical
  Companies
• J.O.I
• Purdue Pharma
• Pfizer Canada

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QuestionFrom an Addictionists perspective,
what impact does scheduling of Tramadol
have? Positive? Negative? No effect?
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Changes in Illicit Opioid Use Across Canada

• OPICAN cohort 679 illicit opioid users
  recruited in 7 Canadian cities in 2001 and
  followed up in 2005
• Avg age 35yrs most were white males
• 50 no stable housing
• 40 received income from illicit sources past 30
  days
• 1/3 used heroin in preceeding 30 days

Fischer B et al. CMAJ 2006 175(11)1385-1387
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Abused Opioids of Choice in Canada

• heroin, morphine, methadone, dilaudid, T3/4,
  oxycodone
• morphine, T3/4, oxycodone, dilaudid, Percocet,
  methadone, heroin
• Percocet, T3/4, morphine, oxycodone, dilaudid,
  heroin, methadone
• heroin, dilaudid, methadone, morphine, Percocet,
  T3/4, oxycodone
• dilaudid, oxycodone, morphine, heroin, T3/4,
  methadone
• dilaudid, oxycodone, T3/4, morphine, Percocet,
  methadone
• dilaudid, T3/4, Percocet, oxycodone, morphine,
  heroin

• Vancouver
• Edmonton
• Toronto
• Montreal
• Quebec
• Fredericton
• Saint John

Fischer B et al. CMAJ 2006 175(11)1385-1387
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Recent Trends in Presentation to Methadone
Treatment Programs

• Younger
• Less injecting
• More prescription opioids
• Less Hepatitis C
• In general Still a higher level of social
  structure maintained

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Advantages of Prescription Opioids to the Abuser
vs Illegal Sustances

• ?Cheaper
• Easier to obtain (especially in rural areas)
• Cleaner
• Produced by reputable companies
• ?Less penalty for being caught
• Prescription Drug Abuse FAQs, www.ccsa.ca, June
  2007

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Question

• Since Tramacet (R) has been available, has there
  been any significant reports of Tramadol abuse?

9
Question

• Has Tramadol been of value in treating pain in
  the patients with a high vulnerability to opioids?

10
Question

• Is Tramadol a safer option to treat pain in the
  vulnerable population?

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Questions

• Will scheduling Tramadol have a positive impact
  on addiction medicine?
• Will not scheduling Tramadol have a negative
  impact on addiction medicine?

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QuestionFrom an Addictionists perspective,
what impact does scheduling of Tramadol
have? Positive? Negative? No effect?