The NWT’s chief coroner is calling for a review of the territory’s prescription of chronic pain medications and subsequent addictions treatment following the overdose of an Aklavik woman in December 2012.
Coroner Cathy Menard released her official report on the death of Arlene Carmichael, 47, who was found to have accidentally died from aspiration pneumonia caused by the ingestion of multiple drugs in her home.
Post-mortem toxicology revealed the presence of several opioids and benzodiazepines in her bloodstream, including morphine, codeine, diazepam, paroxetine and zopiclone, among others. The combined effects of the drugs were capable of causing aspiration pneumonia, Menard said.
Though Carmichael received an “excellent” quality of care, Menard said “it appeared evident (her care providers) lacked training and expertise in the management of prescription opioid and benzodiazepine addiction” to deal with Carmichael’s ongoing dependency.
Carmichael regularly saw doctors for narcotic and sedative medications. Her medical records showed she suffered from chronic pain, osteoarthritis, migraines, anxiety and depression, hypothyroidism, diabetes and long-term alcohol and drug abuse, and that withdrawal symptoms may also have contributed to her hospital visits.
“On several occasions she received early refills on opioids and benzodizepines from her primary care physician, and on different occasions she presented to the emergency department requesting early refills on her medications,” Menard wrote.
Menard said it’s time the NWT department of Health and Social Services established a working group to set standards for doctors and nurses on the prescribing of chronic pain medications, and review its eligibility criteria for the coverage of suboxone, a drug used in opioid replacement therapy.
Though less effective than methadone, suboxone is less likely to cause overdosing and can be prescribed without a special license. It is given through “structured opioid therapy,” which limits misuse through frequent dispensing, regular doctor visits for urine drug screening and a gradual reduction in dosages.
A similar tapering approach is used for benzodiazepine addiction.
In establishing services for prescription drug addiction, Menard said the regional health authorities must work closely in conjunction with communities and Aboriginal governments, noting that in northern Ontario, where opioid abuse is high, some suboxone programs are run independently by First Nations.
Menard added that more training and support is needed for physicians and nurse practitioners in the NWT to identify and manage opioid misuse and addiction, through telemedicine and by providing access to a long-distance clinical support network. She said one or more physicians should be intensively trained on suboxone administration in the NWT.1 comment