Can someone tell me where to find “The Street”?
I mean the place where drug addicts go when they can’t get opioids from the health system. I’ll pay cash, but I want quality stuff, preferably stolen from a pharmacy, hospital or somebody’s home. The pills should be properly marked and unadulterated, because they’re for my friend, “M” and she doesn’t want anything dangerous.
M is not an addict. Her issue is relentless pain — a lot of it. If she’s an addict, then so are people who need insulin or Advil. But the government of Nova Scotia is determined to force M to “The Street” for relief.
She’s been suffering from chronic pain for 20 years, beginning with fibromyalgia, a disease that on its own can change a person’s life forever. I know of a sufferer whose wife once found him on the floor in a fetal position. His pain was so great and so pervasive there was nothing else he could do.
M also has widespread osteoarthritis, and stenosis of the neck and spine. She has endured four joint replacements, one of which was a do-over on her hip. It didn’t work, so that source of pain is back — amplified, of course, by fibromyalgia. M’s bad luck is compounded by her allergy to a class of drugs know as non-steroidal anti-inflammatories (NSAIDs), such as aspirin and Advil. So opioids are all she’s got. Even worse, M has a high tolerance of opioids, which means she needs a lot more than most people to manage her pain. An emergency room doctor treating M once said to me: “I’ve never given a patient so much morphine with so little effect.”
M is “ashamed and embarrassed” to be taking opioids, so it’s a secret. For important occasions, she’ll take an extra pill to get through the event and manages to appear pain-free. Some people see that and suspect she’s not really sick.
So now, as M languishes on the long waitlist for joint surgery (second hip do-over), the provincial government has stepped in to make things worse — a health department unit called the Prescription Monitoring Program (PMP) has forced her doctor to reduce her painkillers to about half of what she needs because — without ever meeting her — they feel she is being over-medicated. (Note to government: M is never pain-free. The drugs just make life bearable.)
The PMP bills itself as “Promoting the appropriate use, and reducing the abuse and misuse of monitored drugs in Nova Scotia.” It sounds nice but belies a casual cruelty.
One thing it does well is violate patient confidentiality. If you’ve ever received a prescription for one of almost 100 drugs monitored by the PMP, you and your drug become part of its database. The PMP looks for those who work the system to obtain unnecessary drugs and practitioners judged to write prescriptions too freely. In the latter case, the PMP has ways of making them co-operate. The harshest is a referral to their licensing board, which is wickedly stressful and possibly even career-ending.
It’s a curious policy for a health department trying to overcome a chronic shortage of physicians — would you want to practice in Nova Scotia if you knew this was going on?
So you may think you have a confidential relationship with your doctor, but if you live in Nova Scotia, the PMP is right there with you the instant your doctor takes out the prescription pad.
The cops are there, too.
Last year, the PMP processed 33 queries from law enforcement, noting in its 2019/2020 Annual Report — perhaps wistfully: “Law enforcement requests remain steady; however, there has been a decline in recent years as a result of the need for reasonable grounds to be demonstrated … The Program remains willing and able to support local law enforcement.” But the PMP is neither willing nor able to support people in pain. No one from that unit has ever — not ever — contacted M to learn about her condition or assess her needs. It seems their algorithm has coughed up her doctor’s name and it’s case closed. M is collateral damage.
Nothing in the PMP’s annual report assesses whether it is accomplishing the fuzzy objective mentioned above. However, elsewhere on the province’s website there is a rough indicator in a chart of “Confirmed and probable acute opioid toxicity deaths in Nova Scotia.” In 2011, six years after the PMP was created, the number was 56. In 2019, the last year before Covid, it was 56. (The official numbers are subject to change.) It makes “The Street” a tempting alternative for people in pain.
In other words, not much has been accomplished. And I wonder how many other people are suffering needlessly at the hands of the PMP. M is tough, so she won’t be resorting to illegal sources for relief. Instead, she’ll endure a drastic reduction in the quality of her life. Others, however, will do what the PMP purportedly wants avoid: they’ll get help from “The Street.”
Note: this piece was written by me and first appeared in the National Post on Oct. 6, 2021 – BT.