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Concerns about prescription drugs
Coroner's report on 2012 death has recommendations for Department of Health and Social Services

Paul Bickford
Northern News Services
Published Monday, February 24, 2014

A new coroner's report is raising concern about overuse and misuse of prescriptions and other medications in the NWT, and how people are being prescribed potentially dangerous numbers of legal drugs.

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The overuse and misuse of legal medication is a concern for the chief coroner of the NWT. - Paul Bickford/NNSL photo illustration

The Feb. 11 report from the Office of the Chief Coroner concerns the 2012 accidental death of 47-year-old Arlene Carmichael of Aklavik.

"The cause of death is multiple drug toxicity," said Cathy Menard, the chief coroner, explaining a combination of prescribed legal drugs led to aspiration pneumonia, which is produced when a person aspirates material from the upper airways and/or stomach into the lungs.

Menard said the aspiration pneumonia would never have happened if Carmichael did not have a combination of drugs in her system.

The deceased woman had many health issues, which led to long-term multi-use of various legal drugs.

Post-mortem toxicology revealed the presence of nine different medications, including morphine, codeine, diazepam and acetaminophen.

"Throughout her records, references were made to her poly-pharmacy use and her drug-seeking behaviours," said Menard. "It is something that we're seeing more and more."

On several occasions, Carmichael received early refills on prescriptions from a primary care provider or requested early refills from an emergency department.

Menard noted that, from 2009 to 2012, there were 17 overdose deaths - including accidents and suicides - from prescription medicine and/or over-the-counter medication.

The coroner's office obtained the assistance of a patient safety death review committee to analyze Carmichael's passing. The panel of experts made seven recommendations on standards and training, prescribing opiate medications and organizing services for addicted patients

"They really felt the quality of care that was provided to Ms. Carmichael was excellent, but they felt that the physicians in the North had lacked training and expertise in the management of prescription opiate addictions," Menard said. "These recommendations are to help the Northwest Territories in preventing future death in similar circumstances."

She passed the recommendations along to the Department of Health and Social Services.

Menard said this is the first time she has made recommendations of this kind to the department.

Debbie DeLancey, the deputy minister of the Department of Health and Social Services, declined to specifically comment on the coroner's report and recommendations, explaining they are being reviewed.

"But I will say generally we are well aware of the concern about prescription drug abuse," she said. "It's a concern that exists nationally and is shared frequently at discussions when the ministers of health from across the country meet ... It's one that we have on our radar screen and certainly have had internal discussions."

DeLancey said one question is, for those people who are abusing prescription drugs, how are they accessing them? "Is it through people who are getting the drugs and then selling them on the street? Or is it through individuals being able to go back and get an inappropriate number of prescriptions filled by going to various physicians, including locums."

The deputy minister said the department recognizes there needs to be good checks and balances in place within health authorities, noting some authorities have taken measures so people can't shop around to get prescriptions.

"We will have a better handle on the issue when we have all the pieces in place to actually put a prescription drug monitoring system in place, and we don't have that today," she said.

DeLancey noted the GNWT has a pharmacy act which gives the ability to set up a monitoring program and the ability to require pharmacists to provide information on prescriptions.

"But we need to get our health information act in place to deal with the privacy barriers. Right now, we can't implement the provision in the pharmacy act 'til we have one more piece of legislation in place that provides the privacy protection," she said, noting the health information act is before the legislative assembly.

"We're hoping that piece of legislation will be approved and that will allow us to start putting a monitoring

program in place. That will take some time. It won't happen overnight, but it is on our work plan."

DeLancey said the department will try to respond promptly to the coroner's report, and that will take a couple of months.

However, she noted some of the work recommended by the coroner is already underway, such as setting standards for practitioners on prescribing, and looking at guidelines and standards for managing opioid dependence.

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