The Opioid Crisis

The complainant, Geoffrey Donaldson, considered reporting about an increase in publicly-funded opioid prescriptions in New Brunswick misleading. He did not agree that there is any concern in the increase. He believed that CBC coverage is conflating legitimate use and the growing number of overdoses. The story provided sufficient context to indicate how the two are related. There was no violation of policy.

COMPLAINT

You objected to a headline on a story about a rise in the number of prescriptions for opioids in New Brunswick: Publicly funded opioid prescriptions increase, despite addiction risk. You stated this was “misleading information” about the prescription use of this class of drugs, and that repeating the “narrative of an over-prescription crisis” is very harmful, something you have pointed out in previous correspondence. You feel that this is depriving people who genuinely need these strong painkillers, that there is no proof of a crisis, and that this view is “only substantiated by anecdote and allegation.”

You challenged CBC News’ journalistic integrity for taking at face value the interpretations of the Canadian Medical and Pharmaceutical Associations. You pointed out that the CMA is using the assertion of a crisis to propagate guidelines to limit the use of opioids to cancer patients, and not others who experience chronic pain.

You provided an alternate context for the increase in publicly-funded prescriptions in New Brunswick - that given the aging population there was growing need, and more people required public assistance to pay for the medication.

You objected to a link within this article to the fentanyl crisis:

The article provides links to other headlines about the fentanyl overdose crisis, plainly trying to connect prescription with the salacious street addict crisis where no such connection can be significantly demonstrated---despite efforts by anti-opioid crusaders to do so. With easily accessible facts available, the question remains as to why they weren't presented or contributed to the analysis. The answer appears to be that the purpose of the article was instead to intentionally misinform readers.

MANAGEMENT RESPONSE

Nancy Waugh, the Managing Editor for CBC News in Atlantic Canada, replied to your concerns.

She told you the reporter used the term “crisis” based on guidelines released this summer by the Canadian Medical Association, as well as the stated position of the professional association of pharmacists:

The Canadian Pharmacists Association also considers the present state to be a “crisis.” In July, the association urged Premiers to focus their discussions on the situation, noting 2400 deaths attributed to opioid abuse or misuse in the previous 12 months. In their final communique (found at this link:
http://www.canadaspremiers.ca/phocadownload/newsroom-2017/communique_justice_social_final.pdf) the Premiers pointed to strategies for dealing with the “crisis” or “epidemic.”

She explained the article was prompted by the publication of the number of publicly-funded opioid prescriptions which showed a 26% increase over six years. She agreed with you - this was just a partial picture as it did not account for privately-filled prescriptions. The experts in the field consulted by CBC news staff thought there was cause for concern with this state of affairs. She noted this was just one story in ongoing coverage of this public health issue.

REVIEW

CBC journalists are obliged by CBC policy to provide balanced and impartial coverage of public policy issues. They do this by seeking out expert opinion and learning important background knowledge, so that they might use their professional judgment to provide a range of relevant views and context so that Canadians might make up their own minds.

You have frequently written to challenge the notion that there is an overprescription of opioids at all, and you dispute that there is any link to the growing number of deaths from opioids, particularly fentanyl, acquired on the street.

This article does not call into question the fact that people suffer from chronic pain and that opioids can and do help them, nor does it finger-point or blame those who seek relief of their pain. The article noted a large increase in publicly-funded prescriptions, and pointed out this does not include privately paid-for medication. You state that this merely reflects the increase in an aging population and a growing need for pain medicine. CBC is not obliged to reflect that view regardless of how passionately you believe it to be true. Medical and scientific consensus is that while there is much genuine need, prescription and oversight have not always been properly practiced and that there are other therapies that might work. Everyone does agree that more research and monitoring are needed. The article quoted Dr. Anthony Knight, CEO of the New Brunswick Medical Society:

"New Brunswick's doctors have noticed the trend [to more prescriptions] and that there's an understanding that more education and understanding around the impacts of opioid prescribing is needed," CEO Anthony Knight said.

The society has launched education programs to help doctors understand the health impacts associated with long-term opioid use.

Knight hopes that a long-awaited prescription monitoring program will help reduce misuse and over-prescribing of opioids.

But he suspects the national over-prescribing problem lies in having few ways to deal with chronic pain.

"There needs to be a strategy and there needs be an approach around how to provide better research and support to doctors who prescribe opioids," Knight said.

The medical profession also acknowledges a place for the safe prescription and oversight for the treatment of chronic pain. This is the preamble to their new guidelines:

As the voice of Canada’s doctors, the CMA remains concerned about the potential harms of opioids, including dependence, overdose and death. While opioids continue to play an important therapeutic role for legitimate purposes, the prescribing of opioids must be done in a manner that is based on evidence, and includes careful assessment and monitoring.

There is data that indicates many abusers of opioids, particularly youth, acquire the drugs from friends and family members who have prescriptions. The more it is prescribed, the more available it is. Several physicians I have spoken to say that they and their colleagues are encountering patients who started off with prescriptions and are now seeking to support their addictions through illegal sources. Canada and the United States have the highest prescription and overdose rates in the world; professionals think there is a link between the two.

It is true that the causes and the relationship are complex. It is important that reporters are clear about the links and the concern. However, to talk about a public health crisis - which includes the legal dispensing of this class of drugs - is not a violation of CBC journalistic policy.

You dispute the role and position of both medical and pharmaceutical professional associations, citing the fact that they have gotten things wrong in the past. I assure you that CBC journalists talk to a range of professionals and experts and reflect consensus views. The Canadian government is developing health policy based on the information and best analysis of Canadian doctors, pharmacologists and addiction experts:

Canada is facing a national opioid crisis. The growing number of overdoses and deaths caused by opioids, including fentanyl, is a public health emergency. This is a complex health and social issue that needs a response that is comprehensive, collaborative, compassionate and evidence-based.

While it is the journalists’ role to critically assess statements made by those in authority - using their professional judgment based on some statistical evidence and the best judgment of experts - the evidence is that there is a crisis in the use and abuse of opioids. You reject any link between the fentanyl crisis and the responsible use of opioids, but professional opinion and some data point to the fact that the two phenomena - the rise in opioid use for legitimate purposes and the abuse and use of street drugs - are connected in meaningful ways. Physicians are concerned that when people addicted to opioids no longer have legal access, they are turning to the streets, and this accounts for some of the significant rise in accidental deaths over the last 25 years. Your admonitions do point to an important reminder as CBC news staff continues to cover this public health issue - and that is to be sure to provide the proper context so that citizens can inform themselves properly. This is a complex issue and requires careful explanation of the various factors contributing to it. One of those factors is the protocols and prescription of opioids. I appreciate your concern that the pendulum might swing and legitimate need might not be met. That does not mean the issue should not be addressed.

Sincerely,

Esther Enkin
CBC Ombudsman