Tracy has suffered from chronic back and neck pain since she had a workplace injury 17 years ago.
Back then, in the early 2000s, before most people had even heard of fentanyl, the drug in time-release patches was a common way to treat pain. Tracy, whose last name CBC News has agreed to withhold because of the stigma she faces as an opioid user, was on prescription fentanyl for years before she asked her family doctor to wean her off, afraid of the harm the powerful drug could cause.
It took two years — and agonizing withdrawal symptoms, as Tracy refused to take methadone to help prevent them — but her doctor was able to move her onto a different painkiller: percocets.
The Thunder Bay, Ont., woman would rather not be on opioid medication at all, but says it “at least gives me enough of a quality of life that I can get up and walk my dog. That is my priority.”
But after her family doctor — who she had been with for 30 years — retired last December, Tracy found out how difficult it would be to find someone else to prescribe the painkillers she now depends on, let alone get another primary care physician.
Doctors at walk-in clinics don’t prescribe opioids, and with an estimated 20,000 people in need of a family doctor or nurse practitioner in northwestern Ontario, medical clinics in Thunder Bay have waiting lists hundreds of people long.
When CBC News visited Tracy, 58, in September, she had one day’s worth of pills left. She predicted that in two days, she wouldn’t be able to walk. On top of that, she’s facing the prospect of major surgery for her deteriorating spine, and fears she’ll have no family doctor to take on her care afterward.
“Due to the intensity of this surgery, I mean, I’m going to be on opioids forever now,” she said tearfully. “I’m going to be at the bottom of a list that the doctors want to pick up, you know? They don’t want to deal with somebody like me.”
Patients suffering from chronic pain — especially if they depend on or are addicted to opioids — do have a harder time getting access to a primary care provider, said Dr. Raymond Balec, a family doctor at Norwest Community Health Centres in Thunder Bay.
There’s “some reluctance specifically around [prescribing] opioids,” he said. “No doctor would in any way want to contribute to the opioid crisis.”
If doctors don’t feel comfortable prescribing narcotics, they shouldn’t, Balec said.
But there are some patients who legitimately need opioid medication, he said, because their pain renders them unable to function and they don’t respond to any other treatments — a fact reflected in Health Canada’s opioid policies. Those policies emphasize the importance of responsible prescribing to those patients, including making sure they understand the risks of addiction, as well as overdose.
Balec has seen many patients suffer after losing the family doctors who had previously prescribed their painkillers.
“[They’re] certainly frustrated, certainly scared,” he said. “Many of them are going through opioid withdrawal, they’re doing their best to make their very last prescription last as long as possible. They’re tapering themselves without any guidance from a health-care provider because all they have is just the last batch of medication they picked up from their pharmacy and they’re trying to manage with that.”
Still, Balec said he can relate to the hesitation some doctors have.
“I’ll even admit that when I finished my residency [in medical school], I did not feel prepared to provide excellent health care to people who suffer from chronic pain. I [also] didn’t feel adequately prepared to provide excellent health care to people who have substance use issues.”
It wasn’t until Balec did some extra training that he began to feel comfortable treating patients with those complex needs.
In addition, he said, it’s important to have the flexibility to book long appointments to talk to patients and fully understand what they’re going through, as chronic pain and addiction affect many aspects of their lives.
Health agency ‘aware of the issue’
The North West Local Health Integration Network (LHIN), an agency established by the provincial government to oversee health services in northwestern Ontario, said it “is aware of the issue” around access to primary care for people taking opioids for chronic pain.
The organization is “working to find ways to ensure that patients who have chronic pain and addictions are able to have their needs met,” a spokesperson said in an email to CBC News.
“The North West LHIN also partnered with the Ontario College of Family Physicians focusing on chronic pain, addictions and opioid prescribing to help build capacity and confidence among family physicians to serve these patients,” she said.
The LHIN said anyone who needs a primary care provider should register with Health Care Connect, a program run by the Ontario Ministry of Health and Long-Term Care that refers people to family doctors and nurse practitioners if they are accepting new patients.