Pill bottles for prescription opioids could be required to carry warning labels, Health Canada's chief medical advisor says.

Next month, the regulator plans to publish a proposal for the stickers, said Dr. Supriya Sharma, chief medical adviser at Health Canada in Ottawa.

The small, brightly coloured warning labels would caution people that the painkillers can cause addiction and overdose.

The sticker would resemble others found on pill bottles, such as those saying "May cause drowsiness" or "Avoid taking with alcohol."

"For this sticker, the proposal would be that we would make it mandatory to be dispensed any time an opioid be dispensed," Sharma said in an interview. "That would actually require a regulatory change on our part and it would be the first time we would be compelling a sticker to be placed."



A panel of experts, including toxicologists, pharmacists, experts in pain treatment and a pain patient, provided Health Canada with advice about helping consumers understand the risks and benefits of taking opioids.



Health Minister Jane Philpott hopes legislation will "turn the tide on this crisis."

Dr. Hance Clarke sees issues with how some patients are deprescribed long-term opioids for pain. (CBC)



Some people might argue the problem is already out of control, said Jeff Bourne, a former opioid abuser in Carbonear, Newfoundland, where he counsels people addicted to their medication.



"Some people might say the problem's already out there, so it's probably a waste of time. But what about the people that was never introduced to this type of pain medication? At least you've got the warning label for them." Some people might argue the problem is already out of control, said Jeff Bourne, a former opioid abuser in Carbonear, Newfoundland, where he counsels people addicted to their medication."Some people might say the problem's already out there, so it's probably a waste of time. But what about the people that was never introduced to this type of pain medication? At least you've got the warning label for them."

'It's complicated'

The issue is "incredibly important," Sharma said, given that Canadians are the second-highest per capita users of opioids in the world, after the U.S.



"The question is why are those being used?" Sharma said. "Is it because people may not necessarily have the appropriate evidence to show when they should appropriately be prescribed? Is it because patients are requesting them? Is it because they are being used in a way where people are not conscious of the risks that are associated with it? It's complicated."

That's why Sharma said both the prescribing and patient sides of opioid use need to be addressed. Fatal overdoses related to both prescribed opioids and bootleg painkillers have increased across Canada.



On the physician side, Health Canada is funding an update to national guidelines on use and tapering of opioids.



As director of pain services at Toronto General Hospital, Dr. Hance Clarke worries the guidelines will discourage the controversial prescribing of opioids for long-term, chronic pain.



"I've seen so many issues now where physicians have de-prescribed an individual who has been stable for 15 years on their opioid and functioning ... and now they're in acute withdrawal," Clarke said.



The U.S. Centers for Disease Control and Prevention released non-binding guidelines last year cautioning against the use of long-acting opioids as first-line treatment for chronic pain. Some provinces have adopted the CDC guidelines.