Measures to support a safer drug supply

Andrea Ryan, Andrea Sereda and Nadia Fairbairn (CMAJ December 07, 2020 192 (49) E1731) draw attention to the anxiety some physicians feel about prescribing opioids: "Supporting clinicians to prescribe without fear of reprisal may affect access to safer supply." In British Columbia presently, young primary care physicians are indeed becoming College-fearful of prescribing codeine for their elderly patients. Concerned this tendency might become Canada wide, I write to promote compassionate access to codeine.

These particular doctors may be distracted by all the talk of Medically Assisted Dying, when they should be paying closer attention to Medically Assisted Ageing, a much more drawn out affair. If alcohol is the anaesthesia by which we endure the operation of life (GBS), then surely codeine is a credible supplement in the PAR of later life. For most of our lifetime, seniors have probably not had much more than a bottle of Aspirin in their medicine cabinet, but as the built-in machinery of a self-destructing organism gradually takes hold, this drug nihilism cannot last.

It is essential doctors understand that ready access to the occasional T3 can be a real boon for many septuagenarians/octogenarians as they weather the assorted ailments that will undoubtedly beset them. Codeine, surely a pluripotential drug, will settle that sleep-depriving dry cough of winter; shut down those occasional summer "runs"; relieve the Tylenol-resistant wet weather aches; and spare the bleed angst when reaching for ibuprofen. And dare I say it, on occasion, rectify elusive sleep. All this, and quite apart from calming down grandma’s restless leg syndrome! Taken alongside a stool softener prn, ubi nocere est?*

None of our younger selves could have even imagined what advanced aging is all about. Young doctors may express sympathy, but they cannot feel empathy. Similarly, as a medical student I never dreamed one day I’d be married to a 76 years old grandmother! And I don’t believe my urologist appreciates what it’s really like having a prostate the size of your fist….

A Professor of Medicine once taught us that pneumonia was the old man’s friend, at least until Fleming took it away from him. Let not the fear of licence loss now threaten another of that old man’s remaining friends, the occasional codeine tablet.

Where is the harm?