Disaster in the Making: Provinces have No Plan to Help Ease in New Oxycontin Restriction

Purdue Pharmaceuticals, which manufactures OxyContin (a powerful opiate and painkiller) is replacing it with a drug that’s supposed to be less prone to abuse. But some provinces have decided that’s not good enough.

On Friday February 171th 2012, Ontario confirmed that starting at the end of the month, OxyContin – and its replacement, OxyNEO – will no longer be covered under the province’s general benefits plan. Any doctor who wants to prescribe a provincially funded dose of the long-acting oxycodone will need to prove that other attempts to treat a patient’s pain have failed. While this and other precautions have been “guidelines” for years, now they are a requirement.

“The active ingredient in OxyNEO is the same ingredient as in OxyContin, so it still has the same risks. … That’s why we felt it was important to strengthen the funding requirements,” said Diane McArthur, Ontario’s assistant deputy minister and executive officer of Ontario Public Drug Programs. “Ontario has the highest level of OxyContin use in the country. And that was quite concerning to us.”

OxyNEO is a new formulation of oxycontin that “tamper proof” – making it harder to crush inhale or to dissolve and inject.

Other provinces are making similar moves. Prince Edward Island, Manitoba, British Columbia and Saskatchewan have all said they would follow in Ontario’s footsteps.

The federal government, which funds aboriginals not covered by provincial programs, has said it will only cover OxyNEO under extenuating circumstances.   This marks a policy change.

One of the more potent and addictive painkillers ever unleashed upon Canadians is coming off the shelves.

OxyContin will be replaced by its successor OxyNEO and will still contain the active ingredient oxycodone.  Neither will be covered under Ontario’s general benefits plan and doctors will have new stricter guidelines.  Any MD that wants to prescribe a provincially funded dosage will need to prove all other attempts at treatment have failed.

But even as provinces move to narrow the supply of opioids, treatment options for addicts remain inadequate – especially where the need is greatest: in smaller, more remote communities with huge addiction rates and few or no treatment services.

Astral’s chief medical correspondent, Dr. Mitch Shulman has pointed out that  Ontario has the highest level of OxyContin use in the country.  He says that by suddenly cutting off the supply and refusing to pay for it, the government will save money, but that none of that money is being applied to detox, addiction treatment, clinics, or the like. Oxycontin has been linked to violent crimes and robberies. Since a great of people with legitimate oxycontin are older Canadians one might even wonder if we will see an increase in violent crimes against seniors as addicts’ supplies run low.

Indeed CARP has found no evidence that any preparations or plans have been made to help abusers/addicts or even help people with prescriptions that have been cut off by their doctors.

In previous articles written for this newsletter, Dr. Mailis-Gagnon, CARP’s resident neurological pain expert, has reported that many doctors don’t know how to wean patients off heavy opiates and that she patients have walked into her office after being suddenly cut-off by the very same doctors who had been prescribed them increasing amount of opiates for years.  Opiate withdrawal makes people seriously ill, it is extremely painful and very dangerous – it can prove fatal.  As one doctor put it to the Globe and Mail: “Picture the worst flu you’ve ever had and mulpliply that by twenty”.

Dr. Mailis has said that while some doctors overprescribed others were scared to prescribe opiates like Oxycontin because of the restrictions. As a result, some people who didn’t need opiates had too much and others who desperately needed them to help them cope with chronic or terminal illness and pain could not find a doctor willing to help.

According to Dr. Shulman, there is effective alternative to this drug, available in the U.S., whose ingredient blocks the associated narcotic high to the brain, and is nearly impossible to become addicted to.  He also points out that Purdue’s patent on OxyContin has run out but now has a new patent on OxyNEO.  

In Northern Ontario, the prospect of OxyContin’s phase-out prompted a call for help from health-care practitioners and community leaders with the Nishnawbe Aski Nation. There are so many addicts, and so few treatment facilities, that a disrupted supply could be a body blow to tiny communities.

Claudette Chase, medical director for the Sioux Lookout First Nation’s health authority and a member of the Nishnawbe Aski Nation’s prescription drug abuse task force, estimates that about a third of the aboriginal population in her area of northwestern Ontario is addicted to prescription opioids. In some communities, it’s as high as 75 per cent. Of the thousands who need treatment, she said, less than 10 per cent are getting help.

Part of the problem is the paperwork needed to access Suboxone, an easy-to-use alternative to methadone, the most common treatment for opioid addiction.

In the meantime, Dr. Chase worries about a drought of OxyContin in communities with high addiction levels. The impacts could range from mass, racking withdrawals to more deaths thanks to an all-too-versatile illicit drug market, she said.  In some markets, pulling Oxycontin has resulted in increased demand for heroin.

“This should be treated as a public health emergency.”

So far, that calls for help have fallen on deaf ears and health officials have not indicated that they are prepared to put a plan in place.

The OXYCONTIN INDEX

Ontario’s methadone caseload in December, 2010: 29,332 patients, 296 physicians, 105 offices

Ontario’s methadone caseload in December, 2011: 35,228 patients, 340 physicians, 120 offices

9,000: Estimated number of aboriginals in northwestern Ontario addicted to OxyContin

5: Estimated percentage of those receiving treatment

33: Estimated percentage of Northwestern Ontario’s First Nations population addicted to OxyContin

75: Estimated percentage of OxyContin-addicted residents in some of Northwestern Ontario’s hardest-hit communities.

Health Canada, Ontario Health Ministry, Nishnawbe Aski Nation

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