Update: New data from the Ontario Coroner’s office indicates that while oxycodone deaths fell in 2012, deaths due to virtually every other painkiller rose – to a total of 576 acute toxicity deaths, up from 547 the year before. Oxycodone deaths, which still make up the plurality of painkiller deaths, dropped to 143 from 167 in 2011. But overdose deaths due to morphine, hydromorphone, heroin, fentanyl and codeine rose. The chart below has been updated.
Even as prescriptions for OxyContin’s replacement plummeted amid a provincial crackdown, prescriptions for other opioids – just as addictive, just as easily abused and even more powerful – skyrocketed, according to data obtained by Global News.
In depth: Canada’s pill-popping problem
Last year Ontario stopped paying for prescriptions of OxyContin’s “tamper-resistant” replacement OxyNEO except in exceptional circumstances.
Prescriptions, predictably, dropped – especially after a grandfathering period ended in early 2013.
But Hydromorph Contin – another painkiller made by the same company that’s more powerful and even easier to abuse – is being doled out in greater numbers than ever before, surpassing levels of OxyContin prescriptions over the past several years.
That switch – predicted by some addiction experts last year – highlights how tricky it can be for policymakers to crack down on prescription drug abuse: How do you tighten the rules while ensuring people who need these drugs get them? How do you put more checks in place without overloading a strained healthcare system?Ontario opioid prescriptions »
Ontario opioid prescriptions
While the province is reviewing the rules governing this class of drugs, Ontario Health Minister Deb Matthews wouldn’t say whether she’d apply the same rules to Hydromorph Contin that now apply to OxyNEO.
She does hope there’ll be fewer prescriptions for it, and said the province can use data from its prescription monitoring system to target doctors or pharmacies with unusual prescribing or dispensing practices.
Doctor and addictions specialist Dave Juurlink attributes the drop in oxycodone deaths to both the new rules around OxyNEO and the province’s narcotics monitoring system, as well as more awareness among doctors that prescribing these pills for chronic, non-cancer pain can be problematic.
That said, he calls the spike in Hydromorph Contin prescriptions “completely predictable” – and much tougher to address.
The provinces were spurred to act on OxyNEO because it was a new drug brought on by Purdue Pharmaceuticals to replace OxyContin.
“I think it was easier for the government to make changes in the public interest last year because external events allowed them to reconsider,” he said. “I think a major government decision on the funding of Hydromorph Contin would be met with an awful lot of resistance.”
The federal government, meanwhile, is still taking flak – from the provinces and the United States – for approving generic OxyContin a year ago.
“It’s that formula of OxyContin that resulted in terrible abuse, deaths, destruction of families destruction of lives,” Matthews said. “So I continue to call on the federal government to demand that only the … more difficult-to-tamper-with formula be available here in Canada.”
Health Minister Rona Ambrose has said she wants to make prescription drug abuse a priority but it isn’t yet clear what that’ll entail.
A statement from her office says she wants to “build on actions already taken to tighten licencing rules that will help to prevent dangerous prescription drugs from being illegally distributed. … We are looking at tamper resistance as a way to address prescription drug abuse.”
Juurlink would like to see generic, easily-abused oxycodone off the shelves in Canada. But failing that, he’d at least like Ottawa to pay closer attention to the number of people killed by these drugs, which he pegs at over 1,000 across the country.
“At a minimum they should be paying attention to the end result of this epidemic,” he said.
“That is the absolute worst possible outcome of opioid addiction, and if they’re not paying attention to that, you can bet they’re not paying attention to much else.”Ontario opioid deaths »