Undoing the damage of OxyContin

Monday’s announcement by federal health minister Leona Aglukkaq that she will not interfere with the approval of generic OxyContin is just the latest development in what has become a major public health crisis.

In Canada, overdose deaths involving prescription medications now vastly outnumber deaths from HIV. By some estimates, prescription drug overdoses have killed 100,000 North Americans over the past 20 years. Astonishing though that may seem, these deaths are just the tip of the iceberg. For each one, there are hundreds of people whose lives have been ravaged by addiction to prescription drugs.

Much of this toll involves opioids — painkillers including codeine, morphine and oxycodone, the active ingredient in OxyContin. Closely related to heroin, opioids produce euphoria, are highly addictive, and can be fatal at high doses or when combined with alcohol or other sedating drugs. Until the 1980s, physicians prescribed opioids primarily for acute pain (e.g., from a broken bone) and pain related to cancer. But today, opioids are more commonly prescribed to patients with chronic conditions like back pain and arthritis, often at doses that would have been viewed as unimaginably high just 25 years ago.

When someone has high blood pressure, there is good evidence that prescribing a drug for many years is beneficial. But with chronic pain, the prescribing of opioids for long periods of time (or at high doses) is not supported by good evidence. Comprehensive reviews of the scientific literature suggest that in many conditions — arthritis, for example — the dangers likely outweigh the benefits. Nevertheless, aggressive marketing by pharmaceutical companies has convinced hundreds of thousands of physicians that long-term treatment with opioids is safe and effective, with little risk of addiction. Some aspects of this marketing campaign have been so misleading that in 2007 the manufacturer of OxyContin pleaded guilty in United States federal court to felony charges of “misbranding” and was fined $634 million.

OxyContin was designed so that the active ingredient would be released gradually over 12 hours, but the controlled-release mechanism was easy to defeat. People seeking a quick high could simply chew the tablets or crush them. For this reason, the manufacturer of OxyContin withdrew the drug from the Canadian market earlier this year and replaced it with OxyNEO. (It is worth noting that this move has also allowed the manufacturer to continue to sell its product at brand name prices for many more years.) OxyContin and OxyNEO have the same active ingredient, and when swallowed whole the two drugs are considered equivalent. OxyNEO, however, is more difficult to misuse because it is harder to crush or dissolve.

All opioids — not just OxyContin — can be misused, and the federal health minister is correct when she says that the law does not permit her to withhold approval of a generic formulation just because of the risk of misuse. But when the legal and regulatory framework results in a situation in which more than a dozen Canadians die each week because of an accidental prescription drug overdose, that framework needs to be changed.

How can we start to undo the damage? A critical first step is to acknowledge the extent of the problem, recognizing that for every celebrity death (Heath Ledger and Derek Boogaard, for example) there are thousands whose deaths do not make the front page. The misuse of prescription drugs and addiction remain taboo topics in our society. This must change. And while recognizing that untreated pain also remains a problem, it is time to stop heeding pleas for continued unfettered access to prescription opioids.

Physicians should re-evaluate how freely we prescribe these drugs for chronic pain, how readily we increase the dose, and we must abandon the widespread perception — implanted in our psyche over many years by the pharmaceutical industry and its agents — that opioids are safer and more effective than other pain relievers. We now know otherwise. Finally, we must become more comfortable treating patients who have become addicted to prescription drugs.

Governments at all levels also need to collaborate on a co-ordinated national approach. The federal government should pass a law requiring that all opioids be manufactured in a manner that makes them difficult to tamper with. It should also review whether opioids are being marketed for too broad a range of problems. Provincial governments should do their part too. For example, they need to move far more quickly in developing online databases so that physicians and pharmacists can see whether their patients are trying to acquire opioids from multiple prescribers.

We don’t need generic OxyContin in Canada. The federal government should still try to find a way to keep it off the market. But more importantly, governments at all levels need to work with doctors to do more to reduce the number of overdose deaths and the burden of addiction to prescription drugs.

This blog originally appeared in the Ottawa Citizen.

The comments section is closed.

  • beth onimod says:

    i would like to know how to get oxycodone prescribed for me.. i have nerve damage in my spine which is only getting worse with age.. i have seen a neuologist and was told that they wont do surgury and i would have to find something to help with the pain.. treatments do not help and when i was on oxycodone, i was able to work, and function in a normal manner.. now since they banned oxycodone.. ive been bed stricken with pain where i cant stand for too long.. i cant walk any distance.. or i cant even sit for any great length of time.. my doctor does not prescribe narcotics and pain clinics just want to do injections.. this is insane.. you say how oxy has caused deaths.. well what about alcohol.. people out drink driving and killing complete families and the statistics are extremely higher of deaths over north america then oxycodone.. all the government had to due was be more strict in how it was prescribed.. they didnt have to banned it here.. clearly they have no idea in what its like to have pain every single day where you cant live any sort of a normal life.. this is no way to live..

  • david blackman says:

    i disagree, and believe there should be generic equivalents available whenever possible for all medications, simply for the reason of cost. That being said, it should be noted that i am in the US where the cost is far more important to this issue.

    I receive a similar medication monthly. The retail cost of 120 tablets (4 per day for one month at a moderate strength) is $118. The negotiated price I pay for a brand name is $50. If the medication had a generic equivalent, it would be $6.

    This cost difference is too wide and significant to ignore. The article mixes the issues, which are mutually exclusive. The discussion of the cost of the drug should not be included with a discussion of the efficacy of the drug. For me, the drug works, and works well. thats why it should be around, and thats why a generic substitute is warranted as well. The cost saving is significant, and that is a secondary reason.

  • R. Cunningham says:

    It is painfully clear that Leona Aglukkaq is horribly out-of-touch and frankly unqualified to act as health minister of Canada.

    She has had no influence on improving health for Canadians, particularly the poor who have the highest risk for experiencing disease.

    That being said, the physicians who prescribe these poisons are as culpable for the Oxy problem as the minister. Same with medical schools and hospitals that liberally tout the benefits of Oxy prescriptions.

    No physicians should ever prescribe extended release opioids for any reason that does not have sufficient A-level evidence to back it up (with the corollary that the evidence is not mired by the influence of the pharmaceutical corporations)

  • doug hepburn says:

    why not insist on naloxone being added to oxycontin to prevent injection.


Irfan Dhalla


Irfan is a Staff Physician in the of Department of Medicine at St. Michael’s Hospital and Vice President, Physician Quality and Director, Care Experience Institute at Unity Health Toronto. Irfan also continues to practice general internal medicine at St. Michael’s Hospital.

David Juurlink


David Juurlink is a physician at Sunnybrook Health Sciences Centre and a member of the Committee to Evaluate Drugs, which provides advice to the Ontario Ministry of Health and Long-Term Care.

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