OxyContin replacement may not solve abuse

The move to replace the prescription painkiller OxyContin with a newer formulation less prone to misuse won’t solve the crisis of widespread abuse, experts say, unless there is additional training for physicians and treatment for addicts.

Following a similar move in the U.S. in 2010, Purdue Pharma will stop manufacturing OxyContin in Canada and replace it —starting Thursday — with OxyNeo pills, which have been treated to make them extremely difficult to break down.

The problem of OyxContin addiction is particularly acute in native communities, and leaders from the Nishnawbe Aski First Nation (NAN), which represents 49 First Nation communities in northern Ontario, will hold a news conference Wednesday in Toronto to warn of a looming crisis as supply of the drug is cut off.

They say addicts make up more than 50 per cent of the population in some communities, which lack adequate treatment resources for addicts who will face painful withdrawal. Others may seek illegal alternatives.

The move to the new drug comes in response to the widespread illegal trade in OxyContin, which produces a heroin-like euphoria when it is chewed or crushed and then injected or inhaled.

"It’s the first mass switch of one drug to a different formulation. I don’t think this has happened before in Canada," said Dr. Meldon Kahan, medical director of addiction medicine service at St. Joseph’s Health Centre in Toronto. "It’s not a magic bullet. It’s not clear whether this will solve the problem or just switch it to another drug. Only time will tell."

Doctors precipitated crisis

Getting doctors to prescribe opioids more appropriately needs to be part of the solution, because many of them may just unwittingly switch their patients to other equally addictive drugs, such as hydromorph contin, fentanyl or morphine, said Kahan.

Hydromorph contin, for example, provides a sustained release of hydromorphone, which like OxyContin can be crushed, injected and is fully covered under the Ontario drug benefit plan.

"This is a very unusual public health crisis because it was generated by the medical system," said Kahan. "Doctors' knowledge of this is not very high, because they don’t get much training on it."

When it was first introduced in 1995, OxyContin was heavily marketed to doctors who were assured it was safe and non-addictive. They began prescribing it to treat moderate to severe pain, typically in people suffering from osteoarthritis, back and neck problems, as well as palliative patients and those recovering from cancer surgery.

However, the addition of long-acting oxycodone — the form contained in OxyContin — to Ontario's drug plan in 2000 coincided with a spike in opioid-related deaths.

Addiction rates high in First Nation communities

Officials say northern communities will be hardest hit by the pulling of OxyContin and urgent action is needed.

"In the absence of any regular treatment, a public health catastrophe is imminent, as there are thousands of addicted individuals with rapidly shrinking supplies — likely leading to massive increases in black market prices, use of other drugs, needle use/sharing, and crime," said Dr. Benedikt Fischer, a senior scientist at the Centre for Addictions and Mental Health.

Chief Matthew Keewaykapow of Cat Lake First Nation has declared a state of emergency, saying in a news release that 70 per cent of his community members ranging in age from 11 to 60 are addicted to OxyContin. In the Sioux Lookout area, with a total population of 25,000, at least 9,000 people are addicted.

"[The] potential for a mass involuntary opiate withdrawal is looming. The number of NAN First Nation community members addicted to OxyContin at risk for painful withdrawal as a result of the change is staggering." said NAN Deputy Grand Chief Mike Metatawabin. 

"The problems are intensified in the remote northern communities for those who are addicted to OxyContin and do not have access to drug treatment programs. It is time for both levels of government to respond with programs and services that are urgently required to implement emergency strategies."

The risk of dying during withdrawal from OxyContin is high, because many addicts become so desperate they commit suicide or overdose when they do finally get their hands on the drug, said Kahan.

Withdrawal symptoms include severe nausea and stomach cramps, he added. "It’s horrible. There is tremendous suffering."

Under the Ontario Drug Benefit program — for residents over 65 years of age and those on social assistance — patients will continue to get OxyContin for one month. After April 2, OxyNeo will be covered for an additional year, but beyond that, approval is required under the Exceptional Access Program.

In the U.S., Purdue Pharma says it has succeeded in reducing illicit demand for its reformulated drug. While that may be true, drug abuse experts and law enforcement officials say it has also served to drive up interest in other narcotics.