Enduring the Aftershock of OxyContin in Canada

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Earlier this month in Ottawa, a woman named Ada Giuduce-Tompson pleaded with the federal government to start doing more to prevent dangerous prescription drugs from being sold and distributed in Canada. In particular, she pointed at opioid medications such as percocet, hydromorphone and OxyContin. Ada's 29-year-old son died eight years ago in his sleep after taking his prescription to hydromorphone. She later found out his doctor had been prescribing him a grab bag of opioid medications that were ostensibly more deadly than anyone could have imagined.

It appears that Ada is right to ask for stricter regulations. Canada’s system for regulating prescription medications in Canada is seriously flawed. Health Canada is technically in charge of monitoring these drugs—yet they have almost nothing to do with the actual regulation of prescription medication. For example, once a drug has been approved for sale in the country most of the regulatory responsibility falls on the pharmaceutical companies themselves. These giant corporations don't keep track of the rates of addiction, because the government has not mandated that they need to report adverse reactions. These companies also don't keep track of basic things either, like the number of prescriptions being written. Outside entities do that, such as IMS, an international company that sells the information back to governments and pharmaceutical companies.

As we’ve reported before, Health Canada also doesn’t have the power to recall dangerous drugs, such as OxyContin, unless the pharmaceutical company agrees to do it it. And on top of all that, there are serious gaps in the structure of the lower operating systems of the medical field in Canada involving doctors, pharmacies and even medical schools. The lines of communication seem to be totally broken between these groups and are there are very little actual checks and balances in place to keep things in order. Big Pharma has essentially been allowed to run rampant on Canadian soil—cashing in big time on their sales of addictive pills and medications, some would say at the cost of human life and suffering.

There is perhaps no greater example of this problem than the OxyContin epidemic that has taken place over the last decade. Oxy abuse has seized North America. Rates of addiction and overdoses from prescription painkillers have far surpassed any other street drug, with an untold number of lives lost and destroyed. In 2007, multi-billion dollar pharmaceutical company Purdue Pharma pleaded guilty to federal court charges of felony in the US for “misbranding” their product OxyContin to physicians, essentially admitting they downplayed its addictive properties, and paid out over $600 million in fines and other assessments. But the damage had already been done—and by 2010, in Canada alone, the number of prescriptions written for the drug reached 1.6 million, while US sales for the drug totaled $3.5 billion.

When I first started contacting Health Canada about this situation back in 2012, I was constantly referred back to the pharmaceutical company, Purdue. Which was confusing as Purdue is an American company and I was trying to honestly figure out how drugs were regulated here in Canada, and why the US was suing Purdue, yet Canada was doing nothing. When I attempted to contact Purdue, I either received no response or some PR bullshit that didn't actually answer any of my questions. For example, here’s one of their blanket responses after notifying me that no one from the company would be available to chat on the phone:

“Purdue believes that it has a responsibility to ensure health care professionals have adequate and accurate information to prescribe and dispense its products. Through its company mission, Purdue has made a commitment to support quality education for the safe use of our products.”

Oxy's have come to be referred to as “hillybilly heroin” because they're equally addictive and much cheaper than “the hezza.” However, at the peak of the crisis in Canada last year, when supplies were thought to be dwindling, the street value of a single80-milligram pill rose from $20 to $80.

So how does a prescription medication become an epidemic of abuse in the first place?

Toronto-based physician Dr. Nav Persaud believes he’s found a major source of the problem. He’s the whistleblower on a massive conflict of interest scheme that occurred at the University of Toronto between the medical school and Purdue Pharma—and I quoted him in a brief story that ran in this month’s issue of VICE Magazine.

In early 2010, Nav was a first-year resident at St. Michael’s hospital in Toronto where part of his job was to review the prescriptions being written by medical students and then to co-sign them before they could be given to patients. He began to notice something seriously wrong about how some students were prescribing pain medications like OxyContin. “Some of the medical students I was working with were making some surprising prescriptions and orders for opioid pain medications,” says Nav,“It seemed to me that some of these students didn’t know what was in the medications they were prescribing.” In one case a student had prescribed an oxycodone pain medication for a patient who had come in with an acetaminophen overdose and in another, without a clear reason, a student had increased the dose of oxycodone for a patient who was already admitted to hospital on a high dose.

Nav couldn’t understand why so many students were wrongly prescribing painkillers until a student brought Nav her lecture notes. After reviewing the notes, he realized there were several serious inaccuracies. One was a description of oxycodone as a “weak opioid,” whereas it described morphine as a “strong opioid,” even though oxycodone is actually more potent. Another part of this lesson had included an explanation that Oxycodone was less addictive than morphine and therefore a better and safer alternative. As it turns out, this, among many other statements made during the lecture, was patently false.

OxyContin has its uses, for instance, it often helps relieve the serious pain associated with cancer. However, in those same lecture notes, a quote that supported the use of opioids for non-cancer pain read: “There is now strong, consistent evidence that opioids relieve chronic, neuropathic and nociceptive pain and improve function in placebo controlled trials with patients who suffer chronic non-cancer pain.” The quote was attributed to an academic paper in the Canadian Medical Association Journal, but Nav discovered that not only was the claim untrue, it did not come from that journal. “I’ve asked university officials, I asked the lecturer, and no one’s been able to say where the quote came from.”

Nav says he was disgusted when he learned about what was actually going on: Purdue Pharma had successfully engineered a slanted, disingenuous marketing campaign clearly designed to sell more OxyContin, and passed it off as an educational lecture at a major university, one that every budding doctor had to take.

“It’s probably a big coup for whoever it was at Purdue Pharma that arranged this partnership with the University of Toronto,” explained Nav, “They could now get into the medical school and get their message to medical students through their book, before they would know enough to question it. It’s a great success if you are trying to alter the prescribing patterns of future physicians.”

Nav is a former student at the university and he, along with thousands of other students, took that mandatory lecture series on pain management. The course had run from 2002 to 2010 before Nav discovered that Purdue Pharma had not only funded part of the program, but also provided the textbooks as a gift to students. Furthermore, as he discovered, the course was being taught by a lecturer who was not even part of the university faculty, despite the university having their own pain specialists. The lecturer was, however, on the speaker’s bureau for Purdue Pharma.

I contacted Purdue about all of this to ask how such serious misinformation had ended up in the books of medical students. Randy Stephen, their VP of corporate affairs, said this about the U of T course:

“Regarding the pain management course at the University of Toronto, Purdue and other pharmaceutical companies provided sponsorship funding from 2002 to 2005. A lecturer for the course recommended that a reference book on pain management be made available to students attending, which Purdue subsequently provided. The book was authored by independent medical experts, sponsored by Purdue, and endorsed by the Canadian Pain Society.”

I still had more questions, like how Purdue feels about their product’s benefits being wrongly described to medical students—among other probing inquiries. After I sent my follow-ups, I received an email from Randy once again that was clearly meant for his assistant. It read: “Lucy, Please get her off my back. I have bigger fish to fry right now. Thanks, Randy.”

I responded the following morning, assuring Randy I would “get off his back” as soon as he answered my questions about what had happened at the University of Toronto. A follow-up from my editor elicited the following, robotic response from Randy:

“Yes, that was a very inappropriate remark and my sincere apologies to Angela. We value all of our constituencies and in this case we did respond to Angela’s inquiries on the pain management course at the University of Toronto by sending a statement. Thank you for contacting us and for the opportunity to clarify our comments.”

Very inappropriate responses aside, the number of students Purdue got to attend their scholastic sales pitch at U of T is impressive. Beyond the two hundred medical students a year who had to attend, the course was also open to other students from other faculties including nursing, dentistry, physical therapy, and pharmacy. Nav estimates that nearly seven thousand students received this faulty information, and so far the university has refused to contact anyone to let them know what had occurred. If you multiply that by the number of other schools in which Purdue Pharma has most likely initiated similar programs, it becomes clear how we might have reached the extremely depressing prescription drug problem we’re facing today.

Despite being convinced that this blatant conflict of interest had altered the prescribing patterns of at least some physicians for the worse, Nav was scared to confront the university on what he had discovered. He says the general perception amongst medical students and doctors is that you shouldn’t speak up about this sort of thing. Nav also says that some of his mentors were advising him to leave it alone and to say nothing. He could not discuss some of the other backlash but says it had been made clear that his career could be in jeopardy. The university’s initial response was that they were confident in the lecturer, and questioned who Nav was to even raise such a question.

In 2010 the school uninvited the lecturer and revamped the program. They have also introduced a policy that will disallow pharmaceutical companies from providing gifts to students. But this may be a case of too little, too late. In fact, the university still allows other types of conflict of interest relationships, such as other faculty members continuing relationships with big pharma, and through the allowance of funding and grants from pharmaceutical companies.

Nav believes this type of thing could be happening at other medical schools all over the world, and that U of T is not unique in this situation: “One of the reasons the opioid epidemic is so sad is because it’s so preventable. You cannot make these medications in your kitchen sink and they don’t fall from the sky. They come from pharmacies, usually with the prescriptions from doctors.”

Nav says people who had to have minor operations have ended up having their lives unravel because they received a prescription for opioids. “Every time I see a patient who is addicted to opioids I think, we have failed you as a system, and the medical system has failed you,” says Nav.

It's clear the system is broken. In Canada, hundreds of people die every year from an overdose of an oxycodone medication, just like Ada’s son. Ada wants transparency, because right now there really is none. But more importantly there is no form of effective regulation taking place to monitor the distribution and prescription of addictive drugs. The Oxy situation unfolded right under the nose of the ultimate health authority in Canada, and still, no one has done anything about it. Purdue removed OxyContin from Canadian shelves in the summer of 2012 and sold a re-formulated drug called OxyNeo instead. Purdue also began testing OxyContin on children in America that same year. Despite Purdue’s apparent strategy shift for the Canadian market, Health Canada just approved a generic form of oxycodone despite warnings from US health officials, while the recent appearance of Krokodil—the terrifying flesh eating heroin—in Canada has been tied to the drying up of the OxyContin supply.

Clearly a company like Purdue has been able to run roughshod over the Canadian medical landscape, given that our government regulatory body is heavily neutered. On top of that, through donations and funding, Purdue was able to influence the curriculum of one of the country’s top medical schools, and continues to do so, albeit in a less overt manner. It seems that Purdue is the top power when it comes to how OxyContin is taught to professionals, sold, prescribed, and regulated—which is bad news for basically everyone who isn’t a Purdue investor.

@angelamaries