Take a walk past your local drug store, and many of you are likely to see a sign near the door with the message: “OxyContin is available by special order only.”
OxyContin is one of the most abused prescription drugs in North America. When chewed or crushed and subsequently injected or inhaled, OxyContin produces a heroin like euphoria. In the last two decades its recreational use has skyrocketed and has earned it the label “street heroin” or “hillbilly heroin.”
The addictive properties of OxyContin are formidable, spreading the substance like wildfire across North America. To control the number of people becoming dependant, in mid-February 2012, Purdue Pharma Canada announced it would stop manufacturing the drug in its current form, replacing it with OxyNeo which is more difficult to crush, snort or inject. To further reduce abuse, Health Care Canada announced they would not be covering costs for the new form of the drug.
First introduced in 1995, OxyContin was marketed to doctors as a safe, non-addictive painkiller. Its addictive nature became increasingly evident, and doctors were told to be cautious when prescribing. However, issues arose when patients began “double-doctoring,” visiting two or more doctors for the same prescription without informing them, in order to use the drug themselves or to sell it on the streets for others’ recreational use.
Some argue that the onus falls on prescribing physicians, particularly where vulnerable populations are concerned. Elderly individuals with osteoporosis and cancer patients who are prescribed the drug after surgery are reporting an addiction to OxyContin.
Susan Michaels, a Toronto resident, recalls that “my mother’s doctor prescribed her a hundred pills without blinking an eye. If that’s not excessive and irresponsible I don’t know what is. She just kept taking them unaware of their addictiveness and it got so bad that I didn’t even recognize her when she was high.”
Many report using the drug for a high rather than pain relief. On the street an 80 mg pill can sell for up to six hundred dollars as the supplies become scarce with new government regulations.
Users describe OxyContin addiction as “all consuming,” and that even when they don’t want to use anymore they feel that they have no choice. As with other kinds of opioid drugs, the withdrawal from OxyContin can cause anxiety, muscle aches, abdominal cramping, nausea and vomiting, intense agitation, and insomnia that begins six to thirty hours after the last use of the drug. The withdrawal process, if uninterrupted by relapse, can last up to a week.
Using the drug during withdrawal can be life-threatening as the process reduces an individual’s tolerance, making it easy to overdose with an amount even smaller than the individual normally takes. Most overdose deaths occur with people attempting withdrawal or detox. This is worrisome since the majority of recreational addicts may, due to new regulations, be forced into withdrawal in the coming months.
Only patients who are currently taking OxyContin for their chronic pain will have their prescriptions for OxyNeo covered and prescriptions for incoming patients will be accompanied by a more intensive screening process said Purdue Pharma Canada in a press release in early March 2012. Ontario will also be tracking prescriptions through a database called Narcotics Monitoring System that can flag unusual patterns of prescribing and dispensing. The price for OxyNeo appears to be higher for both public and private drug plans in an effort to make it less accessible to the masses which may be detrimental to the health of thousands of addicted Canadians if their withdrawal is not treated properly.
Marilyn Lawson, a former Ontario nurse from McMaster Children’s Hospital in Hamilton, outlines the new dangers facing addicted individuals and especially First Nations communities across Canada.
“Certain towns in northern Ontario have cited that up to 80% of their population is addicted to OxyContin as a result of both prescribed and recreational use. Even when doctors refuse to prescribe the drug, people can find it on the streets. Emergency rooms are filled with overdosing patients. There are so many problems associated with OxyContin abuse ranging from high crime rates and poverty to potential miscarriages. Even if the mother and their baby survive the pregnancy, there are addicted infants being born every day, putting incredible financial strain on our health care system.
Lawson added that users who find themselves without their drug of choice often turn to other street drugs and potentially more dangerous combinations of drugs to produce the same high.
“It’s very likely that without available OxyContin, street users will turn to substances like cocaine, heroin and crystal meth instead and I’m not sure if policy makers realize that methadone clinics may not be able to accommodate the staggering percentage of people who will need assistance. Never mind those who have access to methadone clinics, what about those in small communities that lack these types of resources? What are we going to do with all these people?”
It’s a fair question. Methadone clinics are available to individuals suffering withdrawal and there are also counselling centres that offer mental health care to individuals with substance abuse problems, but is it going to be enough?
Some First Nations communities have asked for Health Canada to fund a replacement drug other than OxyNeo called Suboxone as they have limited access to methadone clinics and consider their addicted populations (in the ten thousands) as too large to support without proper funding.
The feared mass withdrawal seems to be under control for the moment. Some Aboriginal communities are reporting that they assume underground supplies of the original OxyContin are still circulating and that the real crisis has yet to hit.
Even with the added precautions health care workers are taking, six provinces in Canada have already decided to remove Oxy-Neo from their drug benefit plans and have announced that approval for requests will be granted on a case-by-case basis.
Canada has been ranked as having one of the highest populations of prescription opioid abusers in the world. Now that Health Canada has made the active move to cut down on peoples’ access to the drug we have to ask: “Will it work?”
Since switching to OxyNeo nearly two years ago, U.S. Purdue Pharma reports have shown that there has been a 74 percent drop in abuse through injecting, snorting and smoking as well as a 30 percent decrease in oral abuse, which is cause for hope in Canada. It is important to note that there have been no independent studies or reviews conducted by the agencies, which means that we may not be home free just yet.
If one thing is clear it is that people need to take more responsibility when it comes to their prescription drugs. While this epidemic may have been caused by a misstep on the part of the health care system, it is evident that patients with prescriptions illegally distributed the drugs and have subsequently caused a wave of individuals who must now deal with not only the physical side effects of substance abuse but also the potential social and psychological difficulties including poverty, discrimination, depression, anxiety and other mental disorders that can be triggered by irresponsible drug use.
It is crucial that patients take the time to understand their prescriptions and that doctors are aware of their patients’ medical pasts and any issues that may make them vulnerable to substance dependence and abuse. It is up to our doctors to educate their patients on responsible prescription use and to refer them to the appropriate mental health professionals if there are underlying psychological problems.
Can we hope that OxyNeo and Purdue Pharma Canada put an end to opioid abuse? Only time can tell.
-Jana Vigor, Contributing Writer