A serious problem, according to the commentary published Monday in the Canadian Medical Association Journal, is that most people become addicted to opioids by taking them as directed by their physician.Darryl Dyck/The Globe and Mail
The federal government's plan to force some pharmaceutical companies to make their opioid painkillers harder to abuse will do little to address Canada's prescription drug crisis, according to a critical commentary published by the country's pre-eminent medical journal.
Health Canada on Friday announced plans to require all oxycodone products to be tamper-resistant, or difficult to crush, chew or otherwise manipulate in order for users to get high. Oxycodone is the generic form of OxyContin, which has been reformulated by Purdue Pharma as the tamper-resistant OxyNEO.
But tamper-resistant formulations are a "gimmick," according to the commentary published Monday in the Canadian Medical Association Journal. The problem, the journal says, is that most people become addicted to opioids by taking them as directed by their physician. Tamper-resistance only targets people who abuse opioids by snorting, shooting or chewing them, but many who misuse or abuse them swallow the pills.
"A lot of this stems from an inadequate conception of what's really going on," said Dr. Meldon Kahan, one of the authors and an addiction specialist based in Toronto. "The root of the problem is doctors are prescribing too many opiates to too many people at too high a dose."
The authors call for a comprehensive approach from the federal government that includes preventing opioid addiction "by reducing initial exposure through evidence-based prescribing practices."
"Regulations requiring tamper-resistance represent an expensive, technical approach that is influenced by pharmaceutical interests and cannot solve the opioid crisis," the authors wrote. "Tamper-resistant formulations are a gimmick, and health professionals should not be fooled by them."
Dr. Kahan also expressed concern the government will only require oxycodone to be tamper-resistant, while other types of opioids, such as hydromorphone, will be exempt. The authors cite research showing that introducing tamper-resistant formulations simply drives drug abusers to other opioids, or to heroin.
"Unless you replace all current opiates with tamper-resistant formulations, it's not going to make much of a dent," he said.
In a statement, a Health Canada spokesman said that tamper-resistance is only one part of the federal government's commitment to dealing with the prescription drug crisis. The government has earmarked $8-million to fund prescriber education programs and to help develop a national monitoring and surveillance system. The government has also committed $13-million over five years to increase pharmacy inspections.
Canada has the second-highest per capita usage of opioids in the world. According to research done by the Institute for Clinical Evaluative Sciences, the number of prescriptions for drugs containing the active ingredient oxycodone jumped almost 900 per cent in Ontario between 1991 and 2007. Rates of opioid-related fatalities increased dramatically in Ontario between 1991 and 2010, jumping to 41.6 from 12.2 deaths per million people, according to ICES. Among young adults aged 25 to 34, one of every eight deaths is related to opioids.
Once used sparingly to treat pain, such as for patients dying of cancer or people recovering from surgery, opioids are now used as a front-line treatment for all types of chronic pain.
Individuals prescribed an opioid for a back problem, for example, can become dependent on the drug in a matter of weeks. And the longer the person is on opioids, the more their tolerance builds, necessitating a stronger dose. That puts patients at an increased risk of accidental overdose and death, because opioids suppress the respiratory system and can cause people to stop breathing.
Carly Weeks