Ottawa urges drug makers to end opioid marketing

The federal government is calling on pharmaceutical companies to stop marketing opioids, and is citing the drug maker whose pain pill triggered Canada’s deadly overdose epidemic for setting a “strong example.”

In a letter to drug companies, Health Minister Ginette Petitpas Taylor asks them to immediately suspend marketing and advertising activities associated with opioids. Ms. Petitpas Taylor sent the letter on June 19, the same day the federal government released new figures showing that opioid-related overdoses claimed the lives of nearly 4,000 Canadians in 2017, a 34-per-cent jump from the previous year. Overprescribing is behind the opioid crisis, which has worsened in recent years with the arrival of illicit fentanyl, leading to a sharp spike in overdose deaths.

Ms. Petitpas Taylor has asked drug makers to voluntarily suspend their marketing activities while Health Canada develops policies aimed at restricting the marketing and advertising of opioids. “I call on industry to show leadership by immediately suspending marketing and advertising of opioids,” says the letter, a copy of which has been obtained by The Globe and Mail.

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However, the letter has raised concerns in the medical community for suggesting drug companies follow the example set by Purdue Pharma, the maker of OxyContin. The Stamford, Conn.-based company stopped marketing opioids to physicians in the United States in February.

“This commitment serves as a strong example of how your industry can support ‘re-centering the pendulum’ on opioid prescribing practices,” Ms. Petitpas Taylor says in her letter. “I would welcome similar actions from Canadian pharmaceutical companies.”

Joel Lexchin, a Toronto emergency-room doctor and professor emeritus at York University’s faculty of health, said Purdue’s marketing was one of the main causes of the current opioid epidemic. “Instead of congratulating Purdue for its strong example,” he said, “the Health Minister should be talking about taking Purdue to court.”

Canada’s opioid epidemic traces its roots to the introduction of OxyContin 22 years ago. Until the mid-1990s, opioids were used primarily for terminal cancer patients. In 1996, Health Canada approved OxyContin to relieve pain that was moderate to severe. Purdue’s marketing encouraged doctors to prescribe opioids more widely for everything from back pain to fibromyalgia. Canada is the world’s second-highest per-capita consumer of prescription painkillers.

OxyContin also became a lightning rod in the early 2000s, as reports of opioid dependence and overdoses exploded. Purdue pulled OxyContin from the market in 2012, shortly before the patent was to expire. A host of other, stronger drugs filled the void, including illicit fentanyl, which began appearing on the streets in Canada in 2012.

Purdue has acknowledged in the United States that its marketing of OxyContin was misleading and paid US$634.5-million in 2007 to settle criminal and civil charges. The company stopped marketing opioids in the United States this year amid mounting lawsuits − several states and American municipalities have sued the company for deceptive marketing.

However, Purdue’s Canadian operation has not made a similar admission of wrongdoing and the ban on marketing was not extended to this country.

Purdue said in a statement on Tuesday that the company is “deeply concerned” about the opioid crisis and is in the process of providing a response to Ms. Petitpas Taylor.

Thierry Bélair, a spokesman for Ms. Petitpas Taylor, said the example of Purdue in the letter was to “impress upon industry the feasibility of such [marketing] restrictions and to highlight the fact that no Canadian company – not even Purdue Canada – had followed suit despite the current crisis.”

Several people have called on the federal government to launch a criminal investigation into the marketing practices of opioid manufacturers in Canada, including former Ontario health minister Eric Hoskins and seven academics who sent an open letter in April to Prime Minister Justin Trudeau, Justice Minister and Attorney-General Jody Wilson-Raybould and the Health Minister.

Nav Persaud, a family doctor at St. Michael’s Hospital and a signatory to the open letter, said he is disappointed that the federal government is writing “nice letters” to industry when what’s needed is a criminal investigation. “If the opioid crisis was going to be solved by voluntary actions by pharmaceutical companies like Purdue Pharma, it would not still be raging on after more than 15 years,” he said.

Health Canada announced last week that it plans to create an enforcement team to proactively monitor opioid marketing and take immediate action when the rules are broken. The department currently responds to complaints rather than doing its own monitoring.

Health Canada has launched consultations on its proposal to restrict most forms of marketing and advertising opioids. It plans to introduce proposed regulations in early 2019.

“While the move is perhaps long overdue, they are beginning to take action and are communicating a clear intention to restrict marketing of prescription opioid drugs,” said Matthew Herder, director of the health law institute at Dalhousie University in Halifax .