Canadian prescriptions for alternatives to the painkiller oxycodone have risen significantly in the past five years, suggesting a crackdown on oxy has pushed addicts and legitimate patients alike toward opioids without the tamper-proof properties Health Canada wants to make mandatory.
The figures, crunched by the prescription-tracking firm IMS Brogan for The Globe and Mail, show a particularly dramatic increase for prescriptions of the morphine-like drugs hydromorphone and fentanyl, which rose by 79 per cent and 20 per cent respectively between 2009 and 2013, after governments made oxycodone harder to get.
"This is not unpredictable," said Peter Selby, chief of the addictions program at the Centre for Addiction and Mental Health. "[If you] just simply demonize OxyContin and keep all the other immediate-release, fast-acting or abuse-able forms on the market, then the population moves to that."
The widespread use of alternatives to oxycodone – the active ingredient in the brand-name medications OxyContin and OxyNeo – helps explain why Health Minister Rona Ambrose is pushing to include all opioids in future regulations that would require them to be resistant to tampering.
Health Canada published a notice of intent to regulate on that front last month; a consultation wraps up at the end of this summer, after which new regulations are expected to be drafted.
Canadian retail pharmacies filled nearly twice as many prescriptions for medications containing hydromorphone – the active ingredient in Dilaudid and Hydromorph Contin, two of the best-known brand names – than for drugs containing oxycodone in 2013, according to IMS Brogan.
Slightly more than 3.5 million prescriptions were filled for hydromorphone products, compared to just over 1.8 million for oxycodone products, including generic versions of slow-release oxycodone and OxyNeo, a newer generation of the drug that is more difficult to crush and inhale or inject for the rapid high that inspired the nickname hillbilly heroin.
In 2013, 795,000 prescriptions were filled for fentanyl, a painkiller commonly sold as a patch.
After research and news reports revealed widespread addiction to and abuse of OxyContin, the drug company that produced the brand-name version replaced it with OxyNeo, which turns into a jellylike substance when crushed or diluted.
Although Health Canada approved generic copies of the old version in 2012, several provinces, including Ontario, declined to fund the generic, and put in place strict new rules for prescribing OxyNeo.
While there were warnings at the time that the changes could prompt addicts to switch to other opioids, the alternatives have not received as much attention.
Amy Graves, whose younger brother, Joshua Graves, 21, died after inhaling crushed Hydromorph Contin at a party in Nova Scotia in 2011, is glad Ottawa is not focusing on oxycodone alone.
"I don't think people see [hydromorphone] as dangerous or as risky," she said. "I wonder if my brother was offered OxyContin that night, if he would have still taken it or if he might have said, 'That stuff's really bad – I've heard about it on the news.'"
Dr. Selby said that, in designing the tamper-resistance regulations, Ottawa needs to be careful not to disadvantage patients who genuinely need opioids to manage their pain. He has heard some patients switched away from OxyNeo because it does not relieve their pain as effectively as its predecessor.
The larger problem, he added, is that treatment programs for opioid addiction are grossly underfunded, especially considering the scale of the crisis.
A new study published on Monday in the journal Addiction found opioid-related deaths rose 242 per cent in Ontario between 1991 and 2010, half of them among people under the age of 42. By 2010, nearly one in eight deaths among 25- to 34-year-olds could be attributed to the pain relievers.
"The bottom line is it doesn't matter whether it's OxyContin, oxycodone, Tylenol 1s or 3s," Dr. Selby said. "What is our overall strategy to have the optimal benefit from this medication without all the risk? One in eight young adult deaths attributable to opioids is unconscionable."