Ontario spent nearly half a billion dollars paying for OxyContin prescriptions in the past decade before making the decision to pull funding for the controversial drug this month.
Most of the spending was concentrated in the past six years, which coincides with the time period addictions to the powerful narcotic painkiller exploded across the province and country.
Under its public drug plan, Ontario spent a total of $412.3-million for prescriptions to OxyContin, manufactured by Purdue Pharma, from 2000 to 2011. In the first year, OxyContin prescriptions only cost the province $900,000. By 2005-06, it had jumped to $35.5-million.
In 2010-11, spending peaked at $77.7-million, representing a sizeable portion of the total $4.3-billion the province spent on prescription drug costs that year.
"It's clearly a lot of money," said Irfan Dhalla, a physician at Toronto's St. Michael's Hospital and leading expert on addition to opioid painkillers.
Dr. Dhalla said the high spending on OxyContin renews serious questions about why so many people are taking and abusing opioid drugs.
"I wouldn't be upset at the amount we were spending if we saw that we were getting a really good value for our money," he said. "I think the issue here is there isn't very good evidence to support the use of long-term opioid therapies in patients with chronic pain."
The provincial public drug plan covers prescription costs for a variety of individuals, such as seniors, people in long-term care and those receiving social assistance.
Purdue Pharma is phasing OxyContin out of Canada and replacing it with a new pill that is tamper-resistant. The new medication, OxyNEO, is the same as its old counterpart, except that it can't be crushed or liquefied, making it difficult to snort or inject.
But Ontario and several other provinces have decided to delist OxyNEO. As of Thursday, Ontario will no longer cover the drug in its public plan.
This doesn't mean OxyNEO is being taken off the market, but that the province is introducing new restrictions to limit how many people have access and how much is spent on the drug.
Patients who had existing prescriptions to OxyContin will still be able to get access to OxyNEO.
Similarly, patients whose private insurance covers OxyNEO, or those willing to pay out of pocket, could get it.
And other opioid drugs will continue to be available, such as fentanyl or hydromorphone, which some addiction specialists predict will become the new drug of choice for addicts.
But the hope is that by delisting the drug, doctors will be discouraged from prescribing it, which could help curb the problem of addiction, said Diane McArthur, the executive officer of Ontario Public Drug Programs. Delisting the drug will also help manage the province's costs, she said.
While the OxyContin costs incurred by the province over the past decade are high, they reflect the complexities involved in treating pain, Ms. McArthur said.
"Pain is an incredibly complicated treatment to make and manage for all providers," she said.
Prescribers must strike a balance between treating pain and preventing drug abuse, which isn't always easy. That's why the province has decided to delist OxyNEO, which is one part of a broader plan to crack down on the multifaceted problem of opioid addiction, Ms. McArthur says.
Dr. Dhalla agrees that delisting OxyNEO is a positive step, but thinks that much more needs to be done across Canada, such as creating guidelines for how doctors should treat chronic pain and better tracking of who is filling prescriptions for opioid drugs.
Dr. Dhalla also pointed out that in the U.S., federal agencies such as the Centers for Disease Control and Prevention have been very aggressive in the pursuit of answers to the country's opioid problem, and suggested that federal leadership is also needed in Canada to address this issue.
Carly Weeks