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Wednesday, 22 February 2012

Oxycodone losing funding in many provinces and First Nations: A case of prescription drug abuse and the potential consequences of a poorly implemented policy change

Media watchers are abuzz with the bold actions in the last few days by Ontario, Saskatchewan and now the Maritime provinces to stop public funding of OxyContin and not fund the newer formulation OxyNEO. This follows a national decision to limit access to the newer formulation under First Nations non-insured drug benefits.   Updated: As of February 28, 2012 - BC is added to the list of provinces. 

Abuse and addiction to Oxycodone is significant public health concern.   Drug Overdose deaths increased after its introduction in 2000, and best estimates would be up to 2000 drug overdose deaths annually in Canada from opiate overdoses, of for which some attribute 30-40% to prescription opiates including oxycodone.   1-3% of the Canadian population are abusing prescription opioid drugs, that is almost a million individuals.   Even the lower limit estimates of 300 overdose deaths and 300,000 addicted persons to prescription opiates should raise alarms, bells and whistles. 

But let’s dig a bit deeper in the story.  The manufacturer has tried to reduce the harmful effects by developing a slower delivery mechanism that reduces the likelihood of overdosing.  Still effective as a pain killer, less potential for overdose.  A legitimate form of harm reduction.   Governments seize the opportunity and just decide to stop funding altogether.

Oxycodone was introduced as an analgesic alternative to morphine.   The widespread use and abuse of the drug is predominately secondary to prescribing practices by health care workers – not illicit distribution rings. 
There do not appear to be therapeutic plans to bridge those addicted during the phase out period for oxycodone.  Most provinces will likely continue prescriptions for current cancer and palliative patients currently using the pain medication as the form of transition and not use the drug for newer patients.  In essence just put those addicted by the health system in a state of distress.  

There is no doubt that abuse of oxycodone is rampant, with some estimates in certain communities in Northern Ontario reaching as high as 75% of the adult population.  Treatment is hard to obtain and many addicted persons probably need the benefit of methadone distribution for maintenance during rehabilitation – a service not available in most rural communities. 

The niche that opens will be an invitation to organized crime to fill in the missing distribution to meet the demand.  Perhaps a Catch-22 situation, but seemingly bizarre that the decision is made when a new product designed to reduce harm is being introduced.  No doubt the cost savings to the health care system in the short term might be an attraction, the long term consequences on society will not be insignificant – but will they ultimately be a benefit?  We are engaging in a massive social experiment without the knowledge of the society that will be impacted.

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