Overdose death sparks renewed concerns over removal of OxyContin from Canadian market

Experts have been warning about the dangers of removing the prescription painkiller OxyContin from the Canadian market and most government drug plans would have serious, possibly deadly consequences.

We're now getting the first indication they may be right.

According to the Globe and Mail, a northern Ontario coroner has reported the death of man in the northwestern region of the province after his doctor switched him from OxyContin to another drug but gave him the wrong dose.

OxyContin, a powerful and widely abused opiod, was taken off pharmacy shelves as of March 1. Drug-maker Purdue Pharmaceutical replaced it with OxyNEO, which is harder to break down so it can be snorted or injected.

At the same time, seven provinces and the federal government announced they would not cover OxyNEO as a treatment for chronic pain except in special circumstances such as cancer therapy or palliative care.

Experts predicted the changeover would have a potentially devastating effect, especially among aboriginal people in northern Ontario, where a high percentage of people in dozens of remote communities are addicted to OxyContin, whose generic name is oxycodone.

Coroner Michael Wilson said the dead man was covered by a federal program for First Nations and Inuit people that delisted OxyContin as of Feb. 15.

The Globe reported the man, who was being treated for chronic pain, was switched to a different opiod by his doctor and died of an apparent overdose shortly after the change was made. It was not clear how he took the drug or what other factors were involved, the coroner said.

"It was clear on review there was an error," Wilson told the Globe. "An incorrect strength was prescribed, and dispensed.

"I'm not trying to establish responsibility or blame but hoping to make recommendations that will prevent deaths in the future."

Dr. Mel Kahan, a drug-addiction expert at the University of Toronto's family medicine department, said the death is "a strong argument in favour of stricter regulation and more training."

Canada issued lengthy, non-binding guidelines for opioid prescription two years ago.

But David Juurlink, a drug-safety specialist at Toronto's Sunnybrook Health Sciencies Centre, said busy doctors simply don't have time to read such documents.

"A substantial amount of re-education of physicians needs to take place," he said. "And that is no easy task."

Andre Picard, the Globe's veteran health-policy columnist, wrote Tuesday the "anger, confusion and physical pain" in the wake of the OxyContin switch "speaks volumes about what's wrong with our approach to drugs in this country."

"We pay far too little attention to the effectiveness of medications used for legitimate purposes like pain control," Picard wrote.

"At the same time, we fret incessantly about drug abuse while doing virtually nothing to prevent or treat addiction. Worse yet, we behave as if these challenges are somehow unrelated when, in fact, they are intricately linked."

The apparent problems coupled to OxyContin's withdrawal has been noted in the United States, which like Canada is wrestling with abuse of the drug.

"In the five years after OxyContin was introduced into the Canadian market in 2000, painkiller-related deaths shot up 41 percent — with over 300 deaths a year in the province of Ontario alone, according to a 2009 study by physicians at St. Michael's Hospital in Toronto," Minnpost.com reported.

Minnpost also noted drug-maker Purdue was "deeply concerned" about limiting access to OxyNEO.

"The restrictions to OxyNEO funding being imposed by some provinces are surprising," the company said in a statement. "This product was specifically designed to help discourage misuse and abuse of the medication."

Purdue's U.S. arm replaced OxyContin with Oxy P in the American market in 2010 to reduce abuse. San Diego's chief medical examiner reported a 300 per cent increase in heroin use since then, along with a spike in heroin-related deaths, Minnpost reported.