Cheaper alternative to Oxycodone coming soon to Hamilton

Addiction experts are concerned

By Flannery Dean, CBC News

Posted: Nov 23, 2012 7:29 AM ET

Last Updated: Nov 22, 2012 8:49 AM ET

Health Minister Leona Aglukkaq wrote that "The law does not permit approval to be withheld on the basis of misuse." (Fred Chartrand/Canadian Press)

The news that the federal government won't interfere with the upcoming release of a cheaper generic version of the painkiller oxycodone has some Hamilton addiction services experts concerned about how that may encourage increased use in Hamilton.

"What happens now is anyone's guess," said Deb Bangs, manager of withdrawal management at St. Joseph's Healthcare Hamilton.

Earlier this month, Federal Health Minister Leona Aglukkaq announced that the Federal government won't stop the sale of a generic version of oxycodone, a generic variant on the problematic and highly addictive opioid Oxycontin.

In a written statement, Aglukkaq argued that it wasn't up to the government to police prescription pill usage. "It should not be up to politicians to determine which drugs should be approved for medical use," she wrote. "While intentions may be noble in this instance, what stops future politicians from caving in to public pressure and allowing unproven, unsafe drugs on the market once political pressure starts to mount?"

Aglukkaq also noted that there is no basis in the Food and Drug Act to withhold approval when a drug is considered safe for its recommended use based on its scientific review. "The law does not permit approval to be withheld on the basis of misuse," she wrote.

Not the medication, but misuse that's the problem

Regan Anderson, executive director of Wayside House a residential treatment facility for men in Hamilton, sees some merit in Aglukkaq's point.

"Do we want the government to tell us what drugs we can and can't use?" asked Anderson. For Anderson, the problem isn't the drug itself, but rather its use. And that includes how and why it's prescribed by doctors. "It's not the medication that's the problem it's the prescribing and the use."

"Doctors write these scrips like mad and people get dependent on them."

The bottom line for Bangs, who manages programs for both men and women in the city, is that oxycodone is "going to be more available and it's going to cost less".

That's the real "worry because it makes it more accessible in the community," she said.

While Health Canada intends to provide some stricter controls on its use and distribution, Bangs says that unfortunately there's "all kinds of systems in place for getting it to people who are not supposed to have it. And now it's going to be cheaper."

But whether or not the generic alternative does more harm than good "depends on how physicians respond," said Anderson.

If doctors continue to prescribe OxyNeo, a version of the painkiller that was introduced to hinder abuse by delaying the release of the medication and therefore interrupting the high achieved, then it may not become an issue, he said.

But if insurance companies opt to pay for the cheaper, generic alternative, then there could be an uptick in abuses and/or raise the risk for potential addiction.

Bangs is a little baffled by the conflicting messages from Health Canada and Purdue Pharma, which produced Oxycontin and OxyNeo.

"Essentially one might ask oneself what was the benefit of Purdue switching over to an OxyNeo product. They're the only ones who can answer that."

Fewer painkillers, more pain clinics

While debate continues about the significance of the federal government's decision, both Bangs and Anderson believe that the real issue is being largely ignored: and that is the need for better treatment options for pain.

"We need more pain clinics, more treatment options and to better educate doctors," said Anderson. "Our monitoring systems need to improve in Ontario and physicians (need) to take greater responsibility for prescribing and the uptick in prescribing."

Bangs agrees. "We need more pain clinics so people can manage pain without medicine," said Bangs who also feels physicians need to take more responsibility for the prescription pill abuse problem.

Bangs adds that she'd like to see more comprehensive monitoring systems in Ontario. But that's not the only change that might reduce addictions in Hamilton and in the rest of the country. Bangs believes there needs to be changes at the societal level too.

With files from CBC News

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