*This post was co-authored by David Juurlink
Monday's announcement by federal health minister Leona Aglukkaq that she will not interfere with the approval of generic OxyContin is just the latest development in what has become a major public health crisis.
In Canada, overdose deaths involving prescription medications now vastly outnumber deaths from HIV. By some estimates, prescription drug overdoses have killed 100,000 North Americans over the past 20 years. Astonishing though that may seem, these deaths are just the tip of the iceberg. For each one, there are hundreds of people whose lives have been ravaged by addiction to prescription drugs.
Much of this toll involves opioids -- painkillers including codeine, morphine and oxycodone, the active ingredient in OxyContin. Closely related to heroin, opioids produce euphoria, are highly addictive, and can be fatal at high doses or when combined with alcohol or other sedating drugs. Until the 1980s, physicians prescribed opioids primarily for acute pain (e.g., from a broken bone) and pain related to cancer. But today, opioids are more commonly prescribed to patients with chronic conditions like back pain and arthritis, often at doses that would have been viewed as unimaginably high just 25 years ago.
When someone has high blood pressure, there is good evidence that prescribing a drug for many years is beneficial. But with chronic pain, the prescribing of opioids for long periods of time (or at high doses) is not supported by good evidence. Comprehensive reviews of the scientific literature suggest that in many conditions -- arthritis, for example -- the dangers likely outweigh the benefits.
Nevertheless, aggressive marketing by pharmaceutical companies has convinced hundreds of thousands of physicians that long-term treatment with opioids is safe and effective, with little risk of addiction. Some aspects of this marketing campaign have been so misleading that in 2007 the manufacturer of OxyContin pleaded guilty in United States federal court to felony charges of "misbranding" and was fined $634 million.
OxyContin was designed so that the active ingredient would be released in stages over 12 hours, but the controlled-release mechanism was easy to defeat. People seeking a quick high could simply chew the tablets or crush them. For this reason, the manufacturer of OxyContin withdrew the drug from the Canadian market earlier this year and replaced it with OxyNEO. (It is worth noting that this move has also allowed the manufacturer to continue to sell its product at brandname prices for many more years.) OxyContin and OxyNEO have the same active ingredient, and when swallowed whole the two drugs are considered equivalent. OxyNEO, however, is more difficult to misuse because it is harder to crush or dissolve.
All opioids -- not just OxyContin -- can be misused, and the federal health minister is correct when she says that the law does not permit her to withhold approval of a generic formulation just because of the risk of misuse. But when the legal and regulatory framework results in a situation in which more than a dozen Canadians die each week because of an accidental prescription drug overdose, that framework needs to be changed.
How can we start to undo the damage? A critical first step is to acknowledge the extent of the problem, recognizing that for every celebrity death (Heath Ledger and Derek Boogaard, for example) there are thousands whose deaths do not make the front page. The misuse of prescription drugs and addiction remain taboo topics in our society. This must change. And while recognizing that untreated pain also remains a problem, it is time to stop heeding pleas for continued unfettered access to prescription opioids.
Physicians should re-evaluate how freely we prescribe these drugs for chronic pain, how readily we increase the dose, and we must abandon the widespread perception -- implanted in our psyche over many years by the pharmaceutical industry and its agents -- that opioids are safer and more effective than other pain relievers. We now know otherwise. Finally, we must become more comfortable treating patients who have become addicted to prescription drugs.
Governments at all levels also need to collaborate on a co-ordinated national approach. The federal government should pass a law requiring that all opioids be manufactured in a manner that makes them difficult to tamper with. It should also review whether opioids are being marketed for too broad a range of problems. Provincial governments should do their part, too. For example, they need to move far more quickly in developing online databases so that physicians and pharmacists can see whether their patients are trying to acquire opioids from multiple prescribers.
We don't need generic OxyContin in Canada. The federal government should still try to find a way to keep it off the market. But more importantly, governments at all levels need to work with doctors to do more to reduce the number of overdose deaths and the burden of addiction to prescription drugs.
Irfan Dhalla is an expert advisor with EvidenceNetwork.ca and both Dhalla and David Juurlink are physicians and researchers at St. Michael's Hospital and the Sunnybrook Health Sciences Centre respectively. Dhalla was until recently, and Juurlink continues to be, a member of the Committee to Evaluate Drugs, which provides advice to the Ontario Ministry of Health and Long-Term Care.
*This article first appeared in the Ottawa Citizen.
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#10 -- Al Capone ($1.3 billion)
Brooklyn-born <a href="http://www.fbi.gov/about-us/history/famous-cases/al-capone">Al Capone</a> is one of the most notorious American gangsters of all time. During prohibition, Capone "controlled a vast criminal empire that smuggled drugs and ran prostitution and gambling outfits throughout the U.S.," <a href="http://www.celebritynetworth.com/articles/entertainment-articles/20-richest-drug-dealers-time/#!/10-al-capone-net-worth-1-3-billion_1074/">Celebrity Net Worth</a> writes. Capone, at one time an influential mob boss in Chicago, was <a href="http://www.fbi.gov/about-us/history/famous-cases/al-capone">sentenced to 11 years</a> in federal prison in 1931. At the time of his death in 1947, Capone was worth over a billion dollars.
#9 -- Griselda Blanco ($2 billion)
The only woman to make it onto this list, Griselda Blanco -- known also as the "Godmother of Cocaine" -- was a ruthless drug lord for Colombia's <a href="http://en.wikipedia.org/wiki/Medell%C3%ADn_Cartel">Medellin cartel</a> during the 1970s and early 1980s. Blanco was assassinated in September by "<a href="http://www.huffingtonpost.com/2012/09/04/griselda-blanco-dead-cocaine-godmother_n_1853873.html">men on motorcycles in Colombia.</a>" Blanco had reportedly spent nearly 20 years in a U.S. prison before she was deported to her home country. At her height, Blanco is said to have been worth <a href="http://www.celebritynetworth.com/articles/entertainment-articles/20-richest-drug-dealers-time/#!/9-griselda-blanco-net-worth-2-billion_1075/">around $2 billion. </a>
#8 -- Carlos Lehder ($2.7 billion)
<a href="http://www.pbs.org/wgbh/pages/frontline/shows/drugs/interviews/toro.html">Carlos Lehder</a>, co-founder of the Medellin Cartel, is a German-Colombian drug dealer who is currently serving a <a href="http://www.celebritynetworth.com/articles/entertainment-articles/20-richest-drug-dealers-time/#!/8-carlos-lehder-net-worth-2-7-billion_1076/">55 year sentence </a>in a federal prison in the U.S.
#7 -- Orejuela Brothers ($3 billion)
Brothers Gilberto (left) and Miguel Orejuela founded Colombia's notorious <a href="http://en.wikipedia.org/wiki/Cali_cartel">Cali Cartel</a>, which "at its peak supplied 70 percent of all the cocaine in the U.S. and 90 percent of the cocaine in Europe," according to <a href="http://www.celebritynetworth.com/articles/entertainment-articles/20-richest-drug-dealers-time/#!/7-the-orejuela-brothers-net-worth-3-billion_1077/">Celebrity Net Worth</a>. Both brothers are currently serving prison sentences in the U.S.
#6 -- José Gonzalo RodrÃguez Gacha ($5 billion)
<a href="http://en.wikipedia.org/wiki/Jose_Gonzalo_Rodriguez_Gacha">Jose Gonzalo Rodriguez Gacha</a> was another co-founder of the Medellin Cartel (all six of them made the top 10). Gacha, acknowledged as one of the most successful drug dealers of all time, was <a href="http://www.pbs.org/wgbh/pages/frontline/shows/drugs/cron/">killed in a bloody shootout</a> by Colombian police in 1989, PBS writes. Thousands of mourners reportedly attended his funeral. In 1988, <a href="http://www.forbes.com/sites/erincarlyle/2012/03/13/billionaire-druglords-el-chapo-guzman-pablo-escobar-the-ochoa-brothers/">Forbes Magazine</a> included Gacha in their annual list of the world's billionaires.
#5 -- Khun Sa ($5 billion)
<a href="http://www.economist.com/node/10097596?story_id=10097596&CFID=26317033&CFTOKEN=13306592.stm">Khun Sa</a>, known famously as the "Opium King," took an army of men into the jungles of Burma to cultivate opium in the 1960s. At the peak of his power, Sa had 20,000 men in his army and was trading some of the "<a href="http://www.businessinsider.com/pablo-escobar-named-richest-drug-dealer-of-all-time-2012-10">largest quantities of pure heroin ever</a>," Business Insider writes. <a href="http://www.economist.com/node/10097596?story_id=10097596&CFID=26317033&CFTOKEN=13306592.stm">Sa died in 2007</a> at the age of 73, reports the Economist.
#4 -- Ochoa Brothers ($6 billion)
The three Ochoa brothers -- <a href="http://www.pbs.org/wgbh/pages/frontline/shows/drugs/interviews/ochoajorge.html">Jorge</a> (left), Fabio (right) and Juan David (not pictured) -- founded the Medellin Cartel along with Carlos Lehder, Jose Gacha and Pablo Escobar, <a href="http://www.celebritynetworth.com/articles/entertainment-articles/20-richest-drug-dealers-time/#!/4-the-ochoa-brothers-net-worth-6-billion_1080/">Celebrity Net Worth writes.</a> All three made the <a href="http://www.forbes.com/sites/erincarlyle/2012/03/13/billionaire-druglords-el-chapo-guzman-pablo-escobar-the-ochoa-brothers/">Forbes' first World's Billionaires list</a> in 1997 and Jorge and Juan David are said to have been worth $6 billion each at the peak of their success (<a href="http://www.celebritynetworth.com/articles/entertainment-articles/20-richest-drug-dealers-time">Fabio's net worth is unknown</a>). The Ochoa brothers, all of whom have spent time behind bars, have since lost their fortunes. While his two brothers have since been released from prison, <a href="http://www.pbs.org/wgbh/pages/frontline/shows/drugs/cron/">Fabio Ochoa</a> is <a href="http://en.wikipedia.org/wiki/Fabio_Ochoa_V%C3%A1squez">serving a 30 year sentence</a> at a federal prison.
#3 -- Dawood Ibrahim Kaskar ($6.7 billion)
<a href="http://en.wikipedia.org/wiki/Dawood_Ibrahim#Recent_events">Dawood Ibrahim Kaskar</a> is "<a href="http://www.businessinsider.com/pablo-escobar-named-richest-drug-dealer-of-all-time-2012-10">India's most wanted criminal</a>," Business Insider writes. The head of the Indian organized crime syndicate D-Company in Mumbai, Kaskar is currently on Interpol's wanted list of organized crime and counterfeiting. Earlier this year, Kaskar's name was in the news again when a UK court <a href="http://www.hindustantimes.com/world-news/Europe/UK-court-orders-extradition-of-Dawood-s-aide/Article1-849884.aspx">ordered the extradition of his aide, Tiger Hanif</a> -- who is wanted in India for his alleged involvement in the planning of two bomb attacks in Gujarat in 1993, the Hindustan Times writes. For more, watch this video on <a href="http://www.youtube.com/watch?v=tXB1m2ZPuig">News X Live.</a>
#2 -- Amado Carrillo Fuentes ($25 billion)
Mexican drug kingpin <a href="http://en.wikipedia.org/wiki/Amado_Carrillo_Fuentes">Amado Carrillo Fuentes</a> became the head of the Juarez Cartel after assassinating his boss Rafael Guajardo. Fuentes, known as "Lord of the Skies" because of the large fleet of airplanes he used to transport drugs, was described as <a href="http://www.justice.gov/opa/pr/1999/September/432crm.htm">one of the most powerful drug traffickers in the world</a> by the U.S. Drug Enforcement Administration in 1999. Fuentes eventually died in a Mexican hospital in 1997 after <a href="http://www.businessinsider.com/pablo-escobar-named-richest-drug-dealer-of-all-time-2012-10">undergoing extensive plastic surgery</a> to change his appearance, Business Insider notes.
#1 -- Pablo Escobar ($30 billion)
With his fellow Medellin Cartel co-founders all making the list, it seems appropriate that drug kingpin <a href="http://en.wikipedia.org/wiki/Pablo_Escobar">Pablo Escobar</a> -- the leader of the largest cocaine organization in history -- would top this list with a peak net worth of $30 billion. As Celebrity Net Worth notes, when Escobar "<a href="http://www.celebritynetworth.com/articles/entertainment-articles/20-richest-drug-dealers-time/#!/1-pablo-escobar-net-worth-30-billion_1083/">was eventually captured, the Colombian government built him a luxurious prison called La Catedral.</a> He eventually escaped and was gunned down in 1993 on the roof of a Medellin apartment." And if Escobar was included on the <a href="http://www.forbes.com/billionaires/list/">Forbes Billionaire rankings today</a>? <a href="http://www.businessinsider.com/pablo-escobar-named-richest-drug-dealer-of-all-time-2012-10">He'd be tied for seventh place</a>, notes Business Insider.
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The second issue is that all opioids can and do cause addiction and overdose.. Its widespread use is simply a trend that can occur just as readily with other opioids. It occurred with OxyContin because it is so widely prescribed. It is widely prescribed because, unlike other narcotics on the market it has a very high oral bioavailability, so patients can take smaller doses than with the others and receive far better pain management. It really is a wonder drug for pain.
The bottom line is that many people require this medication to function normally and live productive pain-free lives. By stigmatizing the drug and making it harder to access, you punish those with a legitimate need of it. Car accidents kill tens of thousands of people across North America every year, but we don't outlaw cars because we believe that the benefits outweighs the risks. Instead we institute laws to make driving safer, and this is precisely what needs to be done with drugs like OxyContin.
Or are we all just being hypocrites.
if a man is starving and the choice is sell a pill or eat what sometimes you think might happen.
IF you want to stop 99.9% of that feed the person and starve the drug trade.
I take percacet for the last ten years ...i quit for a week each month ( 120 times now)
without this id be mostly bed ridden and not even able to type or do much online.
I'll say it i stay on percacet because ive seen the very bad that oxycotin can do and while i sympathize with people its a heavy drug and unless you have a really good support network, it wont in long run help you.At least the way im doing it i have a measure of control of my life and am not stealing selling pills nor causing any crime to "get more" to feed an addiction....
I'm a rare one i'm told.
Opiate drugs are a comparitively safe drug when taken alone. There are far fewer opiate drug deaths, prescribed or illegal, as compared to deaths due to other pharmaceutical drugs!! Who knew? Not you.
In the USA, some studies show 200,000 deaths per year from "adverse drug reactions", and only a small fraction of that number involved opiates.
Good honest statistics are hard to come by, and getting harder - recent data is not being published, but from a 1998 study, published in JAMA, this quote:
"A statistical study of hospital deaths in the U.S. conducted at the University of Toronto revealed that more than two million American hospitalized patients suffered a serious adverse drug reaction (ADR) within the 12-month period of the study and, of these, over 100,000 died as a result."
- and another 100,000 deaths per year if accidental overdoses and medical errors are included!!
Link> http://www.cancure.org/medical_errors.htm
Crack open a history book and have a gander at life before these drugs were illegal. Epedimic - and even then access was difficult. Cheap, mass produced opiates would wipe out civilization pretty quickly.
Other drugs given for arthritis include Methotrexate....look up the side effects on that. Here's a few:
Hematologic side effects have included myelosuppression which is one of the primary toxic effects of methotrexate. Methotrexate suppressed hematopoiesis has been reported to have caused anemia, aplastic anemia, pancytopenia, leukopenia, neutropenia, thrombocytopenia, lymphadenopathy, and lymphoproliferative disorders including reversible hypogammaglobulinemia (which has been reported rarely).
Hepatic side effects including hepatotoxicity, acute hepatitis, chronic fibrosis and cirrhosis, decrease in serum albumin, and liver enzyme elevations have been reported.
Immunologic side effects including case reports of sometimes fatal opportunistic infections have been reported. Pneumocystis carinii pneumonia has been reported most frequently.
http://www.drugs.com/sfx/methotrexate-side-effects.html
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One thing i am tryng to do is show all of you a lil of a persons life long term that has not only done alright but has not gone into crime , harmed anyone or hiself for taking it.
if i was assured that the oxyneo was in fact time released and in fact might last say 8 hrs i might try some and get like a 15 mg pill .....( i usually take 5 mg percacet every 3.5-4 hrs when 2 take away a ankle pain that is caused by my back and is after ten years a pain that i know is there but you just dont register it like normal [hard to describe it])
She is setting up Corporate profits on the back of the people this will kill. I am growing ever more disgusted with our leaders!
War on drugs.......piffle!
fedsare about to sign a deal that gives more patent and drug protection to europe which will increase prices to our health care.....unlike you i look for savings....reason my percacets are cheap is cause the patent ran out and generics are available. HOWEVER truth be told endocet the genric is so brittle when i have to break a pill in half when i get up it crumbles wasting an entire pill
break one in half for morning ....and take that last half to sleep ....