I don’t usually do ‘breaking news’ stories…and well I guess I’m not doing it now either. This news isn’t new at all, it’s just finally getting some mainstream attention as the situation is set to get exponentially worse.
The problem with OxyContin
OxyContin, also known colloquially as hillbilly heroin, is a powerful and potentially addictive painkiller. As has been noted in a number of other news reports, abuse of this drug is a Canada-wide problem.
A study on the use of opioids (including OxyContin) among beneficiaries of Ontario’s public drug plan highlights a number of concerns. More and more prescriptions are being written, and the doses are getting higher, leading to an increase in opioid-related deaths. And this is what we know about legal sales.
Recently Purdue Pharma Canada has announced it is releasing OxyNEO, a supposedly harder to tamper with version of OxyContin that has been available in the US since April of 2010. ‘Regular’ OxyContin will no longer be available in Canada as of March 1st when stocks are expected to run out.
A crisis is declared
In November of 2009, the Nishnawbe Aski Nation (NAN), which represents 49 First Nations in northern Ontario (a population of about 45,000 people) declared a “Prescription Drug Abuse State of Emergency“.
This resolution notes that prescription drug abuse, particularly of opioids like OxyContin, is an escalating crisis and calls upon both levels of government to immediately enhance community-based programming to deal with it.
By September of 2011, policing and addictions were stretched to the breaking point in many NAN communities and the response from provincial and federal governments is described by NAN as ‘minimal‘.
Another First Nations crisis ignored.
Responsibility for health care services
In Canada, most people access health care services through provincial programs and infrastructure. Status Indians and ‘recognised’ Inuit are a federal responsibility when it comes to health care.
Health Canada provides First Nations and Inuit with “a limited range of medically necessary health-related goods and services to which these individuals are not entitled through other plans and programs”.
Under this Non-Insured Health Benefits (NIHB) program, certain prescription and over the counter drugs are covered (paid for) if the patient does not have private insurance. Only drugs on the NIHB Drug Benefits List are eligible for this coverage.
No OxyContin for First Nations/Inuit
On February 15 of this year, Health Canada announced that all “long-acting oxycodones” such as OxyContin have been removed from the NIHB Drug Benefit List stating*:
NIHB will consider requests for long-acting oxycodone on a case-by-case basis and coverage may be granted in exceptional circumstances (e.g. cancer or palliative pain) when alternatives on the NIHB DBL have failed or are not appropriate. Continued coverage of long-acting oxycodone will be permitted for clients who have received coverage of long-acting oxycodone through NIHB in the three months prior to February 15, 2012 (i.e. these clients will be grandfathered).
Thus legal sources of OxyContin will become unavailable to all Status Indians and recognised Inuit across Canada through the NIHB. Those who legitimately need this medication will not be able to receive it in the future.
Still available to non-natives
In most of the rest of the country, OxyContin or its replacement OxyNEO will continue to be available to those who need it. There are some provincial exceptions.
PEI has recently instituted similar measures as those taken by the NIHB, pending a review of treatment with oxycodones compared to other drugs. Newfoundland heavily restricts access to OxyContin, but allows at least 15 other oxycodone drugs under its public drug plan.
More worrisome is the example of Manitoba, where access to OxyContin was restricted last year, reserved for patients with specific ailments only. Fears of this leading to a surge in crime was quickly confirmed as desperate people with OxyContin addictions unable to get into treatment programs turned to armed robbery. This in a urban centre with considerably more addictions resources than isolated First Nations or Inuit communities.
UPDATE: Ontario and Saskatchewan are both taking a similar approach to PEI and Health Canada, and severely restricting OxyContin/OxyNEO from now on. However, similar concerns about lack of addictions programming for populations in these areas are being raised.
A dam about to burst
The situation in many Nishnawbe Aski Nation communities has been already bad enough to warrant the declaration of a State of Emergency. Now the NAN is warning of even worse.
Without OxyContin available, individuals will experience withdrawal. Symptoms may range in severity from stomach upset, muscle and bone pain, anxiety, restlessness, increased heart rate and blood pressure to depression and suicidal ideation.
“In the absence of any regular treatment, a public health catastrophe is imminent, as there are thousands of addicted individuals with rapidly shrinking supplies – likely leading to massive increases in black market prices, use of other drugs, needle use/sharing, and crime,” said Dr. Benedikt Fischer, a senior scientist at the Centre for Addictions and Mental Health.
Health Canada acknowledges that most people in NAN communities are not getting the drug through legal prescriptions funded by the government. How withdrawing OxyContin from the Drug Benefit List will in any way address abuse is unclear.
Despite a stated willingness by Health Canada to fund drugs used to treat opioid dependence such as methadone (which is not available in most remote communities) and suboxone (but only on a case-by-case basis), no mention is made of what addictions programming will be put into place to deal with the worsening situation.
In short, the resources are not there to help deal with what is about to be a flood of people with addictions going through serious withdrawal in these communities.
From emergency to catastrophe
Action needs to be taken now to ensure that adequate resources are provided to communities struggling with such severe addictions problems and lack of treatment programs. It is unacceptable that an emergency gone unheeded should be allowed to turn into a catastrophe, yet again.
The Nishnawbe Aski Nation has developed a Prescription and Drug Abuse framework focused on four areas:
- Addressing root causes
However, with the exception of $100,000 from Health Canada and INAC for Prescription Drug Abuse Coordinator for the 2010-2011 fiscal year, no support has been given by provincial or federal governments to support this framework.
A online documentary titled The Life You Want provides a stark view of how lack of access to addictions treatment is already affecting many First Nations and Inuit people in remote communities.
Also available for download attached is a copy of a Marten Falls Ogoki Report to Community (Word document). Chief Eli Moonias, NAN Prescription Drug Abuse Task Force representative has given permission for this report to be shared with others to create awareness about the impacts of PDA in a remote First Nation. I warn you, this is not light reading.
NAN has also released a briefing note on the widespread nature of OxyContin addictions in many of its communities, outlining as well the obstacles to accessing adequate treatment.
My thanks to the Health Policy & Planning Department of the Nishnawbe Aski Nation for sharing this information.