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Thus far, there's been a moderate uptick in referrals to methadone clinics both in Toronto and Thunder Bay, but not as much as we expected.
About the OxyNEO, here's an excerpt from an email from someone working in Toronto Public Health:
CBC's The Fifth Estate did a show on Oxycontin this week. Canadians can view it online HERE.
Thread drift: Libby Davies is on CBC in a minute to talk about drug shortages from Sandoz which controls 90% of the injection drugs in Canada.
ETA: That was a longer interview with Libby than I expected - here's what I can remember:
1. The NDP have an Opposition Day tomorrow and are filing a motion calling on the Cons to get involved in this file.
2. She syas the Health Minister is playing the game of blaming everyone except her own government where clearly most of the blame lies.
3. She is calling for bulk buying of medications - like Harper is doing with the F35s
- because bulk buying is cheaper and ensures a guaranteed supply.
4. She is calling for more generics to be made available - doctors are reluctant to prescribe generics because the available supply runs out too quickly.
5. She calls for an end to 'voluntary' practices - such as voluntary reporting of coming shortages in pharmaceuticals.
There was more and I will add to this post as I recall them.
Libby is an amazing health critic and is clearly on top of this file - the same can't be said for the health minister.
Too bad she won't call for nationalization of the pharmaceutical industry. Then we could produce the drugs that are most necessary, rather than the ones that are the most profitable.
That sounds like a great idea, MS. Has anyone in Canadian politics today called for nationalization of the drug industry?
(I don't think Martin Singh will be here for a Q&A, but I'll ask him in the other thread if he supports nationalization, as he is a pharmacist after all)
I must admit I'm quite stunned to learn from Libby that Sandoz has a 90% monopoly on injectable drugs in this country (including morphine derivatives) - how the hell did that happen?
It happened because of lack of government regulation and oversight of the industry. We are left entirely dependent on the whims of multinational drug companies for our supplies. If it isn't profitable they cut back production and we suffer. If it's super-profitable, it will be pushed hard through physicians and advertising, and everyone will end up on Viagra, Oxycontin, Lorazepam, etc.
That's good argument for nationalization, MS.
Shhh! don't say stuff like that too loud around here. You'll be deluged with right-wing social-democrats who insist that nationalization will bankrupt the country and that publicly-owned enterprises will fail unless they act exactly like privately-owned ones.
Kudos to Dr. Brian Goldman for coming clean about his role as a shill for Purdue, yesterday in the Globe:
http://www.theglobeandmail.com/news/opinions/opinion/i-was-part-of-big-p...
Part of the trouble here is the fee-for-service model that rewards doctors for writing scripts and seeing high numbers of patients, and punishes those doctors who spend more time with patients, finding a way to treat the cause of the pain instead of drugging them.
BTW, one of the reasons for the drug shortage at Sandoz is the FDA inspected one of their plants and found it didn't comply with American standards, so they halted production to spruce things up. I don't think nationalization of big pharma would have helped in this instance.
Apparently there have been a rash of robberies on pharmacies due to the discontinuation of OxyContin - just saw it on the news today. Made me think of this thread where you were saying that retail pharmacists are getting antsy - no wonder!
I like to think that a nationalized drug company would comply as a matter of course with federal regulations and standards. After all, once you remove the profit motive as Job #1, you can make a priority of health, safety, and quality control standards.
Word is that the price of Oxycontin is soaring as supplies dwindle.
Oddly, we haven't seen a big jump in methadone clients, regardless of what Toronto Public Health said. Some people have been asking me about Suboxone, but those are folks already on methadone. Turns out that Ontario Drug Benefit is "grandfathering" Oxycontin patients for one month, covering OxyNeo and giving these folks the time to get onto another drug that is covered.
The federal regulations and standards of a foreign country? We answer to Health Canada, not the FDA.
http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm281843.htm
Hey.. I knew I was forgetting something. Thanks Spector!
Well, you are the one who said nationalization would not have helped in this instance because Sandoz didn't comply with FDA standards. If Sandoz Canada were a nationalized pharma company, it would be subject to Canadian regulations, not the American FDA.
And doesn't Health Canada have comparable standards to the FDA anyway?
If the US wants to send the FDA into Canadian manufacturing plants, I don't think they care whether they are nationalized or not. The head office of Sandoz is in Switzerland. Drug manufacturing plants adhere to the standards of the company they are in, regardless of where the central office is - that's why some American companies have moved plants off shore, to take advantage of less rigorous health and safety standards, for instance.
FDA standards would be similar to Health Canada standards. But I don't think nationalizing drug companies ensures their compliance with standards. Speaking as a civil servant, nationalizing doesn't automatically result in better oversight.
You'd hope so. But after 17 years of working in the public sector, I'd say people are equally capable of incompetence whoever the bosses are. In my experience, removing the profit motive is most consistent with keeping costs down, but ensuring quality is dodgier.
What you seem to have trouble acknowledging is that a nationalized Canadian drug company would not have a head office in Switzerland, the USA, or anywhere other than Canada. It would be solely governed by Canadian laws, as a 100% Canadian company.
Have you already forgotten what you posted above? "The federal regulations and standards of a foreign country? We answer to Health Canada, not the FDA."
My point was that the profit motive is often the cause of cutting corners, which reduces quality, safety, and compliance with regulatory standards. Removing it removes one of the main motivations for disregarding those things.
Whether we are talking about government ownership, or just stronger government regulations, standards can still be disregarded.
Harper was able to override our nuclear regulatory standards with the stroke of a pen.
And there is no way one central agency is going to be able to produce all the health care products which are currently available. Furthermore, there will always be a need for some imports.
The FDA is inspecting plants in Canada because it's a requirement to sell drugs in the American market. The ownership of the plant/location of its central office has no bearing.
OTOH, I can see a scenario where a nationalized manufacturer would be inspected by Health Canada, with an agreement with the FDA that they would respect our inspection infrastructure to the extent that they wouldn't need to re-inspect...
The massive diversion of Oxycontin occured despite our single-payor health care system and the oversight provincial governments have over this system. (Just dragging things back o/t
)
So it's been almost two months since the discontinuation of Oxycontin, and the results so far have been the opposite of what I expected: I've got the fewest number of patients on methadone since 1999. Talking to a methadone patient today, he said, some people are going to heroin or other opioids, but "They aren't the same as Oxycontin. So people are kicking."
I remain cautiously optimistic.
Is heroin better than methadone?
You mean as treatment? There are some data saying heroin is better for patients who have failed methadone. But I'd be hesitant to give heroin to Oxycontin addicts, especially those who have never injected drugs. Some people injected Oxycontin, but many chewed or inhaled it like "chasing the dragon."
It has been my observation that Oxycontin created addicts where there were none before. Early days, but maybe now that it's gone, some people may be able to stop using altogether.
This sounds to me as if oxycontin addicts are switching to heroin, instead of going on methadone, and thus "kicking" the oxycontin addiction.
I don't understand the basis for your expression of (cautious) optimism, unless you see heroin as preferable to methadone treatment.
Hence my question.
It has been my experience with drugs that some drugs grab some people but not the same drugs for all people. So one might be able to drink without being addicted, do coke recreationally or smoke pot occasionally. Others can and do get addicted to the same things. Oxycontin addicted people who were not into the street culture so kicking the drug is not a major lifestyle change. The problem is those people all had real pain before they went on Oxycontin so what can they take now for the pain that is not addictive to some.
And a reasonable question it is - we all presumed that the withdrawal of Oxycontin meant that Oxycontin addicts would either switch to another drug, such as heroin, or seek treatment, resulting in a rise in demand for methadone maintenance. But instead I've seen the opposite: a drop in the number of people on methadone.
Generally, the number of people on methadone reflects the number of addicts there are, as a certain percentage will seek treatment. Fewer methadone patients implies fewer addicts.
This.
Though like I said, it's early days.
I still don't get it. What happened to the addicts? If there are fewer addicts, and also fewer methadone patients, where did the addicts go? Did they die? Or did they kick the addiction without methadone treatment?
If the rules of the game suddenly change, as they have now, couldn't the "percentage" of addicts seeking methadone treatment change as well? For example, if oxycontin addicts are switching to heroin and other opioids rather than seeking methadone treatment, doesn't that imply that more, rather than fewer, people are choosing to remain addicts instead of seeking methadone treatments?
There are some fairly effective non-narcotic non-addictive pain meds out there that, in my opinion, don't get prescribed enough. For those of us who can't take NSAIDs (non-steroid anti-inflamatory drugs) there are combinations of acetaminophen and narcotics that, while effective, do have addictive qualities. Percocet, for example. For serious pain, like post-surgical pain above 6 on the 1-10 pain scale, there's morphine. Neither is ideal.
Morphine, while more judiciously administered now, is awful on withdrawal. You haven't had nightmares until you've been subjected to morphine withdrawal nightmares. Percocet is effective, but the initial euphoria is enough to hook people for life. There's nothing like the cessation of severe pain, combined with the "everything is lovely and I don't give a shit" feeling to haul the least addictive personality into a hell of substance abuse.
Clearly, there must be better ways to control pain -- chronic or acute -- that don't involve opiates or other addictive substances. The question is, what do pharmaceutical companies have to gain by marketing those? How much of their R&D will be recovered if they produce pain meds that don't addict people? What's the profit margin?
And the answer is, that's why we need a nationalized pharmaceutical industry in Canada - one that doesn't need to make a profit in order to provide the safe and effective medications that we need.
As of a month ago, there was still a lot of Oxycontin on the streets of Toronto, according to my patients. But there has been this development in Alberta. This article is from a pharmacy journal behind a subscription firewall, so I'll just quote the pertinent section:
Less theft means less demand. I still don't know if heroin has picked up the slack, however.
Here's an excerpt from a pharmacist's comment on the site: