Fentanyl: Canadian Government Fail

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Fentanyl: Canadian Government Fail

Isn't health care a provincial jurisdiction?


The surge in use of opioids was manufactured by the pharmaceutical industry with the US government failing to take on its regulatory duty, resulting in the US becoming #1 in opioid addictions. Canada is #2 in addictions partly because our federal government followed the US pattern of allowing the pharmaceutical industry to promote these drugs for chronic pain for 25 years with little check on their effectiveness and addictiveness until the last few years. 

There is an opioid crisis in the US. And there is no doubt that this addiction crisis is based on pills. These pills come from legal manufacturers and marketers - companies in the business category called - without intentional irony - "ethical pharmaceuticals".

The usage of opioid-based painkillers has been pushed aggressively by the sales and marketing forces of the ethical pharmaceutical companies in the way they market all their drugs - seminars that are really expense-paid trips for doctors to sunshine resorts, free samples, speaker fees, coupons to patients for 30-day "starter supplies", rebates to wholesalers who keep the drugs off of "prior authorisation" lists, and so on.

The "ethical pharmaceutical" companies did something even more basic than that. They manufactured a disease called "chronic pain". They promoted the idea of making pain "the fifth vital sign" (after pulse, temperature, blood pressure and respiration) that doctors should examine on every visit. To back that up, they created Astroturf groups - American Pain Society, the American Academy of Pain Medicine, Partners Against Pain.

It has become common practice in US medicine, once a medication is invented and patented, to determine, define, even invent, the disease or condition it is a cure for. After it's been approved for one use, to get doctors to use it for lots of others things.

In numbers: The US opioid epidemic

20.5 million People 12 or older living with a substance abuse disorder in the US in 2015.

115 Opioid-related deaths per day in 2016.

200% Increase in opioid-related overdoses among US adults from 2000 to 2014.

80% Of heroin users first misused prescription opioids.

1 in 9 US heroin deaths in 2015 happened in Ohio.  

383% Increase in postnatal drug withdrawal syndrome in newborns from 2000 to 2012.

$78.5bn Estimated economic burden of prescription opioid abuse including healthcare, treatment and criminal justice involvement.

Sources: STAT, Centers for Disease Control and Prevention, National Institute on Drug Abuse, American Society of Addiction Medicine

In 2016, the CDC finally realised that there was little good evidence that opioids helped chronic pain for more than six weeks. Given how dangerous opioids are known to be, that should have been "discovered" years ago. If more doctors actually paid attention to their patients, they would have realised it long ago.

This takes us to another question. Why did prescribing opioids become so popular, so easily?

It's a manifestation of the profit-based US healthcare system. The financial structure commends -commands - everyone in the system to fix things as quickly and simply as possible, in a way that is billable by entering a number and that works for the various financial players - insurance companies, pharmaceuticals, large healthcare providers. The whole system works to promote quick visits and quick fixes.

In a related story, an investigation by 60 Minutes and the Washington Post revealed that the big pharmaceutical companies had sponsored the election campaigns of congressmen who in return promoted a law that stops the prosecution of major corporations for being the drug pushers they are. 

All of this fits into the story of a 50-year movement to increase the power of corporations and big money, to alter the legal system to put corporate criminals beyond the law, and to normalise the sort of corruption that has representatives paid to protect corporate excesses, even if they play a big part in 64,000 deaths a year. 




No Canadian government has ever prosecuted pharmaceutical companies for illegally marketing drugs in Canada despite the fact that the US government, even with its very poor record on regulating this industry, has done it sporadically. It's not surprising as the major pharmaceutical companies have been major contributors to both the Liberal and Conservative parties.

"Corporations have been banned from making donations to federal political parties for more than a decade. But that hasn't stopped some of Canada's most powerful business families from making hefty personal donations. In total, the 10 most generous political donors have funnelled more than $1.1-million to federal parties since 2004, an analysis of Elections Canada records shows. (see url below for list of personal donors by party)



Federal Liberal and Conservative governments have allowed the pharmaceutical industry to self-regulate with disastrous consequences. 

A reporter for the Toronto Star asked Health Canada why it had never prosecuted drug companies for illegally marketing drugs in Canada despite the same companies being fined for doing so in the United States. 

The response from Health Canada was that it “has not been made aware of any specific similar issue in Canada and has not received complaints concerning these companies promoting off-label uses of their products in Canada.”

In theory, the Food and Drugs Act and its regulations give Health Canada the ability to directly regulate promotion. 

In practice, the agency has turned over the day-to-day regulation of promotion to a combination of industry, as represented by its lobbying arm Innovative Medicines Canada (IMC), and an independent external group with strong industry representation, the Pharmaceutical Advertising Advisory Board (PAAB).

The PAAB is governed by a 14-person board, with representatives from five organizations that directly benefit from drug advertising: IMC, BioteCanada, Association of Medical Advertising Agencies, Canadian Association of Medical Publishers and Consumer Health Products Canada.

Its Code of Advertising Acceptance is deeply flawed. 

This code requires a “fair balance of risk to benefit” but there is no specific requirement that equal space in the ads be devoted to harms and benefits, and there is no provision for the font size used to describe benefits and harms to be equal in size. 

The generic name does not have to be used each time that the brand name is given, despite evidence that use of the generic name leads to better prescribing

The most serious penalty that the PAAB can impose where “information may cause inappropriate product use or constitutes an imminent and/or significant health hazard” is that the head of the organization may require letters of correction, published notices or the immediate withdrawal of the advertisement. ...

Health Canada presumably approves of how the PAAB operates since it acts as an adviser to the organization. ...

The validity of complaints about code violations is decided by the Industry Practices Review Committee (IPRC). The permanent members of the IPRC are two company representatives, two external health-care professionals all appointed by the IMC Board of Directors, a representative appointed by the IMC president and IMC’s general counsel. 

The maximum financial penalty after a fourth violation in a 12-month period is $100,000. After the third violation, the chief executive officer of the company is required to appear before the R&D Board of Directors to provide a detailed explanation of the violations and a comprehensive written action plan to ensure remediation. 

When companies are spending upwards of $14 million promoting a single product, $100,000 is lunch money. The way in which companies promote their products should be no surprise; they are in the business of making a profit for their shareholders. 

What is surprising is that Health Canada condones their marketing practices. It’s time for that to change.




voice of the damned

80% Of heroin users first misused prescription opioids.

Does this prove a causality, however? "Misusing prescription opioids" could include things like taking the pills on the same day that you have a glass of wine with dinner, taking them at a three-hour interval instead of four(even if that just happens once), or giving a swig of your codeine cough syrup to a family member who has a sore throat, but isn't named on the prescription.

None of which is commendable behaviour, but I'd be willing to bet that there are lots of prescription opioid users who have done things like that, without ending up anywhere near heroin.