More than 2,000 deaths by overdose between January and July 2018 in Canada; 72,000 deaths by overdose in 2017 alone in the United States (more than the combined number of deaths due to motor vehicle accidents and guns): such is the toll of the opioid crisis in North America. Many people who fall prey to addiction start by taking medication for a backache, arthritis or chronic pain; their doctors prescribe opioids, highly effective painkillers that are also extremely addictive.
History of an Orchestrated Epidemic
The story begins with a purported miracle pill: OxyContin. Introduced in 1996 by the American pharmaceutical company Purdue Pharma, OxyContin is an opium-based painkiller and, like all opioids, it is extremely addictive. Nonetheless, Purdue Pharma launched OxyContin with advertising, conferences and promotional materials relentlessly claiming that it posed no risk of addiction or overdose. The marketing plan went even further by directly targeting the people who could help sell the medication, namely doctors. In 2002, with the financial support of Purdue Pharma, the Canadian Pain Society published a book on pain management used to train physicians, which stated that the use of opioids such as OxyContin for the treatment of chronic pain posed a lesser risk of abuse. A televised ad by Purdue claimed that less than 1% of opioid medication users develop an addiction, a widely-broadcasted figure that was not backed by any serious scientific study. According to Radio-Canada, Health Canada approved the product in 1996 even though “no studies on the risk of addiction or the long-term efficacy of the product had been submitted by the company at the time.”
Initially
developed for terminal phase cancer patients, Oxycontin would go on to be
prescribed to millions of Americans with chronic pain. To promote the
prescription and sale of the product, 34,000 boxes of OxyContin were
distributed free-of-charge by Purdue Pharma, according to a 2019 report by the
French investigative journalism show « Envoyé Spécial ». In 2007, the
American pharmaceutical company was convicted of false advertising and sentenced
to an $830 million dollar fine[1].
The story could have ended there, but that’s not what happened. Quite the
contrary. In fact, the pharmaceutical group worked even harder to sell their
product. Although Purdue is not a publicly-listed company and its accounts are therefore
not disclosed, experts estimate that sales of Oxycontin brought in $35 billion.
Purdue Pharma’s new strategy was to target general practitioners in addition to
pain specialists. Millions of Americans were prescribed opioid medications before
developing an addiction.
Study on Fentanyl Prescribing Yields Devastating Findings
In the United States, the Food and Drug Administration (FDA) is tasked with monitoring the distribution of opioid medications. Nonetheless, a recent study[1] conducted by Johns Hopkins University and Yale University showed that the program to monitor opioid prescriptions had failed in its mission. Fentanyl is a synthetic opioid that is a hundred times stronger than morphine and extremely addictive (read : Fentanyl: A Murderer in Disguise). Since 2016, 72% of overdose-related deaths in Canada have involved Fentanyl.
The study found
that between one third and one half (34.6% to 55.4%) of the thousands of
patients who were prescribed Fentanyl should not have received the medication. It
also found that half of the patients were not aware of the fact that Fentanyl
is only indicated for the treatment of certain cancer patients. One out of five
doctors were also unaware of that fact. Fentanyl was prescribed to relieve
chronic headaches and back pain.
According to
Caleb Alexander, co-author of the study published in the Journal of the
American Medical Association (Jama), there is no doubt that people have died as
a result of inappropriate prescribing of these products.
Impact on Life Expectancy in North America
The opioid crisis in North America is not abating and health authorities are starting to sound the alarm. In Canada, life expectancy increased by nearly three years between 2000 and 2016, from 79.27 to 82.25.[1]. But that rate of increase has slowed down significantly since the onset of the opioid crisis. In an interview with La Presse, the Chief Public Health Officer of Canada, Dr. Theresa Tam, stated that the opioid crisis had slowed down the increase in life expectancy by eight weeks.
The situation is even more concerning in the United States, where average life expectancy has decreased in the past two years. A report by the National Centre for Health Statistics indicates that a decline in life expectancy has not been seen since the Spanish flu epidemic of 1918.
Now more than ever, the North American opioid crisis is killing without distinction. The reasons behind the crisis are known and have prompted a debate on the pharmaceutical laboratories and people involved in allowing the epidemic to take root. In the United States, 1,500 lawsuits have been brought against pharmaceutical groups. More than 40 states and 100 American municipalities have launched lawsuits against opioid producers. In a statement to Radio Canada last November, Dr. Meldon Kahan, Medical Director of the Substance Use Service at Women's College Hospital in Toronto described the situation as the most shameful medical scandal of our time.
[1] https://ici.radio-canada.ca/nouvelles/special/2018/11/opioides-purdue-pharma-oxycontin-canada/
[2] https://jamanetwork.com/journals/jama/article-abstract/2725233?resultClick=1
[1] Public Health Agency of
Canada (PHAC)
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