HEALTH PLAN FUNDS KILLER DRUG

Publicly Paid Prescriptions for Potent, Often-Abused Painkiller
Skyrocket - and So Does the Death Rate

Public dollars are funding a dramatic rise in the use of narcotic pain
pills that are killing more and more people in Ontario every year, a
Star investigation shows.

Last year, doctors prescribed $54 million of OxyContin - called
"hillbilly heroin" by street dealers - under a provincial program that
provides free medications to people on social assistance, seniors and
people with disabilities. That's nearly triple the $19 million handed
out five years before.

Meanwhile, addiction rates are soaring and an estimated 464 deaths in
five years in Ontario have been blamed on the drug contained in the
pain pills, with the number steadily increasing each year.

"It's an epidemic," said Dr. Graeme Cunningham, a leading expert in
addiction treatment. "We are seeing broken families, violence, police
involvement."

Cunningham and others who have studied the impact of the drug believe
there are two contributing factors.

Some doctors are too quick to prescribe OxyContin, the brand name of
the drug oxycodone, giving it to people who do not really need it.

Also, some patients lie to doctors about symptoms to obtain the drug
for trafficking.

Properly used, the drug's manufacturer, Purdue Pharma, says it can
benefit people with chronic pain.

But addiction experts say the potent pills are too often trafficked to
users who crush the slow-release tablets and snort or inject the drug.
A pill that costs the public plan $4 at the pharmacy fetches up to $45
on the street and gives users an instant high.

It is as addictive as heroin and critics say users are not properly
warned of its dangers.

Purdue Pharma and three top executives were fined $635 million in the
U.S. two years ago for failing to properly warn consumers. The
executives were put on five years' probation after a plea agreement
ended the criminal prosecution.

OxyContin is rapidly becoming one of the top medications prescribed by
doctors under the Ontario Drug Benefit program (ODB). The public
assistance plan covers a quarter of the people in Ontario, but funds
half the OxyContin prescriptions in the province. Private drug plans
have also seen a growth, but at a slower rate.

Ontario is now grappling with a problem that first surfaced in the
U.S. in the mid-1990s, and has dogged Atlantic Canada since the early
2000s.

A rise in OxyContin use in the U.S. led to crime waves and death,
particularly in rural areas.

In Ontario, no one is willing to put a figure on it, but most agree
some of the province's publicly funded narcotic is being misused.

Ontario's Centre for Forensic Sciences told the Star the estimated
number of deaths attributed to oxycodone - OxyContin is a slow-release
brand of the drug - reached 123 in 2008, up from 63 in 2004. In total,
there were 464 deaths over the past five years.

The provincial health ministry committee that oversees the Ontario
Drug Benefit program calls the dramatic increase in OxyContin use a
"public health concern."

Last month, the Centre for Addiction and Mental Health (CAMH) released
a study showing the greatest increase in patients seeking treatment
for narcotic addiction from 2000 to 2004 came from people hooked on
OxyContin.

A study by another agency showed increased use of OxyContin among
teenagers in Ontario. It's become a party drug, with teens taking it
at the same time as they drink alcohol.

Even the drug's manufacturer is worried. "There's a lot of
prescription fraud and pharmacy theft," said Purdue spokesperson Randy
Steffan. "It is certainly a growing issue."

The Star's investigation began with a detailed look at provincial data
showing prescriptions paid for by the government and dispensed at
retail pharmacies.

About half the OxyContin Purdue Pharma sells in Ontario is paid for by
the public ODB plan. In 2007-08, the total ODB bill for OxyContin was
$54 million, representing 337,000 separate prescriptions. Two-thirds
of the people receiving the drug are on social assistance.

The per-pill cost at the pharmacy depends on the strength: the 10 mg
dose is 92 cents under the ODB; the 40 mg pill is $2.39; and the 80
mg. pill is $4.41. The more potent the pill, the higher its street
value.

The amount of OxyContin prescribed under the ODB has grown steadily
for five years, with annual increases of roughly $8 million.

Ministry of Health spokesperson Andrew Morrison said the government
believes drugs like OxyContin are "an important therapeutic option for
the management of cancer and non-cancer-related pain."

He said the ministry is aware of the risk of abuse, and said that is
why the drug is listed as a "limited-use product" on the ODB program,
meaning it is only to be prescribed to patients with chronic pain.

OxyContin is the brand name of an opioid pain pill composed of
oxycodone, first developed in the early 1900s. Oxycodone became
popular as a one-shot painkiller in drugs such as Percocet, which are
also often abused.

In 1995, Purdue Pharma obtained U.S. approval for a slow-release form
of oxycodone that would provide pain relief for 12 hours. Within a
year, communities were struggling with addiction problems as people
learned to crush and snort or inject the drug for a rapid dose.

West Virginia, Tennessee and Kentucky were first and hardest hit. The
nickname "hillbilly heroin" came from there.

Purdue's Steffan said his company does its best to inform the public
of the risk of addiction by educating doctors. Purdue is aware of the
rising death rate and "it reminds us that prescription drug abuse is a
serious public health problem."

Steffan encouraged the Star to speak to pain medicine experts,
including Dr. Roman Jovey, a family physician paid by Purdue to
conduct workshops, lecture, and train doctors.

"(OxyContin) is an effective drug when given to the right person for
the right reason," said Jovey, medical director of a chain of clinics
called the Centres for Pain Management and also the director of Credit
Valley Hospital's addiction program in Mississauga.

Jovey said one in five Canadians suffers from pain daily; he
prescribes "lots" of OxyContin and thinks more people should be taking
the drug or other pain medication. However, he said the government
should also fund other types of pain treatment, such as physiotherapy
and psychological counselling.

In their absence, Jovey said doctors and patients have little choice
but to turn to OxyContin, which is covered by the public program.

"Unfortunately, a huge market has developed on the street,
particularly with people aged 16 to 25," he said.

Meanwhile, addiction experts are sounding the alarm. A study of CAMH's
Toronto in-patient service saw the number of people suffering from
OxyContin addiction go from 3 in 2000 to 92 in 2004. (Updated figures
were not available.) In a recent five-year period, there were 39
heroin deaths in Ontario, compared to 464 oxycodone deaths.

Cunningham said pain has become fashionable and profitable to treat.
He and Jovey sometimes spar at debates over the issue.

"OxyContin is way over-prescribed, in my opinion," said Cunningham,
director of the centre's addiction division. Of 1,500 new patients the
centre sees each year, 600 are drug addicted. Nearly two-thirds of
them are hooked on OxyContin and other, less potent prescription narcotics.

Last week, a new patient at his clinic had to "snort 120 mg of
OxyContin just to get the courage to come in to get help for her
addiction." Cunningham said the drug has a "tremendous euphoric
effect" on people.

In Toronto, Daniel Roppa, 22, got off Oxycontin two weeks ago. He paid
up to $1,000 a week to buy the drug illegally for the past year.

He got the pills first from friends, then dealers, who charged him
$30-45 for each 80 mg. tablet. He does not know where the dealers got
their supply. "All I cared about, after a while, was hanging onto a
dealer. That was like gold."

On his worst day, Roppa recalls taking four pills twice a day,
crushing and snorting them.

"I got so I was spending so much money on this stuff just to survive.
Two weeks ago I broke the cycle, tested negative on my urine test and
I am like a new man," he said.

"I call this drug the devil."

[sidebar]

COMPANY PLEADED GUILTY, AGREED TO PROPER WARNINGS

The manufacturer of OxyContin has been hit by numerous legal actions
since the painkiller hit the U.S. market in 1995.

The drug was designed to be digested over 12 hours. But abusers chew
or crush and snort the drug, which gives them an instant heroin-like
high.

In 2007, Purdue and three of its top executives pleaded guilty in
criminal court in West Virginia to making false claims in promotional
materials.

Purdue and the executives - the former president, top lawyer and
former chief medical officer - paid a $635 million (U.S.) fine and the
company agreed to provide proper warnings about the addictive quality
of the drug.

The company and executives were put on five years' probation.
Executives also paid fines of $19 million to settle complaints that
Purdue had encouraged physicians to over-prescribe the drug.

Company spokesperson Randy Steffan said the company in Canada operates
separately from the U.S. parent and has not done anything differently
as a result of the U.S. action. Steffan said the Canadian company
complies with all Canadian regulations.

Steffan defended the product, saying that while the company is "aware
of the potential for diversion and abuse," OxyContin is the "only kind
of medicine effective for severe and chronic pain."

In Canada, several lawsuits have been launched in the past two years
against the Pickering-based Canadian arm of the company. One lawsuit,
which is seeking certification as a class action, seeks $175 million
from Purdue for allegedly misleading consumers about the dangers of
the product and not recalling the drug after its addictive qualities
becameknown.

Joel Rochon, a Toronto lawyer working on that case, said the Ontario
Drug Benefit plan figures the Star unearthed show a problem in the
system - the government is not properly monitoring the drugs it allows
doctors to prescribe.

"It's a drug addict's haven," said Rochon. "Here's our government
funding drug addicts."

Purdue is not required to file a defence until the action is certified
as a class suit by the courts.

Steffan said company policy prevents him from responding to questions
about legal actions.