N.S.'S CONCERN OVER OXYCONTIN USE RISES

Government And College Step In To Stem Narcotic Abuse

HALIFAX ­ Concerns about the abuse of prescription narcotics, particularly
OxyContin (oxycodone), have reached such epidemic proportions in Nova
Scotia the deputy minister of health and the registrar of the College of
Physicians and Surgeons of Nova Scotia have stepped into the fray. The
former is trying to reduce the escalating panic; the latter is offering
physicians prescription advice.

Much of the controversy swirls around the use of oxycodone in Cape Breton,
where this and other prescription narcotics are reported to have been
involved in the death of 12 residents within the last year. Three sudden
deaths in 2004 alone are linked to prescription narcotics. Oxycodone, which
sells for $80 a pill on the street, is often called hillbilly heroin or
"oxycotton." Glace Bay, a once-thriving mining town in Cape Breton, is
often referred to as "cottonland."

"I was stunned to hear oxycodone is now the number one street drug in Cape
Breton," said Dr. Richard MacLachlan, head of the department of family
medicine at Dalhousie University.

In response to the public outcry, N.S.'s deputy minister of health has
attempted to inject a calming voice by pointing out inaccuracies. Some
published figures on oxycodone use in Cape Breton are incorrect, Dr. Tom
Ward said. Only 0.47% of people in Cape Breton—not 4.7%—are prescribed
oxycodone, he noted.

Still, according to the province's prescription drug monitoring system, the
Cape Breton District Health Authority has 653 people on the drug compared
to 545 in the Capital Health District, a more populated area.

"The high number of people being prescribed Oxycodone in Cape Breton . . .
may reflect the burden of illness in Cape Breton resulting from the large
number of workers employed in industrial jobs, physicians' favouring one
medication over another and the higher incidence of cancer in Cape Breton,"
said Dr. Ward in a statement.

Questions for physicians

The Nova Scotia College of Physicians and Surgeons issued a letter to all
its members in an effort to minimize diversion and abuse of oxycodone and
other narcotics. Dr. Cameron Little, registrar of the college, provided a
list of questions for physicians to answer.

"If you answer 'yes' to any of the questions below, consider revising your
practices accordingly." Among the questions: "Do you prescribe on demand?
Do you accept the diagnosis made by a patient? Do you prescribe small
quantities of medication to 'get the patient out of the office?' "

Dr. Little also recommended physicians establish a contract with all
patients to whom they prescribe opioids and attached a sample contract for
doctors to review.

The controversy has also cast a shadow over the province's prescription
drug monitoring system. "We have in Nova Scotia arguably the best program
for monitoring prescription narcotics. It's the tightest in the country,
and it's obviously not working," said Dr. MacLachlan. "I have to fear my
profession is being lax about (prescribing)."

Dr. MacLachlan recommended the use of a special authorization system for
long-acting narcotics like oxycodone. Under such a system the prescription
request would be processed before the drug was released.