Tag Archives: Opioid

OxyContin maker Purdue Pharma pleads guilty, admits to role in deadly opioid epidemic

Purdue Pharma pleaded guilty Tuesday to three criminal charges, formally admitting its role in an opioid epidemic that has contributed to hundreds of thousands of deaths over the past two decades.

In a virtual hearing with a federal judge in Newark, N.J., the OxyContin maker admitted impeding the U.S. Drug Enforcement Administration’s efforts to combat the addiction crisis.

Purdue also acknowledged that it had not maintained an effective program to prevent prescription drugs from being diverted to the black market, even though it had told the DEA it did have such a program, and that it provided misleading information to the agency as a way to boost company manufacturing quotas.

It also admitted paying doctors through a speakers program to induce them to write more prescriptions for its painkillers.

The guilty pleas were entered by Purdue board chairperson Steve Miller on behalf of the company. They were part of a criminal and civil settlement announced last month between the Stamford, Conn.-based company and the U.S. Justice Department.

Members of the Sackler family, who own the company, have also agreed to pay $ 225 million US to the federal government to settle civil claims. (Seth Wenig/Associated Press)

Hundreds of thousands of deaths attributed to opioids

The deal includes $ 8.3 billion US in penalties and forfeitures, but the company is on the hook for a direct payment to the federal government of just a fraction of that, $ 225 million. It would pay the smaller amount as long as it executes a settlement moving through federal bankruptcy court with state and local governments and other entities suing it over the toll of the opioid epidemic.

Members of the wealthy Sackler family who own the company have also agreed to pay $ 225 million to the federal government to settle civil claims. No criminal charges have been filed against family members, although their deal leaves open the possibility of that in the future.

“Having our plea accepted in federal court, and taking responsibility for past misconduct, is an essential step to preserve billions of dollars of value for creditors and advance our goal of providing financial resources and lifesaving medicines to address the opioid crisis,” Purdue said in a written statement after pleading guilty.

“We continue to work tirelessly to build additional support for a proposed bankruptcy settlement, which would direct the overwhelming majority of the settlement funds to state, local and tribal governments for the purpose of abating the opioid crisis,” the statement read.

Purdue’s plea to federal crimes provides only minor comfort for advocates who want to see harsher penalties for the OxyContin maker and its owners.

The ongoing drug overdose crisis, which appears to be growing worse during the coronavirus pandemic, has contributed to the deaths of more than 470,000 Americans over the past two decades, most of those from legal and illicit opioids.

Purdue has admitted that it impeded efforts to fight the deadly opioid crisis and paid doctors to prescribe more of the painkillers. (Craig Chivers/CBC)

Opposition to settlement

There were an estimated 16,364 apparent opioid-related deaths in Canada between January 2016 and March 2020, according to the Public Health Agency of Canada. 

Cynthia Munger, whose son is in recovery from opioid addiction after being prescribed OxyContin more than a decade ago as a high school baseball player with a shoulder injury, is among the activists pushing for Purdue owners and company officials to be charged with crimes.

“Until we do that and we stop accusing brick and mortar and not individuals, nothing will change,” said Munger, who lives in Wayne, Pa.

The attorneys general for about half the states opposed the federal settlement, as well as the company’s proposed settlement in bankruptcy court. In the bankruptcy case, Purdue has proposed transforming into a public benefit corporation with its proceeds going to help address the opioid crisis.

The attorneys general and some activists are upset that despite the Sacklers giving up control of the company, the family remains wealthy and its members will not face prison or other individual penalties.

The activists say there’s no difference between the actions of the company and its owners, who also controlled Purdue’s board until the past few years.

Last week, as part of a motion to get access to more family documents, the attorneys general who oppose the deals filed documents that put members of the Sackler family at the centre of Purdue’s continued push for OxyContin sales even as opioid-related deaths rose.

Company tried to ‘supercharge’ opioid sales

The newly public documents include emails among consultants from McKinsey & Corp., hired by the company to help boost the business.

One from 2008, a year after the company first pleaded guilty to opioid-related crimes, says board members, including a Sackler family member, ” ‘blessed’ him to do whatever he thinks is necessary to ‘save the business.’ “

Another McKinsey internal email details how a mid-level Purdue employee felt about the company.

It offers more evidence of the Sacklers being hands-on, saying, “The brothers who started the company viewed all employees like the guys who ‘trim the hedges’ — employees should do exactly what’s asked of them and not say too much.”

The documents also describe the company trying to “supercharge” opioid sales in 2013, as reaction to the overdose crisis was taking a toll on prescribing.

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CBC | World News

Provinces pursue OxyContin maker for $67B US in costs associated with Canada’s opioid crisis

In an effort to claw back the public health-care costs incurred by the opioid crisis, Canada’s provinces have filed a $ 67.4-billion US claim against OxyContin producer Purdue Pharma. 

The provinces are some of the more than 600,000 claimants listed in documents filed against Purdue Pharma on Nov. 5 in the U.S. Bankruptcy Court for the Southern District of New York.

OxyContin was introduced about two decades ago, marking what addiction experts recognize as the beginning of the opioid crisis. The drug quickly spread to the streets, leading to a full-blown public-health crisis involving various other opioids and eventually a devastating influx of fentanyl, which killed many of the more than 4,500 Canadians who died of drug overdoses in 2018 alone. 

British Columbia’s claim is for more than $ 9.1 billion US, while Ontario’s is $ 26.1 billion US, and Quebec’s is $ 15.3 billion US.

British Columbia’s claim against Purdue is for more than $ 9.1 billion US, while Ontario’s is $ 26.1 billion US, and Quebec’s is $ 15.3 billion US. (Douglas Healey/The Associated Press)

Reidar Mogerman is the lawyer handling the class action cost recovery litigation for British Columbia. He says this situation is comparable to past societal actions after mass public injury was caused by tobacco and asbestos.

“The Canadian number looks large and it is large because it’s a significant problem. I believe if you add in claims from U.S. entities you get numbers in excess of $ 2 trillion US. It’s really staggering,” said Mogerman.

In the United States, Purdue paid $ 634.5 million US about 13 years ago to settle litigation after being charged with misbranding OxyContin as less addictive than other prescription pain medications.

Health Canada has never investigated Purdue.

“It’s a product that we thought was useful and it turned out to be extremely dangerous. The carnage can only be addressed with society-wide tools,” said Mogerman.

Society-wide health care crisis created

He explained that as the drug maker became overwhelmed by claims related to the opioid crisis it moved to apply to the U.S. courts for bankruptcy protection, which has stalled the legal process.

Purdue paid $ 634.5 million US about 13 years ago to settle litigation after being charged with misbranding OxyContin as less addictive than other prescription pain medications. (George Frey/Bloomberg/Getty)

Mogerman says Purdue continues to sell opioids in Canada and the U.S., but the way they are used and marketed has become safer.

However, the fallout from the introduction of OxyContin has been a “society-wide health care crisis,” he said. 

Three years ago Canadian provinces seemed willing to whittle down their $ 85.5-billion Canadian claim — for everything from emergency medical care to overdose prevention sites and addiction treatment programs — to a $ 2 million share of the settlement offer. 

But outspoken Saskatchewan judges raised the alarm that the provinces were failing to protect public funds.

Purdue initially offered $ 20 million Cdn to settle a 1,600-member victim-centred Canadian class-action lawsuit that’s been ongoing since 2007.

But in the end provinces withdrew their support, after the judges’ rebuke.

In 2018 the B.C. government launched its own lawsuit against more than 40 pharmaceutical companies, including Purdue. That claim alleges they knew, or should have known, that opioids were addictive and leaking into the illegal market.

But all claims were frozen after Purdue sought bankruptcy protection in 2019.

Mogerman says patient claims began to be at odds with provincial interests — so they had to move another way.

He said B.C. takes this crisis so seriously that billions have been spent trying to solve it.

“The province needed to protect the larger public interest that it’s trying to pursue,” he said.

 “But nobody has a silver bullet. It’s not an easy thing to solve.”

He predicts a reckoning will come and pharmaceutical companies will pay B.C. and other provinces compensation or his team will pursue the company and the family who owns it.

“We will pursue the cases to the ends of the earth if we need to,” he said.

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CBC | Health News

Canada’s opioid crisis killed 4,614 people in 2018, but more loss and ‘heartache’ can be prevented

About 13 people a day in Canada died as a result of opioids in 2018, according to a new report that shines a spotlight on preventable poisonings.

Released on Thursday, the report by Parachute, a Canadian charity dedicated to injury prevention, and the Injury Prevention Centre at the University of Alberta’s School of Public Health focused on poisoning — the toxic effects of substances such as medication, cleaning products or gas vapour — on the body.

The report found that in 2018, opioids were responsible for 4,614 deaths in Canada, equating to about 13 lives lost per day, based on data from the Public Health Agency of Canada. It breaks down the top 10 pharmaceutical and top 5 non-pharmaceutical causes behind cases at Canada’s five poison control centres.

“We know that the vast majority of these are preventable,” said report co-author Pamela Fuselli, president and CEO of Parachute.

The numbers are stark, Fuselli said, with nearly half of all opioid-related poisoning deaths occurring in those aged 30 to 49, primarily men.

Pamela Fuselli, president and CEO of Parachute, a Canadian charity dedicated to injury prevention, says what sends people to hospital for poisoning varies by age group and can include over-the-counter medications such as acetaminophen, alcohol, prescription drugs, including opioids, and cleaning products. (Kelda Yuen/ CBC)

“We’re losing people who can contribute to Canada and [losing] lives … that don’t need to be lost.”

Individuals using illicit substances can be at increased risk of poisoning despite using their usual amount because of the growing degree of contamination of the drug supply with fentanyl and other ultrapotent opioids, the report said. Respiratory arrest and death can result.

The report recommends steps to prevent the loss of a family member and the “heartache” that follows, such as:

  • Harm reduction to reduce the negative effects of stigma surrounding people with a substance use disorder.
  • Offering treatment and rehabilitation services for those with substance use disorders and associated mental health disorders.
  • Expanding safe consumption sites where people can access safe needles and receive medical attention and support, including conversations on accessing treatment and rehabilitation services.
  • Clamping down on illegal drug production and trafficking.
  • Providing educational campaigns to inform people of the risks associated with use of substances.
  • Looking at what leads people to take drugs in the first place.
  • Providing naloxone to prevent deaths among people who take opioids.
  • Locking up medications and cleaning products to keep them out of reach of young children.
  • Getting rid of any medications that are no longer needed.

Fentanyl detected in majority of illicit drug deaths

Co-author and epidemiologist Kathy Belton, associate director of the Injury Prevention Centre at the U of A, said Western Canada has been hit hard, with British Columbia seeing 1,542 deaths related to illicit drug use in 2018. Of these, fentanyl was detected in 87 per cent.

When both Fuselli and Belton crunched the numbers, they said they were surprised to find that twice as many people now die of unintentional poisonings than traffic-related injuries — the leading cause of unintentional injury deaths for children and teens for nearly 20 years.

“It just jumped out at you on the page,” Belton said.

She also pointed to a 2018 study in Alberta that showed the increase in death and disease accompanying the opioid crisis was largely due to unintentional poisoning rather than intentional self-harm or suicide by poisoning.

‘Long road to go to solve poisoning’

“An overdose is really the wrong term,” Belton said, because people taking opioids to get high aren’t intending to die.

“If we start looking at that’s not the intended outcome, then we look at this whole issue of poisoning and opioid poisoning differently,” she said. “Maybe they would stop blaming the individual because addiction is a disease just like any other disease.”

Jason Mercredi, executive director of Prairie Harm Reduction in Saskatoon, says he thinks the report underestimates the scale of hospitalizations from opioids and would like to see an expansion of harm-reduction services across Canada supported with long-term funding. (Don Somers/CBC)

Jason Mercredi, executive director of Prairie Harm Reduction in Saskatoon, was not involved in writing the report, but he said he thinks it underestimates the scale of hospitalizations from opioids given how busy paramedics are in Saskatchewan.

“I think the most frustrating part of my job is when I get a call from somebody’s mom whose kid died, and they’re calling and asking what they can do to support us,” Mercredi said. “That’s backwards. It should be the opposite relationship, but they have nowhere to go to and they don’t feel like they’re being listened to.”

Mercredi said he would like to see an expansion of harm-reduction services across Canada supported with long-term funding.

WATCH | COVID-19 pandemic exacerbates opioid deaths:

There has been an unprecedented spike in opioid overdoses in Canada during the COVID-19 pandemic, with a 25 per cent increase in Ontario and a 39 per cent increase in British Columbia. 1:59

Fuselli said when it comes to other types of poisoning deaths, people may think that the problem of poisoning slowed with the introduction of child-resistant caps and blister packs for medications, but that’s not the case.

“We actually have a long road to go to solve poisoning,” she said.

What sends people to hospital varies by age group and can include over-the-counter medications such as acetaminophen, alcohol, prescription drugs, including opioids, and cleaning products, depending on how much is ingested, Fuselli said.

Belton said that as a scientist, it’s important to get more information on the circumstances surrounding an event to find out what’s the best point to intervene and stop injuries from happening.

A pair of shoes representing a life lost hangs on the Burrard Street Bridge in Vancouver as part of an art display on International Overdose Awareness Day in August. (Ben Nelms/CBC)

But that data is not collected in the same database in Canada. Instead, the report was compiled based on 2008 to 2018 data on deaths and hospitalizations in all provinces except Quebec, as well as emergency department visits in Alberta and Ontario.

The authors recommend setting up a national phone number that would allow health professionals to connect seamlessly with a poison control centre. They would also like a database similar to what’s in the U.S. and European Union to look for signs of contaminants, which could also help inform health-care providers when exposures occur.

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CBC | Health News

Opioid deaths skyrocket, mental health suffers due to pandemic restrictions, new federal report says

The COVID-19 pandemic has wreaked havoc on Canadians suffering from mental illness, opioid addiction and other substance abuse problems, says a new study released today by the Public Health Agency of Canada (PHAC) which confirms anecdotal reports warning that the pandemic’s health consequences extend well beyond the novel coronavirus itself.

Efforts to curb the spread of COVID-19 through social distancing and shutdowns have kept the Canadian caseload relatively low compared to other jurisdictions globally. But the overall health of the population has deteriorated over the last eight months, with more people turning to drugs, alcohol, tobacco and screen time over physical exercise to cope with the stress.

“This year’s annual report describes the heavy toll that the COVID-19 pandemic has had on Canadian society, both directly and indirectly,” Chief Public Health Officer Dr. Theresa Tam said Wednesday as she released her agency’s annual report.

“These findings are more than just uncomfortable facts about our country during this pandemic. They’re the lived realities of countless Canadians.”

One pandemic, different levels of risk

Confirming what has been well-documented already, PHAC found that long-term care (LTC) homes have been the epicentre of COVID-19-related deaths because “pandemic preparedness did not extend into these settings.” The report said LTC facilities’ limited supplies of personal protective equipment, old infrastructure, poor ventilation and chronic understaffing led to more infections.

People of colour in Canada also have been far more likely to contract the virus, PHAC found. The report says Arab, Black, Middle Eastern, Latin American, South Asian and Southeast Asian Canadians accounted for more than 80 per cent of the cases in Toronto, despite collectively making up slightly more than half of the city’s population.

Friends and family members of residents meet at Extendicare Guildwood, in Toronto, on June 12. (Evan Mitsui/CBC)

While the reasons for this minority/majority split in the caseload numbers are unclear, PHAC suggested that pre-existing health disparities, the stress of racism and the preponderance of low-wage work in high-risk places could be to blame.

Beyond the COVID-19 pandemic, Canada is still in the grips of an opioid crisis — a crisis that is now much worse than it was just a year ago. With travel and border restrictions in place, the local opioid supply has grown more toxic and dangerous, PHAC said.

While Canada made meaningful progress in reducing the rate of overdoses in 2018-19, the number of deaths has increased significantly since the start of this year.

A surge in opioid deaths

In B.C., there were more than 100 “illicit drug toxicity” deaths per month for six consecutive months from March to August 2020, and more than 175 such deaths each month in May, June and July, according to data compiled by PHAC.

B.C.’s highest monthly opioid death toll, in June 2020, was 181, up from 76 in June 2019. First Nations people account for a disproportionate number of these deaths — they were nearly six times more likely to die from an overdose than other B.C. residents.

In July, B.C. paramedics responded to a record high number of overdose calls — a 75 per cent spike in calls compared to the same month last year. Paramedics in B.C. also responded that month to an average of 87 overdose calls a day, or 2,706 calls in total.

Last week, the B.C. Coroners Service said 1,202 people have died of fatal overdoses so far this year, compared to just 983 deaths in all of 2019. The death toll in B.C. in September was more than double the 60 fatalities recorded in the same month last year.

Preliminary data from Ontario also show that the number of confirmed and probable deaths from opioid-related causes has increased by almost 50 per cent, from 148 deaths in January to 220 deaths in May.

A drug user at a safe injection site in Vancouver on March 27, 2018. (Tina Lovgreen/CBC)

Alberta also experienced a dramatic increase in opioid-related deaths in the three-month period from April to June 2020 — 302 deaths, up from the previously recorded high of 211 deaths in a three-month period in 2018.

PHAC heard from frontline workers who said that, because of social restrictions, many more people have been using opioids alone, “decreasing the chance of intervention if they overdose and contributing to the increase in overdose-related fatalities.”

Physical distancing measures at safe-consumption sites designed to prevent the spread of COVID-19 also resulted in more opioid-related deaths.

At least one supervised consumption site in Ottawa did away with physical distancing measures after several clients overdosed while waiting in line to get in.

We’re drinking and smoking more, moving less

Meanwhile, many Canadians have increased their use of alcohol, cannabis and tobacco during this pandemic.

By early summer, based on surveys by Statistics Canada, alcohol consumption was up 19 per cent, cannabis use jumped 8.3 per cent and tobacco smoking rates were up by 3.9 per cent over pre-pandemic levels.

CBC North has documented a surge in alcohol and substance abuse in Canada’s northern territories thanks in part to more bootlegging and access to cash through the Canadian emergency relief benefit (CERB) and other relief supports.

WATCH: Dr Theresa Tam says pandemic exposed existing inequities in Canadian society

Canada’s Chief Public Health Officer Theresa Tam says some groups in Canada have been disproportionately affected by the COVID-19 pandemic.  1:11

The pandemic and its resulting restrictions on social and economic life have had a lasting impact on mental health.

PHAC found that, due to shelter-in-place restrictions, more women have had to stay with abusive partners and LGBTQ kids have been confined to homes with homophobic and transphobic parents and caregivers.

Child welfare agencies are reporting a drop in abuse or neglect reports — but they fear it’s because fewer cases are being reported now that more school-age children are stuck at home without access to school or sports.

“This may be the result of fewer detection opportunities, as children are likely to be isolated at home and without community involvement,” PHAC said.

But it’s not just the vulnerable and marginalized among us who have seen notable drops in mental wellness.

Canada has gone from one of the happiest countries in the world — ninth out of 156 countries according to a 2019 UN report — to one that is noticeably less so.

Less happy, more anxious

In 2018, 68 per cent of Canadians age 15 years and older reported excellent or very good self-perceived mental health. This figure dropped to 54 per cent in late March and early April 2020 before going lower still to 48 per cent in early May, according to Statistics Canada data.

Indigenous people, the disabled and low-income Canadians also have reported experiencing more suicidal thoughts since the outbreak, PHAC found.

With strict social distancing measures and limits on social gatherings in place, many Canadians feel isolated and are worried about the state of their friendships and familial relationships.

70 per cent of Canadians who responded to a recent Statistics Canada survey said they were concerned about maintaining social ties.

54 per cent of respondents with kids said they were very or extremely concerned about their children’s loneliness or social isolation.

While thousands of Canadians have died from COVID-19 — nearly 80 per cent of them in long-term care homes, as of August — there were also more deaths in general this year than last.

“Alberta, British Columbia, Ontario and Quebec all showed increased numbers of deaths compared to the same time period over the past five years. Some of these additional deaths are directly related to COVID-19, however contributions from other causes not directly linked to COVID-19 cannot be excluded,” PHAC concluded.

Hospitals have seen a drop in walk-in patients for other maladies in emergency rooms. Surgeries have been cancelled or postponed due to capacity restraints, and health professionals fear that people may be avoiding necessary medical care because of pandemic-related worries.

With gyms closed in many jurisdictions and recreational sports leagues on pause, some Canadians are less active. Those who weren’t particularly active before March 2020 lockdown reported being even less so in the months that followed.

More than 60 per cent of Canadians reported spending more time using the internet and watching TV during the pandemic in early April.

“Limited physical activity as a result of public health measures to physically isolate may also have an impact on mental health. Research has demonstrated that people who were able to engage in physical activity outdoors were more likely to report excellent or very good mental health,” PHAC said.

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CBC | Health News

OxyContin maker Purdue reaches plea deal in opioid probe

Purdue Pharma LP agreed to plead guilty to criminal charges over the handling of its prescription opioid OxyContin in a deal with U.S. prosecutors that effectively sidestepped paying billions of dollars in penalties and stopped short of criminally charging its executives or wealthy Sackler family owners.

In a far-reaching agreement unveiled on Wednesday, Purdue formally admitted to criminal conduct related to distribution of its painkillers and agreed to pay $ 225 million US to resolve U.S. Justice Department investigations.

Prosecutors imposed significant penalties exceeding $ 8 billion against Purdue though the lion’s share will go largely unpaid.

Purdue agreed to pay $ 225 million toward a $ 2 billion criminal forfeiture, with the Justice Department foregoing the rest if the company completes a bankruptcy reorganization dissolving itself and shifting assets to a “public benefit company” or similar entity that steers the unpaid portion to thousands of U.S. communities suing it over the opioid crisis.

A $ 3.54 billion criminal fine and $ 2.8 billion civil penalty are likely to receive cents on the dollar as they compete with trillions of dollars of other claims from those communities and other creditors in Purdue’s bankruptcy proceedings, according to court documents and people familiar with the matter.

Sacklers pay civil penalty over false claims

Members of the billionaire Sackler family who own Purdue agreed to pay a separate $ 225 million civil penalty for allegedly causing false claims for OxyContin to be made to government healthcare programs such as Medicare, according to court records.

Neither the Sacklers nor any Purdue executives were criminally charged. The agreement does not release any individuals associated with Purdue from potential criminal liability. A separate Justice Department criminal investigation scrutinizing individuals is ongoing, according to a person familiar with the matter.

Purdue conspired to engage in criminal conduct over the years that kept medically questionable prescriptions of its opioids flowing, prosecutors said. The Stamford, Conn.-based company has agreed to plead guilty to three felonies, two of them violations of a federal anti-kickback law and another charge of defrauding the U.S. and violating the Food, Drug and Cosmetic Act.

Representatives for Purdue, its Sackler family owners and the Justice Department had no immediate comment or did not immediately respond to requests.

Opposition from lawmakers

The settlement had already come under fire before its unveiling from Democrats on Capitol Hill, who called for Purdue and its owners to face more severe consequences for their alleged roles in the opioid crisis, criticism that followed Reuters reporting details of the looming agreement.

Dozens of state attorneys general, meanwhile, oppose a plan that would essentially put government litigants in charge of a restructured company continuing to sell OxyContin.

Purdue reaped more than $ 30 billion from sales of OxyContin over the years, enriching Sackler family members while funnelling illegal kickbacks to doctors and pharmacies, U.S. and state officials have alleged.

The cases against Purdue and the Sacklers reflect an attempt by officials to hold accountable alleged perpetrators of an epidemic that has claimed the lives of more than 400,000 people since 1999, prompting the Trump administration to declare it a public health emergency.

Purdue’s misconduct included paying illegal kickbacks to doctors and to a vendor called Practice Fusion that created a software alert designed to push the drugmaker’s opioids on physicians, prosecutors said. Practice Fusion earlier this year entered a deferred prosecution agreement and admitted that it received kickbacks from an opioid company, which Reuters reported was Purdue.

Restructuring into public benefit company not certain

Purdue also ignored doctors suspected of improperly prescribing opioids that were flagged by its internal controls and failed to report OxyContin prescriptions from these physicians to the Drug Enforcement Administration as legally required, officials said.

Purdue, which filed for bankruptcy protection last year under an onslaught of litigation, has proposed settling thousands of lawsuits in a deal it values at more than $ 10 billion. That is contingent on donations of opioid reversal and addiction treatment medications it has under development and a $ 3 billion cash contribution from the Sacklers. The Sacklers would cede control of Purdue.

The part of that plan reshaping Purdue as a public benefit company is no longer assured, said people familiar with the matter. Attorneys general from two dozen states and Washington, D.C., last week said it would improperly entangle them with a restructured Purdue’s continued OxyContin sales while they attempt to hold alleged perpetrators of the opioid crisis accountable.

Purdue asked its bankruptcy judge on Wednesday to approve the plea agreement, including the $ 225 million payment it owes.

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Ottawa comes out in favour of injectable opioid therapy, urging Alberta not to shutter program

Canada’s health minister is calling on the Alberta government to reconsider the closure of its injectable opioid agonist treatment program, which Premier Jason Kenney says will end in the spring when the province stops funding it.

The service provides patients with severe opioid use disorder, a recognized condition, with injections of pharmaceutical-grade heroin, known as diacetylmorphine, or hydromorphone.

“We are disappointed by this decision from the Alberta government, and we urge them to reconsider,” a spokesperson for Patty Hajdu said.

The health minister’s call comes one week after a group of patients benefiting from Alberta’s injectable opioid agonist treatment (iOAT) pilot program filed a lawsuit seeking an injunction to stop Alberta’s provincial government from ending it.

If the three Alberta clinics that offer the treatment close, few people east of British Columbia would have access to the program, which is a cornerstone of the federal government’s latest strategy to combat the opioid crisis. 

“Many people are struggling with substance use, and in too many communities, the COVID-19 pandemic is compounding this ongoing public health crisis,” the minister’s statement said.

From January 2016 to March of this year 16,364 Canadians died from opioid overdoses according to figures from the federal government. The numbers have shown an increasing trajectory, with 3,799 deaths last year, and over 1,000 in the first three months of 2020.

The federal government began opening the door to community-based iOAT treatments in 2018 and has provided funding for pilot projects.

The move followed decades of research — first in Europe, then in British Columbia. Multiple studies suggested that providing daily access to pharmaceutical grade injectable opioids allowed long-term chronic users to stabilize their lives, find homes and stop engaging in criminal activity many relied on to support their addictions. Most stuck with the program long term, and some were able to stop using injection drugs altogether.

Alberta’s previous NDP government launched the pilot program in late 2017. Premier Jason Kenney is giving the 60 patients currently enrolled one year to transition to other programs that do not involve injecting opioids. He has called the federal government’s approach “facilitating addiction.”

“Handing out free narcotics to addicts is not compassion,” the premier said in response to questions from CBC News in September.

Patients file lawsuit to keep Alberta program operating

Patients enrolled in the program have have filed 11 affidavits in a lawsuit that is attempting to put a human face on the treatment. People who had focused their entire lives on the pursuit of drugs described awakening to a new world free of the stress and danger on the streets. 

Taylor Maxey receives injectable opioid agonist treatments at a clinic in Calgary. He fears a return to the streets when the program is ended. (Taylor Maxey)

Among them a once nationally ranked swimmer. Taylor Maxey began taking opioids following an injury in his late teens. He was soon homeless, panhandling on the streets and committing petty crimes. 

Maxey’s drug habit was costing $ 900 a day. He watched friends die around him. He attempted suicide. He tried and failed multiple treatment programs. 

Today, at the age of 32, he says in an affidavit that he has stable housing, a new network of supportive friends, and hopes of becoming an outreach worker. Instead of hustling for street drugs, he is injected with opioids at the Calgary clinic slated to close in the spring.

Maxey is terrified of what will happen. 

“My life would be shorter and much harsher if I returned to the streets and were denied access to iOAT,” he says in an affidavit. “I would be subject to the violence of the streets and the unsafe and precarious world of opioid use. I would be exposed to unsafe supplies of opioids.” 

Patients of Edmonton’s injectable opioid agonist treatment program meet outside the office of lawyer Avnish Nanda on October 8, as they announce legal action to block the program’s closure. (Sam Martin CBC News)

The Alberta government has not filed a statement of defence in the case. The injunction application will be heard in November.

What the research shows

Beyond personal testimonials, iOAT is supported by a range of clinical research that began in Switzerland in the 1990s. on what was then known as heroin assisted treatment, or HAT. A  two-year study of 1,000 people across several centres in Switzerland found “substantial improvements for illicit heroin use, health status and crime among HAT patients,” according to a published review of the evidence. It also found a positive cost-benefit ratio because those provided with drugs had fewer medical issues and committed less crime.

A groundbreaking study published in 2009 in the New England Journal of Medicine concluded heroin-assisted treatment was safe and effective. Researchers followed 251 people in Vancouver and Montreal over 12 to 15 months. They found 88 per cent of patients receiving heroin stayed with the program, and among them, there was a 67 per cent decrease in criminal behaviour.

Overdoses and seizures were the most common adverse events recorded, though the study noted that since the patients were under close medical supervision, the overdoses were treated and the patients recovered.

As fentanyl and carfentanil have increasingly tainted the illicit drug supply, creating an overdose crisis, the provision of pharmaceutical heroin has increasingly been seen as a potential solution. 

In 2019, the federal government formalized regulations, and the Canadian Research Initiative on Substance Misuse added clinical practice guidelines. At the time, Theresa Tam, Canada’s chief public health officer, said expanding the availability of pharmaceutical-grade heroin “will save lives.”

Availability limited as overdose deaths increase

But in spite of expectations the therapy would expand across Canada, it remains limited to a handful of sites in B.C., mostly in Vancouver. If the Alberta program shuts down, the only other places in Canada offering it will be Ottawa’s Managed Opioid Program, which treats a maximum of 25 people in a residential setting, and a newly opened program in Fredericton, which currently serves seven patients.

Rob Boyd, the program director of another Ottawa treatment centre, would like to offer iOAT but says he can’t, because the drugs are not adequately covered by Ontario’s health plan.

“Lots of places want to do it,” he said. “We would fill up right away.”

As overdose deaths increase — there have been more than 1,000 in British Columbia alone this year — Canada’s health minister is urging provinces and regulatory bodies to adopt the treatment. 

“Do all you can to help provide people who use drugs a full spectrum of options for accessing medication,” she wrote in a letter to her provincial counterparts and regulatory bodies on Aug. 24.

“We need immediate action from all levels of government and health care practitioners to prevent further deaths from the contaminated illegal drug supply and COVID-19.”

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Pandemic worsens Canada’s deadly opioid overdose epidemic

An epidemic of fatal drug overdoses across Canada is on the rise amid COVID-19 pandemic restrictions that harm-reduction workers and doctors say exacerbates the toxic supply.

Overdose prevention sites continue to run but physical distancing guidelines mean fewer people are able to use the services. For example, a site in Toronto that previously averaged more than 100 visits a day now sees fewer than half that.

From March 2019 to May 2020, Ontario’s coroner reported a 25 per cent increase in fatal overdoses, based on preliminary estimates for all substances.

Nick Boyce, director of the Ontario Harm Reduction Network, said the increase is significant.

“It matches anecdotally what I’ve been hearing from the front-line workers we work with around the province,” Boyce said. “They’re all saying deaths are going up. But to hear that number and to see that number, I was not expecting it to be that high.”

Last year, fentanyl directly contributed to about 75 per cent of opioid-related deaths in Ontario.

More than 14,000 Canadians have been killed by opioids in the last four years, according to federal data

“Laws actually incentivize drug dealers and suppliers to come up with new and different drugs,” Boyce said. “We learned this lesson in the 1920s with alcohol prohibition when people switched from drinking beer to toxic moonshine. We’re seeing that with the opioid drug supply now.”

Nick Boyce says front-line workers report overdose deaths are going up across Ontario and a safer drug supply would help reduce the problem. (Melissa Haughton/CBC)

Stimulant-related deaths have also increased in Ontario.

British Columbia saw a 39 per cent jump in overdose deaths in April compared to the same month last year.

And in Alberta during the pandemic, the number of opioid-related calls to EMS increased from 257 in March to 550 this May.

Dr. Theresa Tam, Canada’s chief public health officer, has pointed to similar overdose trends across the country.

Back when COVID-19 was first declared a pandemic in March, a woman CBC News is calling Lisa to protect her identity was living in a tent in downtown Toronto. When people were ordered to stay inside, she said there were few places to go. Her struggle with street opioids deepened.

“I OD’ed three times and woke up alone because I was using alone,” Lisa said, referring to overdoses.

Lisa relies on overdose prevention sites; her health-care provider worked with a pharmacist to offer methadone or Suboxone as well as safe supplies as part of harm reduction services.

“I see a lot more deaths in my circles,” Lisa said.

‘Disaster of epic proportions’

Guy Felicella, a peer clinical adviser at the BC Centre for Substance Use in Vancouver, blames increasingly toxic street drugs, usually laced with fentanyl or its analogues, for the increase in deadly overdoses. The direct relationships users  had to get drugs from dealers were cut off in the pandemic.

“You add COVID into the mix, I mean it’s just a disaster of epic proportions,” Felicella said.

In pandemic prescribing, Felicella said a medical version of a drug is offered to users instead of the tainted street version. But that doesn’t address what most people who use substances are seeking in order not to feel sick from withdrawal, he added.

Dr. Jennifer Brasch leads addiction psychiatry at St. Joseph’s Healthcare in Hamilton, Ont. She’s heard from patients that it is harder to access their substance of choice during COVID-19.

“It’s very stressful to be socially isolated and fearful of catching COVID-19,” said Brasch, who also works at the Hamilton Clinic, a medical service provider. “When people are stressed and anxious, they may use more substances in order to cope.”

Health Canada has temporarily eased restrictions on some medications used for treatment of addictions. Brasch said some doctors are also prescribing slow-release morphine with methadone to protect patients from fentanyl in street supplies.

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Alberta government to end funding for intensive opioid therapy program

The Alberta government plans to cut funding for an opioid treatment program offered as a last resort to people with severe addictions when other therapies are ineffective.

The government says 65 people on injectable opioid agonist treatment (iOAT), a two-year pilot program, will be transferred to other health services before funding for the program ends on March 31, 2021.  

A spokesperson said there are no plans to fund the program past next March. 

Critics maligned the government’s decision, saying it endangers clients on iOAT. 

“I’m heartbroken over this and I don’t understand how the government can cut a program that is effective and has helped people to find stability and health in their life and deal with their substance use issues,” said Petra Schulz, Edmonton-based co-founder of national harm-reduction advocacy group Moms Stop the Harm.  

Doctors only refer a client to the iOAT program when other treatments fail, according to Alberta Health Services background documents.

Clients inject hydromorphone three times a day under the supervision of a nurse, who adjusts the dose based on the response. 

An attack on most vulnerable: Opposition critic

People with chronic opioid dependency may find methadone treatment is ineffective. Some report their cravings persist and others simply can’t reach a therapeutic dose with an oral-based therapy, according to the Canadian Research Initiative in Substance Misuse. 

“This is literally attacking the most vulnerable individuals at a time when they are finally being given stability,” said NDP MLA Heather Sweet, the Opposition critic for mental health and addictions. 

A two-year pilot program was announced by the previous NDP government at the end of 2017, at a time when an average of more than two people were dying from opioid overdoses every day.

The latest AHS statistics show overdose deaths are at the lowest levels in more than three years — 120 people over three months — a development harm reduction advocates credit to the introduction of supervised consumption sites and programs like iOAT. 

This is literally attacking the most vulnerable individuals at a time when they are finally being given stability.– NDP MLA Heather Sweet, opposition critic for mental health and addictions

AHS treatment centres in Edmonton and Calgary introduced iOAT by early 2019, making Alberta the second province after British Columbia to offer the treatment. 

Research shows iOAT cuts rates of illicit opioid use, treatment drop-out, criminal activity, incarceration and death among clients who resisted methadone treatment, according to a review by the Canadian Research Initiative in Substance Misuse

A $ 14-million grant for the program was set to expire at the end of this month, but a government spokesperson said it was renewed for another year to transition patients into other forms of treatment. 

“Patients will be transitioned to the health services that are most appropriate for their needs, determined by medical professionals,” said Kassandra Kitz, press secretary for Jason Luan, associate minister of mental health and addictions. 

‘Very heartless message’ 

In the face of the opioid crisis, advocates say the program keeps clients with the most severe addictions off a dangerous opioid street supply and out of illicit drug trafficking markets, while connecting them with other support services such as counselling. 

Schulz said she learned about the government’s decision on Friday, one day after the Supervised Consumption Services Review Committee publicly released its findings.

The panel — made up, in part, of police officers, an economics professor and health-care professionals with a history of support for abstinence-based treatment — was tasked with studying the social and economic impacts of supervised consumption sites in Alberta.

The review did not consider the merits of harm reduction or the impact to housing and homelessness after the government placed those topics outside the panel’s mandate. 

A spokesperson for associate minister of mental health and addictions Jason Luan said patients on iOAT will be transitioned to other programs by March 2021. (Trevor Wilson/CBC)

Upon seeing the preliminary report in January, Premier Jason Kenney said it underscored the negative impact the consumption sites were having on communities around some drug injection sites, calling them illegal drug sites.

Staff at the province’s seven consumption sites have tended to more than 4,000 overdoses since doors opened in 2018 and no client has died, according to AHS statistics. 

Sweet said the decision to end the iOAT program is an example of the government’s hostility toward harm reduction, and suggested it could be a harbinger for future cuts to treatment. 

“This is just an ideological decision being made by this government that is ultimately going to hurt individuals with addictions,” Sweet said. “It’s the medical professionals that should be making these decisions.”

Kitz, the associate ministry spokesperson, said the program was always intended to be a pilot and the previous government had no transition plan for clients past the two-year mark.

There was no transition plan because there was no plan to end funding, Sweet said. 

Given other treatment options have proven ineffective for clients referred to iOAT, Schulz is concerned some will turn to street drugs again at the risk of arrest or death. 

“To a person in iOAT, it says, to me, this province doesn’t care if you live or die. If you don’t fit into our ideology, you’re not worth saving. And that is a very, very heartless message and that’s not how we do things here in Alberta,” Schulz said. 

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Study finds correlation between U.S. opioid deaths and auto plant closures

A recent study published in the journal JAMA Internal Medicine and co-authored in part by researchers from the University of Pennsylvania has found a correlation between automotive assembly plant closures in the U.S. and opioid overdose deaths. 

Dr. Atheendar Venkataramani, the lead author on the UPenn study, and a team of researchers spent about a year combing through a list of all the automotive plants that were in operation in the U.S. between 1999 and 2016, and comparing plant closure numbers to opioid overdose deaths.

“About five years after a plant closure, the opioid overdose mortality rate — and that’s per 100,000 people — was 85 per cent higher than one would expect had the plant not closed,” said Venkataramani. 

Researchers also found that young, non-Hispanic white men were disproportionately affected by opioid overdose death following an automotive plant closure.

According to the study’s findings, just more than 20 non-Hispanic white men between the ages of 18 and 34 died for every 100,000 people.

In contrast, almost 13 non-Hispanic white men between the ages of 35 and 64 died for every 100,000 people.

A study co-authored in part by researchers at the University of Pennsylvania showed that non-Hispanic white men were disproportionately affected by opioid overdose deaths following automotive plant closures. (Submitted by Dr. Atheendar Venkataramani)

The study found no significant increases in deaths among non-Hispanic white women between the ages of 35 and 65, Hispanic white men and women and non-white men and women. 

Despite the study’s findings, Venkataramani explained that the type of research conducted means that researchers can’t conclusively state that automotive plant closures cause an increase in opioid overdose deaths.

“Because ours is not a clinical trial where the exposure is randomized to people and we’re doing work with observational data, that type of research design can’t prove that the exposure causes the outcome,” he said. “So we can’t say that we can prove it.”

Venkataramani said that his team “did a number of tests” to see if there was a factor other than automotive plant closures that drove the trend in increased opioid overdose deaths. 

… Ours is not a clinical trial where the exposure is randomized to people …– Dr. Atheendar Venkataramani, University of Pennsylvania

“We don’t find any evidence of something else that was going on at the same time,” he said. “Putting all that circumstantial evidence together, we think this is probably what’s happening, but we can’t prove it.”

Though he said it was possible that plant closures in Ontario — like the recent closure in Oshawa, Ont. and the upcoming Nemak plant closure in west Windsor — could suggest Canadians will see a similar increase in opioid overdose deaths, Venkataramani was hesitant to suggest that a similar trend will take place over the course of the next few years.

Listen to Dr. Atheendar Venkataramani’s Windsor Morning interview:

The G-M assembly plant in Oshawa is now closed, but Windsor’s minivan factory continues chugging along. Will the health of people here be better than that of the area around Oshawa in the years to come? An intriguing new study from the United States has interesting implications. Peter Duck speaks with Atheen Venkataramani ,the author of that research. 9:29

“The one thing about our study is that the plant closures we looked at occurred really between 2002 and 2009, during a time when there was less recognition about the opioid crisis here in the U.S.,” he said.

“So it’s possible that in today’s day and age, when we know a lot more about the opiate crisis, we’re more aggressive in screening for substance use disorder, and that there’s more responsible prescribing, that plant closures may not have the same kind of effect that we saw they did in the last 20 years.”

A total of 48 people died of opioid-related causes in Windsor-Essex throughout 2018.

Preliminary data released by Public Health Ontario shows that 38 of the 152 people who visited Windsor emergency rooms due to opioid poisoning died in the first six months of 2019.

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Could cannabis be a ‘silver bullet’ in the fight against the opioid crisis?

This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.

A new study suggests cannabis could be a safer and more effective substitute for opioids in the treatment of chronic pain, but can it help fight the opioid crisis?

Researchers at the University of British Columbia and the B.C. Centre on Substance Use conducted over 5,000 interviews with 1,152 people who used heroin and other drugs and reported chronic pain at some point from June 2014 to June 2017. 

The participants were largely from Vancouver’s Downtown Eastside, and lead author M-J Milloy said the study aimed to discover “new interventions” that might “lower or address the risk of overdose” in heavy opioid users. 

More than 12,800 apparent opioid-related deaths occurred in Canada between January 2016, when the federal government started tracking the data, and March 2019, according to the latest available statistics from the Public Health Agency of Canada.

Milloy said chronic pain is one of the “driving factors” of the opioid crisis, adding that many who can’t get effective pain relief can turn to the black market for opioids.

“This is the population that’s really suffering the worst burden of mortality in the crisis,” he said. “And there’s been some work suggesting that cannabis might be beneficial in the overdose crisis. So we’ve really tried to use our data to figure out if that is true.”

What they found was that daily cannabis use was associated with significantly lower odds of daily illicit opioid use, suggesting cannabis may serve as a substitute treatment in people with chronic pain. 

The story went viral online this week and was picked up in publications in Canada and overseas, including the Daily Mail and The Sun in the U.K.

What the articles failed to mention, however, is that Milloy is also UBC’s inaugural Canopy Growth Professor of Cannabis Science

M-J Milloy was named inaugural professor of cannabis science at UBC last November. (Rafferty Baker/CBC)

While a spokesperson for the university says he receives no funding from any industry group, it is worth noting the cannabis company contributed $ 2.5 million to UBC and BCCSU for the professorship and research. 

Milloy said the fact that his study looked at daily cannabis use raised a “valid concern” about the risk of addiction, but added it’s also linked to therapeutic benefits. 

“A lot of people who are benefiting from cannabis are the people who are using it every day,” he said. 

“We are very aware of the risk of harms. And I want to emphasize that none of us think that cannabis is a panacea or a silver bullet to knock out the overdose crisis. What we do think, though, is that it has tremendous potential.”

Conflicting research raises questions

A day after the UBC study was published, researchers at McMaster University published a review of almost 30 years’ worth of data in the Canadian Medical Association Journal that examined the use of cannabis as a replacement drug for people with opioid addictions.

Researchers looked at six studies involving 3,676 participants dating back to 1991 in an effort to determine the effects of cannabis use on opioid addiction during methadone treatment.

What they found was starkly different than the UBC study — there is no consensus among studies that cannabis use is associated with reduced opioid use.

“There’s a lot of hype and interest and hope that this could be a replacement. Could this be helping people with chronic pain or with opioid addiction?” said senior author Dr. Zainab Samaan, associate professor of psychiatry and behavioural neurosciences at McMaster.

“The reality is that there are no good studies or good evidence to show us it’s beneficial.”

The research also found cannabis use did not result in patients with opioid addiction staying in methadone treatment longer.

Challenges to cannabis research

Samaan concedes that studying the positive or negative effects of cannabis is difficult, especially when studying drug users with addictions to multiple drugs.

“When you’ve got a mix of drugs and a population who are already addicted to drugs, it’s really hard to decipher,” she said. “What is the benefit, what is the harm?” 

The McMaster study also concludes the overall quality of evidence was “very low,” with “critical issues of inconsistency and imprecision to moderate risk of bias.” 

Dr. Hance Clarke says some patients find benefit from cannabis in the treatment of opioid addiction, but the evidence isn’t conclusive either way. (CBC)

“Even though it has been part of our society for decades, the study of this drug was hampered by its illicit label,” said Dr. Hance Clarke, director of pain services at Toronto General Hospital.

“Many of the trials that the medical community are so desperately seeking are just about to be performed, and Canada has the opportunity to create the evidence that will decisively answer many of the unknowns,” he said. 

“Unfortunately these reviews are only as good as the evidence being reviewed.”

‘Benefits for some’

Clarke uses cannabis as a treatment for chronic pain patients at the University Health Network Transitional Pain Service Clinic on an individual basis. 

“I have had patients that have completely stopped using opioids upon the introduction of cannabis, some have been able to reduce their daily opioid dose and remain on both often at lowered doses, others that have completely failed,” he said. 

“The introduction of cannabis for individuals is neither risk-free nor a panacea, however in clinical practice there are benefits for some.”

Clarke said more research on cannabis and opioid dependency is essential to get “credible data” for Canadians, and another review of poor quality research can’t provide definitive answers.

“This is not the end of our journey to help Canadians,” he said. “We remain at the doorstep.” 

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