Tuesday, January 3, 2017

How Big Pharma sparked Canada’s opioid crisis

In 1992, the Canadian subsidiary of U.S. drug giant Purdue Pharma promised remarkable things from it's new pain reliever. It said it would "transform the way doctors treat pain" and not only that, it was safe, doing it all “without unacceptable side effects”.

The drug was awarded Canadian Patent No. 2,098,738. Its official title: controlled release oxycodone compositions. Purdue called it OxyContin. It would go on to become a blockbuster drug – the most popular long-acting prescription painkiller in Canada for more than 10 years, and one of the most lucrative pharmaceutical inventions to ever hit the market.
The profits from OxyContin were massive, and growing every year. In Canada and the United States Purdue made more than $30-billion from OxyContin since the mid-1990s. One of the biggest backroom battles in Canadian pharmaceutical history followed as other drug makers fought over OxyContin’s spoils. Known to all were the deadly problems emerging with the drug.

OxyContin is highly addictive. Patients were becoming hopelessly dependent, unable to break their habit and requiring stronger doses as time went on. Some people were dying.
Morphine was first isolated in 1803, and its use as a painkiller took off in the 1850s. In a quest to find a less-addictive alternative, researchers began working on isolating other parts of the plant. Diamorphine was found in 1874, before Germany’s Bayer Pharmaceutical created a painkiller nearly three times as potent as morphine. Bayer called the drug heroin, coined after the German word heroisch, which meant “strong and heroic.”

Heroin was just as habit-forming as morphine, and even more addictive. The company was forced to pull it from shelves in 1913. Researchers turned to the third element of the Persian poppy – thebaine – and ended up creating oxycodone in 1916. While morphine is a natural derivative of the Persian poppy, heroin and oxycodone are chemically modified versions of the plant’s narcotic properties. Like all opioids, the most dangerous side effect was its depressive effect on the respiratory system. Patients who took too much would simply stop breathing.
Purdue was new to the opioid business – but it had a lot of experience in marketing. It used all-expenses-paid educational seminars, held in sunny locales 5 or 6 times a year, to further highlight OxyContin’s safety. Another approach known as the KOL, or Key Opinion Leader. KOLs were physicians the drug company targeted to spread the word to others in the medical community. With an army of representatives on incentive plans, Purdue also took its message to medical schools.

Aimed at ‘softening up’ the medical profession to see OxyContin as a benign drug, it worked to perfection.
As physicians began prescribing OxyContin for conditions beyond severe pain, the rate of addictions soared. And because the pain of withdrawal was often worse than the condition the opioid had been prescribed to treat, some patients quickly became long-term users and built up a tolerance that required more powerful dosages. Purdue later admitted that it knew it's claims about OxyContin weren’t accurate, but as the profits piled up, the company wasn’t about to stop.
The scope of the problem did not become publicly known until May 2007, when the company’s U.S. parent and three of its top executives settled criminal and civil charges against them for misbranding OxyContin as less addictive than other narcotics. The company agreed to pay $634.5-million in fines – at the time, one of the largest settlements a pharmaceutical firm had paid for marketing misconduct.