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A ‘controlled substance’ is any type of drug whose manufacture, possession or use is tightly regulated by a government because of the higher-than-average potential for abuse or addiction. In Canada, controlled substances fall under the parameters of the Controlled Drugs and Substances Act (S.C. 1996, c.19).  How is it, then, that hundreds of thousands of doses of OxyContin, morphine and other prescription narcotics are ‘robbed, pilfered or otherwise lost’ from the supply chain each year in this country?

On January 23, the National Post’s Tom Blackwell published some startling statistics about the not-so-slow leak of prescription narcotics from the supply chain. According to the Post’s research (based on Health Canada statistics), only 64% of the loss and theft of oxycodone (the active ingredient in OxyContin) is attributable to theft from, or robbery of pharmacies. Suppliers higher up the chain (e.g. manufacturers and importers) are also losing significant volumes of product, accounting for the other 36% of total loss. What scale of loss are we talking about here? If we just look at oxycodone, the combined black-market value of losses from pharmacies and ‘licensed dealers’ (producers, distributors, wholesalers) in 2010 was just over $18 million. That’s roughly a half million tablets.  Professor Benedikt Fischer, an addictions expert at Simon Fraser University summed it thusly: “This isn’t some trivial problem. We’re now looking at a problem that is a major source of disease and death. These drugs are killing a lot of people.”

The volume of drugs taken from wholesalers and distributors has also increased substantially in the past five years.  It is difficult to put a finger on any single cause.  Blackwell's article presented some prime suspects for consideration, including cutbacks in the number of controlled substance inspectors and the bare fact that a trend of increasing prescription rates for opioids translates into more opioids being in the proverbial pipeline.

It is critical that Health Canada gets to the root of the supply chain leaks.  Fischer's "these drugs are killing a lot of people" was no overstatement.  Indeed, as discussed in an earlier blog, accidental deaths in Ontario due to opioid use exceed deaths from HIV.  And from the Globe and Mail (January 6, 2012): the same number of people die from opioid-related deaths in Ontario each year as they do from motor vehicle accidents.  

Jennifer Hartman, guest blogger

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Last Friday, the Ontario Ministry of Health announced plans to introduce legislation later this month that will allow the province to expand its drug database to track prescription drugs. The narcotics database will identify prescription ‘hot spots’ and alert officials when a patient attempts to fill prescriptions from multiple doctors at multiple pharmacies. Prescriptions under both public and private drug plans will be monitored. [Currently, the tracking system only tracks drugs prescribed under a provincial program that funds meds for seniors, welfare recipients and the disabled.] Provincial Health Minister Deb Matthews indicates that the plan will also work with regulatory groups like the College of Physicians and Surgeons of Ontario to create ‘better pain management strategies for its members’. The proposed narcotics strategy has received resounding support from both the Centre for Addiction and Mental Health (CAMH) and the Ontario Pharmacists’ Association.

Earlier this year, I blogged about the issue of ‘doctor shopping’, defined as the practice of visiting numerous doctors, dentists, or pharmacies to fraudulently obtain prescriptions for non-medicinal use. Of particular concern are narcotics and other controlled substances, including painkilling opioids (including morphine, codeine-containing Tylenol 2s, 3s and 4s, Percocet, Oxycontin, and Fentanyl), stimulants (amphetamines such as Ritalin) and sedatives (such as Valium, Xanax, and Ativan).  Some stark statistics:
• In the past decade, prescriptions for oxycodone-containing drugs jumped 900% in Ontario. Last year, under the OHIP drug plan, the province spent over $150 million for narcotics, half of which was for Oxycontin.
• 18% of students (Grades 7 – 12) report using prescription opioids non-medicinally in the past year. The overwhelming source for the students’ opioids was not schools, or the street, but their own homes.
• Ontarians, per capita, use three times more prescribed narcotics than patients in other provinces.
• Last year, the Canadian Medical Association Journal reported that in Ontario, accidental deaths due to opioid use exceeded deaths from HIV.

As an aside, I am curious: In estate proceedings where testamentary capacity is in dispute, will the contents of the narcotics database be accessible pursuant to court-ordered production of “all relevant medical records”?
 

Jennifer Hartman, Guest Blogger
 

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'Doctor shopping' is the practice of visiting numerous doctors, dentists, pharmacies and/or emergency rooms to fraudulently obtain prescriptions for non-medicinal use. Increasingly making headlines, doctor shopping is considered to be the most common means by which people addicted to prescription drugs get their hands on their drugs. It is often assumed that someone doctor shops for the purpose of feeding their own personal addiction, however, there is a subset of doctor shopping activity for the intent of street sale. Depending on the drug, street value can range from $0.25 to $75.00, per pill.

Is it illegal?  Under the federal Narcotic Control Regulations (made under the Controlled Drugs and Substances Act, 1996), “a person who has received a prescription for a narcotic shall not seek or receive another prescription or narcotic from a different practitioner without disclosing to that practitioner particulars of every prescription or narcotic that he or she has obtained within the previous 30 days”. To wit, in 2006, a Toronto woman was charged with filling prescriptions for almost 14,000 pills at nine pharmacies across the province.

How is it monitored?  Nine of ten provinces have some form of system in place to track prescription-related information such as double doctoring. As an example, in 2008, Health Canada ordered pharmacies in Atlantic Canada to track narcotic prescriptions by family physicians after rates of narcotics abuse were found to be highest in that region. However, since there is no national surveillance system in place, the monitoring of doctor shopping and fraudulent prescription drug acquisition in Canada is a patchwork approach, at best.

How big is the problem?  In 2002, Canada reported the fourth highest per-capita use of prescription narcotics in the world. The Centre for Addiction & Mental Health, in a study published that same year, indicated that 11% of admissions to substance abuse treatment programs in Ontario were for prescription drug abuse. A 2007 study released by the Canadian Centre on Substance Abuse (CCSA) cited evidence that “Canadians are among the heaviest consumers of psychotropic medication in the world”. And according to a 2008 study published in the journal Contemporary Drug Problems, North America has the world’s highest consumption of medical prescription opioids (consumption levels have, in fact, doubled in the past decade). Earlier this year, Narconon Alcohol and Drug Rehab Center reported that nearly half the calls they receive are with regards to prescription medications (primarily Oxycodone, Percocet and morphine).

How does prescription drug abuse relate to mental capacity?  The most coveted drugs targeted by doctor shoppers are the opioids (including morphine, codeine-containing Tylenol 2s, 3s and 4s, Percocet/Percodan, OxyContin and other pain-relieving agents) and the benzodiazepines (including Valium, Serax, Xanax, Ativan and Halcion and other agents used for sedation, relief of anxiety or as muscle relaxants). These drugs are known to have detrimental effects on perception, attention, alertness, memory, orientation, attention and decision-making.

Jennifer Hartman, guest blogger