Oxycontin in Ontario: Wildly Addictive and Barely Regulated

Crushed up oxys. via.

Roger Martin lights a cigarette and takes a drag, his eyes are squinting from the bright sun shining on him.  He has sunglasses sitting on his head, but he wants to look you in the eye, dead on. He has become very good at this. For over a decade Martin has been an expert at tricking his audience of family members, physicians, and pharmacists, faking injury or using forged prescriptions to get his next fix. Once a family man and small business owner, Martin has spent the last year in and out of homeless shelters because of his addiction to the prescription medication, OxyContin. A drug developed by Purdue Pharmaceutical.

Last month Masionneuve magazine published a story, "First Do No Harm", about Dustin King and Donna Bertrand, two individuals who were fatally affected by the drug in 2008. The article explores the issues of negligence in the medical field and possibly on behalf of Health Canada and Purdue Pharmaceutical. But I wanted to take a closer look at someone like Roger Martin who, so far, has lived through the addiction—as well as try to get to the bottom of what’s really cracked in the system. I know this problem affects more people than we might ever know in exact numbers. Addiction embarrasses people—but since OxyContin hit the market in the late 90s, it has turned some of the most unsuspecting people into hardcore addicts.

Last spring, I started researching the culture of prescription drug-abuse in Ontario in an attempt to figure out what was going on. My initial questions about the structure of pharmaceuticals in Ontario led to even more questions about how it’s all accounted for—and eventually I realized that the whole system is pretty much fucked. Basically Health Canada, as the regulators of therapeutic products in Canada, has been allowing Purdue Pharmaceutical to run rampant and Canadians have paid the price.

The active ingredient in OxyContin is Oxycodone, an opioid drug. OxyContin is basically a synthetic version of heroin, and as such, is often referred to as ”Hillbilly-heroin.” It was marketed as an effective, time-released painkiller, but its highly addictive nature has created an epidemic of severe long-term dependency in some users, and in some cases, has even resulted in death.

The first time Martin was given OxyContin was at St. Joseph’s hospital in Toronto after hurting his knee while doing some small home renovations. He waited in the emergency room for a couple of hours, met with an emergency room doctor for about twenty minutes, and was sent him home with his first prescription of OxyContin in the form of 50, 40-milligram pills. “I’d never felt so good in my life, I’d just never felt anything like it. It’s like being in a dream, nothing can bother you when you're high like that.”

Martin, who had never before suffered with substance abuse issues before, says he became hooked almost instantly. The prescription he was given lasted long past the pain of his injury, and when that first prescription ran out, he quickly realized how addicted he had become. “Being high on Oxys feels like heaven, but coming down feels like the worst kind of hell you could ever imagine. I honestly couldn’t take it.” I talked to a few more OxyContin addicts to hear about their experience with withdrawal symptoms, and they all described as being basically the most horrendous thing they’d ever experienced. Most of them hadn’t recovered and have turned to Methadone for help. Oxy withdrawal is considered to be more painful than almost any other drug out there. One addict shared a story with me about a friend of theirs who died from trying to quit the habit cold turkey.

It seems like the main problem for Martin started as soon as his knee had healed—the pain he continued to experience was no longer from his injury but the withdrawal of OxyContin after being over-prescribed the medication. This is often how and why the cycle of abuse begins. In no time at all, Martin discovered how easy it was to get more.

“It’s honestly easier than buying drugs on the streets,” says Martin who had filled up to five prescriptions in one day in Toronto. Sometimes he would use a forged script, which usually starts with a stolen script pad from a doctor’s office and then signing the doctor’s signature along with the required info of the required drug. Martin learned how to do this very well. “The independents are the best ones to go to, because they just want their fee. They don’t really care what you’re up to.”

The OxyContin epidemic in Ontario could be blamed on a number of flaws in the system. Negligence on behalf of regulators (Health Canada) is obvious, but accessibility has been a major problem too. There has been absolutely no monitoring system in place. A total lack of interconnectedness between pharmacy networks has made the system very easy to abuse.

In Ontario, someone like Martin could refill multiple prescriptions in one day, often with no questions asked, even at big chain pharmacies, such as Shoppers Drug Mart. While other provinces such as British Columbia and Nova Scotia, have very strict monitoring systems in play. So it has basically been a free for all here. Head of communications for Ontario College of Pharmacists, Lori DeCou, agreed Ontarians probably would have benefited from a proper monitoring system years ago.

“Groups of physicians have been asking for years for an opioid prescription monitoring system and have got nothing,” says Dr. Sharon Cirone, who works in a Methadone clinic in downtown Toronto and has describe this new culture of drug addiction as an epidemic in Ontario.

“I never really thought of myself as a ‘drug addict’ because I was getting these pills from doctors and at pharmacies.” Martin began double-doctoring, which means he would visit multiple doctors to get multiple prescriptions for the same treatment. Martin told me this was pretty easy to do. “The more I needed the drug, the more of a criminal I became. I started stealing pads of empty prescription sheets and filling them out myself. It sounds bad, but at the time, it’s all I could think about.” Aside from the highly addictive properties of Oxycodone, users will build a dependency and begin needing more and more of the drug. Someone who starts off taking one or two a day, like Martin, will start to need double, then triple that amount, in order to achieve a desired high and avoid the disgustingly painful withdrawal symptoms.

Martin’s life quickly spun totally out of control and it wasn’t long before he’d lost everything. Lying and cheating almost everyone who knew, Martin had become the ultimate con, and he says there isn’t anyone he didn’t screw over. For Martin, his addiction to OxyContin cost him life. “I had a business, I was happy, I had money and a family. Now I got nothing, the clothes on my back,” says Martin with a laugh while he shakes his head.

The ability to double-doctor in Ontario is a serious problem, but there have also been cases of “dirty-doctoring” where physicians have prescribed drugs for people who don’t need it. And since no one was really counting prescriptions, for the most part it went undetected.

The motives of dirty doctors are still not fully understood. Martin told me most people speculate cash is probably the incentive. “Some doctors have made a lot of money doing it, you got a deal with a guy, and everyone makes money. I know doctors that can see up to a hundred people in one day,” says Martin, laughing at how shitty the system is. The street value of prescription drugs is high and since abuse began to skyrocket in the early 2000s. It’s not a bad business for anyone. To put it in perspective, a prescription for 100 pills of 80-milligram OxyContin could have earned you $8,000 dollars last spring.

“Physicians will be disciplined for incompetence or poor prescribing practice. Professional misconduct or incompetence allegations can lead to penalty,” says Kathryn Clarke from the Ontario College of Physicians, who is aware this is a problem. In the spirit of transparency, Clarke told me all acts of misconduct can be found on the CPSO website. On this site you can see all the physicians the CPSO’s Disciplinary Committee has outed. There are all kinds of doctors who have engaged in “disgraceful, dishonorable or unprofessional behavior.” Including negligent prescription writing. Good to know!

Purdue Pharmaceutical in Pickering, Ontario. via.

In the spring of 2012, Purdue Pharmaceutical announced that they would be changing the construct of their drug into a harder to abuse version, OxyNEO. “OxyNEO is an effort to make the tablets more difficult to be manipulated for the purpose of misuse and abuse,” said a spokesperson for Purdue Pharma Canada. I guess you could argue that Purdue changed the construct of their drug out of the goodness of their heart, figuring they had made enough money. But it was probably because their patent for OxyContin was going to be running out later that year and in a bid to stay competitive, they altered it slightly.

Health Canada has not once intervened. “Once Health Canada has authorized a product to be sold in Canada, the decision to make it available for sale on the market rests on the manufacturer,” says Gary Holub, spokesperson for Health Canada, after I started trying to figure out who approved this stuff. Health Canada approved OxyContin in January of 1996 and has never seemed to question its crazy rise in sales or its highly-addivtive ingredients. Even despite awareness that, in 2007, three executives of the American branch of Purdue Pharma pled guilty to misleading regulators and the public about the risk of addiction to OxyContin. Purdue Executives agreed to pay over $600 million dollars in criminal and civil fines. Seriously—why hasn’t Health Canada done anything? After hardly answering anything at all, Holub told me if I had any further questions about OxyContin and the related issues of dependency and deaths of Canadians, to “please contact the manufacturer.”

Anyone can do a search on Health Canada’s website and find records of the reported deaths related to misuse of OxyContin. I spoke with a representative from the Office of the Chief Coroner who quickly emailed me some graphs related to Oxy deaths. These records showed that from 2002-2011, 1137 people had died from the use of a prescription Oxycodone product in Ontario and that was the highest death rate of any narcotic.

When I started asking Health Canada more narrowed questions, they didn’t have a lot to say. They didn’t know how many people had developed a drug dependency to Purdue’s product. They rely on people to report their own addictions, and admitted that most people don’t.

They also had no idea how many prescriptions for OxyContin had been written. They told me they don’t count that and that instead they hire an outside company, IMS, to do that for them. IMS is an independent, worldwide company who also sells that information back to pharmaceutical companies, such as Purdue, so they can better understand how and where their products are selling. When I asked Health Canada how they could regulate something they aren’t counting, they said they needed time to respond and never did.

Dr. Cirone told me she believes there are huge faults in the system. “A main problem is that all Opioids are addictive and physicians don’t have the proper training to understand this. They have training in writing prescriptions but little-to-no training when dealing with opiods, addicts, or addictions. Addiction can happen to anyone.”

OxyContin is a drug that suburban moms and typical “junkie” types are hooked on—and addictions don’t go away because you start calling the drug something else, like OxyNEO. There are still plenty of other opiods available to the public anyways, like Hydromorphone, Fentanyl, and Heroin. “If I go back out I would probably smash heroin, it would be easier to get now and it would be cost effective too. I wouldn’t like it, but it’s probably what I will do,” says Martin to me.

Both OxyContin and OxyNEO continue to hold valid authorization in Canada, although “OxyContin” technically is not being produced, other companies are making basically the same product. Health Canada approved, despite some public outcry, the generic versions of OxyContin last summer so that when Purdue’s patent did run out, others could go ahead and make it. Now there are six other pharmaceutical companies making similar versions of this killer drug.

When I asked a representative of Purdue, which is located at 575 Granite Court in Pickering, how they felt about all the people who have suffered because of their product, they had no comment. When I asked them how they felt about about all the people who had died as a result of using their product, they had no comment. When I asked them how they felt about being compared to tobacco companies (although heavy abuse of Oxys, or any other Oxycodone product, will kill you much quicker than tobacco), they had no comment on that either.

When Martin is talking to me his words come out more like warnings than conversation. “Withdrawal symptoms are so severe, you could never imagine. You feel like you're going to die. I have puked for hours, days even. I would do anything to relieve that pain.” he keeps looking at me, wide-eyed and confident. Not the picture of a wounded drug-addict, but instead the picture of a man scared as fuck that he’s not going to be able to stay clean.

Martin takes one more drag of his cigarette and finally puts his sunglasses on, just as the sun has started to go down. He has a kind face. He is trying hard to stay clean, but it’s a serious uphill battle after years of abuse. Addiction stays with you for life, whether you are in recovery or not. He is terrified of himself.

Follow Angela on Twitter: @AngelaMaries

More on Oxycodone from VICE:

How Big Pharma Created a Generation of Oxyconteens in the US

Drugs 101

Extreme Close-Up of a 30mg Oxycodone