Oxycodone toxicity deaths in Ontario totalling about 150 a year, more than from HIV, says chief coroner

BROCKVILLE, Ont. | Ontario’s chief coroner says in 2008 almost three deaths each week in the province were due to oxycodone toxicity, and that the levels remain about the same today.Dr. Andrew McCallum, speaking at a coroner’s inquest here June 21, said the “narrative” around the 148 deaths recorded in 2008 revealed that in the “vast majority” of those cases the deceased had taken long-acting OxyContin. (Post mortem toxicological analysis cannot identify the source of the active ingredient oxycodone or how it was ingested.)Some of those who died were using diverted OxyContin that was not prescribed for them, he explained. But “some—and this is an important consideration—were using it within the context of therapy. . . they may have just been taking more than was intended or they may have been prescribed a dose that was above the safe level.”The inquest began on June 2 and is examining the events surrounding two deaths in this eastern Ontario town in late 2008. Dustin King, 19, died of an unintentional oxycodone overdose in the apartment of Donna Bertrand, a 41-year-old mother who also died from an overdose of anti-depressants. She passed away 11 days after King’s death.Witnesses have testified Bertrand sold some of her OxyContin prescriptions.Dr. McCallum said oxycodone toxicity deaths in the province escalated “exponentially” from 2000 to 2005. The numbers then continued to climb from 96 deaths in 2005 and now appear to have plateaued. He said internal coroner's office figures from 2009 (the latest available) indicated 143 deaths that year but the rate is not declining, he told the inquest.The annual tally for oxycodone toxicity deaths in Ontario is more than for HIV-related deaths and is approaching the level of sepsis deaths, Dr. McCallum observed. Concern among professionals centres on the high doses of oxycodone that are being prescribed for patients with chronic (non cancer) pain, he added.At the time of her death, local family physician Dr. Alan Redekopp was prescribing Bertrand, who was on antidepressants and complained of a sore back, a daily dose of 1440 mgs of OxyContin, the inquest has heard.The inquest is hearing from a range of expert witnesses on the issues of “prescribing, diversion and monitoring of opiates,” as inquest documents state.“Doctors are very unhappy about what is going on but feel somewhat abandoned,” Dr. Meldon Kahan told the inquest June 20. Dr. Kahan is the medical director of the Addiction Medicine Service at St. Joseph’s Health Centre in Toronto, and was brought in as an expert witness.Until recently, physicians were getting very little prescribing information and help from regulatory bodies and instead their major source of information was pharmaceutical companies, he said.Dr. Redekopp told the inquest that he saw sales representatives for Purdue Pharma, the manufacturers of OxyContin, on average every two months and that they never mentioned a maximum dose for the drug.Dr. Redekopp has lost his narcotics prescribing privileges and is to appear before a College of Physicians and Surgeons of Ontario (CPSO) discipline committee in connection to his prescribing practices.A written complaint about his prescribing practices was made to the CPSO by Brockville police detective constable Tom Fournier, the inquest heard June 22.Practice guidelinesThe Canadian Guideline for Safe and Effective Use of Opioids for Non-Cancer Pain, created by experts with regulatory college funding, was published in early 2010 and later that year the CPSO published a guiding document for physicians, entitled Avoiding Abuse, Achieving a Balance: Tackling the Opioid Public Health Crisis.Detective Sergeant Rick Hawley of the Ontario Provincial Police told the inquest that because prescription painkillers are legal, addressing their misappropriation and abuse is challenging.Unlike illegal drugs, where organized crime is involved and supply can be affected by many factors, “we are talking about a drug that people get attached to . . . and once they have a source they can usually get it,” said Det. Sgt. Hawley, who is the operational support and training coordinator with the OPP drug enforcement unit.A false sense of security also surrounds the drug, he said. People assume it is “clinically safe,” yet the addictive quality of OxyContin is very high and its impact has been described by users as similar to heroin, he said.Det. Sgt. Hawley told the inquest the problem with prescription painkillers is so serious the province should create a special joint police task force. The Ontario Ministry of Health has already provided for three OPP officers to investigate suspected prescription narcotic problems within the Ontario Drug Benefit Plan, but that covers only about 25% of the province’s population.The chief coroner attributed the rise in prescription painkiller deaths to a change in opioid prescribing philosophy over the last 20 years from an “as needed” basis, where the pain control was proving to be inadequate, towards constant, slow release, dosing.“There is evidence that, for example, in the post operative situation (constant dosing) is beneficial—people heal better if their pain is better controlled. The problem in my estimation is that it has spilled over into other areas where there is a more chronic pain situation” and medication is being prescribed at much higher doses than in the past, said Dr. McCallum.The inquest continues.

Oxycodone toxicity deaths in Ontario totalling about 150 a year, more than from HIV, says chief coroner

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