he opioid epidemic has taken lives across Canada at such a scale that it is beginning to affect average life expectancy. According to Stats Canada, 2017 was the first year average life expectancy did not rise in Canada for nearly four decades.
Hardest hit were the provinces of BC and Alberta, where life expectancy actually dropped. (Ontario and Manitoba saw no change, while the remaining provinces all had small increases.)
Stats Canada is unequivocal about the cause, titling one section of its report on life expectancy “Accidental drug poisoning deaths offset gains in life expectancy in other areas.”
Where Did the Opioid Crisis Come From?
The roots of the opioid crisis can be traced back to the development of pharmaceutical marketing in mid-century America by a man named Arthur Sackler.
Arthur Sackler pioneered direct-to-doctor marketing and dramatically changed the way doctors prescribe medication all across North America, “bringing the full power of advertising and promotion to pharmaceutical marketing,” as the Medical Advertising Hall of Fame put it. Working with his two brothers he constructed a media campaign that would see the amount of antibiotics in the United States increase five times over from 1950 to 1956. (It didn’t hurt that he published a periodical for doctors or that the head of the US Food and Drug Administration’s antibiotics division was paid almost $300,000 by one of Sackler’s companies, as a bribe to promote their drugs.) In the ’60s, Sackler promoted the mass prescribing of tranquilizers like Valium and Librium.
The Sackler brothers purchased Purdue-Frederick Company in 1952, later Purdue Pharma. By the ’80s, Purdue’s biggest seller was a time-release opiate called MS Contin, but the patent was about to expire, threatening their profits. After Arthur died in 1987, his son Richard spearheaded the development of of a time-release version of oxycodone, a powerful opioid developed by German scientists in 1916.
NAZI HISTORY SIDE NOTE
NAZI HISTORY SIDE NOTE
Incidentally, the Nazis seem to have had a soft spot for oxycodone. They overdosed concentration camp inmates with it and dressed them in Polish army uniforms in 1939 as part of Operation Himmler, the false flag operation that opened World War II; Hitler received regular oxycodone injections and the unavailability of the drug in Germany in January 1945 probably contributed to some bunker crankiness as he went through withdrawal; Goring must have been holding out on him, however, as he was later captured by American forces with thousands of doses of it in two suitcases.
As Purdue rolled out their new drug, OxyContin, the Sackler family applied Arthur’s modus operandi to massive success.
The Marketing of Oxycontin
Prior to the release of Oxycontin, opioids were used to treat cancer pain during end of life care, due to their addictive nature.
Purdue’s massive marketing campaign succeeded in convincing doctors it was safe to prescribe these opioids for anything from chronic back pain to acute postoperative pain. As captured in a 1993 New York Times article, experts on Purdue’s payroll opined that opioids were a “gift from nature” and that reticence to prescribe them was nothing more than “opiophobia” based on a “medical myth.”
Meanwhile Purdue had done no studies to establish if OxyContin was addictive, but got the FDA to insert messages into the drug’s packaging asserting that its delayed formula “is believed to reduce the abuse liability.” (The FDA official who approved this measure was rewarded with a plum post at Purdue two years later.) This became a slogan sales reps were trained to parrot, the New Yorker revealed. Purdue also recklessly pushed high doses to maximize profits.
The Opioid Epidemic in Three Waves
The consequences of these overprescribing patterns have been severe. The Washington Post found as many as one third of people who take prescription opioids for chronic pain misuse them. Between eight and 12 per cent of prescribed individuals go on to develop an opioid use disorder, according to the U.S.-based National Institute on Drug Abuse (NIDA).
As people become addicted, they take higher and higher doses of the drug, leading to overdoses. OxyContin, Methadone, and Vicodin are the deadliest prescription drugs, according to the U.S. Centers for Disease Control and Prevention (CDC).
The widespread misuse of these prescription opioids, beginning in the ’90s, is considered the first wave of the opioid crisis. As this opioid crisis began to take hold, study after study was published indicating opioids were largely ineffective in treating chronic or long-term pain – but increased the risk of serious harms due to abuse and overdoses.
Yet even as prescription rates dropped dramatically, deaths did not.
When people’s prescriptions run out or are restricted, some turn to heroin – the so-called second wave of the crisis, visible by the mid-2000s. This trend is visible all across Canada and the U.S , according to both the CDC and CIHI: rates of prescription drug abuse are falling, but deaths have largely remained steady.
In the last five years, a third wave of the epidemic has emerged: accidental overdose deaths from heroin laced with synthetic opioids – in particular fentanyl. Fentanyl is extremely potent – anywhere from 50 to 100 times as powerful as morphine, NIDA says – and can be easily manufactured, making it easy to produce in illicit labs.
Cutting batches of heroin with fentanyl is an easy way to make money selling drugs. It has become increasingly common for drug dealers to mix large quantities of low-quality heroin with a small amount of fentanyl. Doing so dramatically increases the chances of an accidental overdose.
Despite the double digit drop in opioid prescription rates across B.C. from 2016 to 2017, deaths from illicit street drugs rose from 993 to 1,495 – nearly 74 times the number of deaths just 10 years earlier.
Fighting the Opioid Epidemic
To combat the epidemic, officials in cities across the province have been calling for access to medical-grade heroin for those in need.
To date, Vancouver is the only city in North America to have instituted such a policy. Providence Crosstown clinic offers “medical-grade heroin (diacetylmorphine) and the legal analgesic hydromorphone within a supervised clinical setting to chronic substance use patients,” according to their website.
Additionally, Vancouver mayor Kennedy Stewart recently called for a Health Canada exemption from federal drug laws so that a non-profit organization can offer diacetylmorphine, a safe substitute opioid.
BC has also opened dozens of overdose prevention and supervised consumption sites, where people can use illegal drugs under medical supervision. So far, no deaths have been recorded at these sites and they may be helping to turn the tide of overdose deaths. The BC Coroner’s office reported that overdose deaths dropped 30% in the first five months of 2019, compared to the same period in 2018.
Accountability for Pharmaceutical Companies?
Meanwhile, pharmaceutical companies are only now beginning to face the repercussions for the aggressive marketing tactics that launched the opioid crisis.
The state of Oklahoma became the first state to successfully sue a major pharmaceutical company over this epidemic on Aug. 26 of this year, according to CNN. The suit named three major pharmaceutical companies: Teva, Janssen, and Purdue Pharma. Two of the companies, Teva Pharmaceuticals and Purdue Pharma, settled for amounts of $85 and $270 million (U.S.) respectively.
The state won its case against the third company, Janssen Pharmaceuticals, the creator of fentanyl and a subsidiary of Johnson & Johnson. Janssen was ordered to pay $572 million to Oklahoma.
On Sept. 15, Purdue Pharma officially filed for bankruptcy as part of a 12 billion dollar settlement to resolve over 2,600 additional cases across the United States.
Days after the ruling, Purdue Canada proclaimed itself to be a separate entity from its southern neighbor.
BC Attorney General David Eby intends to continue the class-action suit he filed in 2018 against Purdue Canada, according to CBC. The suit aims to recover healthcare costs for the opioid crisis on behalf of the federal, provincial, and territorial governments, on account of Purdue Canada’s misleading and aggressive opioid marketing.
Amid reports of the Sackler family transferring funds to offshore locations, Reidar Morgan, Lead Council on the B.C lawsuit, applied to add individual Sacklers and senior Purdue Canada management to the claim.