OxyContin phase-out brings 'panic' for addicts
B.C.'s decision to clamp down hard on prescription access to oxycodone-based narcotic painkillers has prompted concern that desperate addicts may turn to other drugs or crime.
OxyContin, dubbed "hillbilly heroin" on the street, is being phased out by its maker and replaced with OxyNEO, which contains the same active ingredient but comes in a different pill form that's harder to crush and then snort or inject.
B.C.'s health ministry said Wednesday it will no longer cover OxyContin through PharmaCare as of March 8 and new prescriptions for the replacement OxyNEO will be approved only in exceptional cases through a special authority program.
Dr. Caroline Ferris, who works at the 30-bed Creekside Withdrawal Management Centre in Surrey, said more than one-third of incoming detox patients are addicted to prescription drugs and many of them are on OxyContin.
"It's a big problem," she said, predicting a rise in armed robberies and other crime as the last of the drug vanishes later this month and its street price skyrockets.
"I think there will be a lot of panic," Ferris said. "We're probably going to see more break-ins to pharmacy warehouses and other places stockpiling the last of the OxyContins."
Most illicit users will simply switch to heroin, she predicted.
Legitimate patients will still have access to either OxyNEO or other opioids, Ferris said, adding she supports the province's decision to try to curb abuse of the prescription drug.
"It's just as well that this stuff comes off the market," she said.
OxyContin sells for $50 to $60 per 80-milligram tablet on the street, where it trades like currency.
Ferris said part of the problem is that plenty of people obtain the drug by prescription who don't actually use it themselves.
Some who have good benefit plans get it for free and pass it on to friends or family who would have to pay more for it.
Ferris said others on welfare may get OxyContin free through PharmaCare, sell the pills, and then use the money to buy alcohol, crack or heroin – all of which are much cheaper.
She estimated 20 per cent of controlled prescription drugs like OxyContin end up in unauthorized hands.
Ferris said a serious effort should be made to "weed out the diverters" – possibly by doctors conducting urine tests of patients to find those who don't actually use the pills they're prescribed.
She also expects PharmaCare to carefully scrutinize all OxyContin patients who seek to switch to OxyNEO.
Ann Livingstone, an advocate with VANDU (Vancouver Area Network of Drug Users), also expects reduced oxycodone access to trigger a switch to more potent narcotics such as morphine derivative Dilaudid or heroin.
"There needs to be some outreach," Livingstone said. "People can be very, very vulnerable when they're in withdrawal. That's when you'll see women take stupid chances if they're selling sex or men decide to rob some place."
She said OxyContin abuse is big in the Abbotsford area, where recreational users have taken to crushing the pills and snorting the powder.
Others start on the drug after a car accident or sports injury and over time increase their dosages beyond what is covered as their dependency grows.
"Then they just start buying from the black market."
Livingstone said health officials should look at ways to offer substitution therapy drugs, like Suboxone, to help wean users and prepare for a surge in detox demand.
But at Creekside Withdrawal, the sole inpatient detox centre serving the entire Fraser Health region, there are no empty beds and a three-week wait to get in.
Health ministry spokesman Ryan Jabs said OxyContin was prescribed to 11,000 B.C. patients last year, mostly for short-term use. He said that represents about 1.5 per cent of all opiates prescribed for chronic pain.
There will be a one-year transition period allowing patients with existing special authority approvals to continue to get OxyNEO until Feb. 28, 2013. Palliative care patients are not affected by the policy change.
Jabs said B.C. already had more stringent safeguards on prescription drug access and therefore does not expect as challenging a transition as other provinces, such as Ontario, that are taking similar steps.