Yesterday the Canadian government decided that it would not interfere in the release of generic OxyContin. Ministers of Health from several provinces had asked the Federal Minister of Health, the Hon. Leona Aglukak, to intervene and block the release of this medication. She refused, citing that it was only “one of many” prescription drugs that is abused, and calling on her provincial counterparts and doctors to work harder to deal with the problems of prescription drug abuse. This is another example of the Federal Government relinquishing its role in health care but that is a topic for another time.
Today I want to consider what the release of Generic OxyContin will mean in my psychiatric practice, comprised of youth aged 16 to 20. As the Director of a large Youth Outpatient and Outreach Psychiatry Program, my team provides assessment and treatment to hundreds of youth each year. While the most common conditions we treat are Anxiety Disorders and Major Depressive Disorders, over 60% of the young people we see are abusing alcohol and other mood-altering drugs, including prescription drugs, to such an extent that they cannot safely be treated with antidepressants. A harm reduction program to reduce that use and psychotherapy are ususally our first treatments because of this.
The impact of drug abuse in this population is devastating. At a time when schoolwork must be a primary consideration, schoolwork and attendance are often affected. As well, most drugs of abuse are mood-altering and it is very difficult to determine to what extent the drugs are causing the mood disturbance. The impact of the substances they are using is not always accepted by youth – often because we are dealing with those who are addicted to a substance and not ready to accept the impact it is having in their lives.
Last year at this time, OxyContin was one of the drugs commonly abused by the young people in my clinic. Sometime in February 2012, the Ontario Provincial government(along with other provincial governments) announced that it would no longer fund OxyContin. As the supply of Oxycontin diminished, we did notice a few young people whose drug use overall diminished, likely because they were forced into a “harm reduction” situation and once that began, these young people were able to move forward to a much reduced level of use. While abstinence is usually cited as absolutely necessary for the treatment of addiction, we often start pharmacological treatment for anxiety and depression once drug use has dropped significantly. Some practitioners will start pharmacological treatment even when drug use is at its peak but the evidence would suggest that, in the treatment of Anxiety Disorder and Major Depressive Disorder, mood-altering drugs can interfere with the efficacy of medication. In that circumstance, in my view, it is not possible to conduct an adequate trial of a medication. I wait to see reduced use before introducing medication.
But now, generic oxycontin will be released, possibly within days and so I anticipate that, with this prescription drug available once again, we will see its impact as it comes into the system. The Provincial Ministry of Health will no doubt restrict funding under the Ontario Drug Plan, but this drug will make its way back. The Federal Government could have prevented this. Provincial Ministers asked for the Federal Government to intervene and stop the release of this drug. Given the evidence that this would have been supportive of addiction treatment and a good strategy in the Federal Government’s own anti-drug strategy, one is left wondering about the rationale. The first young people to find it as they seek relief from their pain will likely have it by the end of the month…