Via CBC News, a chronicle of many deaths foretold: New questions about old Canadian study foreshadowing opioid crisis. Excerpt:
More than 20 years ago, a team of Vancouver doctors discovered disturbing signs of a future opioid crisis — research that was noticed at the time by U.S. officials from Purdue Pharma, the company that made OxyContin, according to a report this week in the New York Times (NYT).
It raises new questions about how long the pharmaceutical industry knew their opioid pain pills were being abused and whether early warnings were ignored.
It also raises questions about what Canadian regulators knew about the addiction risk of the new opioid drugs and whether Health Canada could have acted to avoid the crisis that has killed thousands of Canadians over the last two decades.
Back in 1997, Dr. Stefan Grzybowski was getting repeated requests for large quantities of prescription narcotics at his downtown Vancouver medical clinic.
"I remember one fellow telling me that if I didn't give him the pills he'd just have to go buy them on the street," he told CBC News.
That prompted Grzybowski, who is also a research professor at UBC, to investigate the illegal dealing of prescriptions drugs. He began by asking his patients for information about which drugs were selling on the street and how much they cost. But he wasn't getting very far. Then his colleague, Dr. Amin Sajan, a medical resident, tried a different approach.
"He [went] right downtown and interviewed the buyers and sellers on the steps of the Carnegie Centre, which was quite a brave and amazing thing to do."
What they discovered shocked them. They found that lots of prescription sedatives and narcotic drugs were selling on the street at surprisingly high prices. And the most valuable drugs were morphine MS Contin pills made by Purdue Pharma — called "peelers" because the coating on the pill was peeled back to release the drug inside.
This was one of the first formal studies on the street value of prescription drugs. When the findings were published in the CMAJ in July, 1998 the research came to the attention of Purdue Pharma officials, according to the NYT story.
Aggressive marketing campaign
The opioid manufacturer was running an aggressive marketing campaign to promote its new opioid, OxyContin, a synthetic oxycodone-based pain medication — stronger than morphine — approved a few years earlier.
"Purdue Pharma, the company that planted the seeds of the opioid epidemic through its aggressive marketing of OxyContin, has long claimed it was unaware of the powerful opioid painkiller's growing abuse until years after it went on the market," NYT reporter Barry Meier wrote.
"But a copy of a confidential Justice Department report shows that federal prosecutors investigating the company found that Purdue Pharma knew about "significant" abuse of OxyContin in the first years after the drug's introduction in 1996 and concealed that information."
CBC News has not seen the documents and has not been able to independently verify the NYT story.
Among the evidence in Justice Department documents cited by the NYT are references to the Canadian study. The NYT story quoted a Purdue Pharma spokesperson who said, "The company did not consider the small study's results significant because it was already known that morphine could be abused."
But back in 1998, in the same CMAJ issue, Dr. Brian Goldman wrote an editorial saying the Vancouver study should "ring alarm bells."
"The relatively high street price of controlled-release opioid analgesics reported in this study clearly indicates that these drugs are coveted," Goldman wrote, adding a prescient warning about the new opioids.
"Now that controlled-release oxycodone has been licensed in Canada, we can expect that it and other controlled-release opioid analgesics will also find their way onto the black market."