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| Serena Eshaghurshan |
The liberalization of opioid prescriptions and the correlated increase in illicit opioid use have rendered a devastating impact on our society, both economically and socially. An analysis of the multifactorial causes of the opioid crisis provides a tangible framework for understanding how such a crisis occurred and why it has disproportionally affected our most vulnerable. Likewise, such discourse and analysis aids in analyzing what legal ramifications are at play. In recent times, various provinces have sought to engage in legal action to hold various stakeholders and pharmaceutical companies responsible for their role in the opioid crisis.
Genesis of the opioid crisis
The opioid crisis in Canada can be understood in terms of “waves.” Starting in the early 1980s, there was an increasing influx of opioid medications into the Canadian pharmaceutical market. In 1996, Purdue Pharma released a novel opioid drug into the consumer market: OxyContin. OxyContin, like several other opioid medications, is used primarily to treat severe acute or chronic pain (such as cancer pains) when other medications fail to provide adequate relief.
While opioids can be a useful tool in alleviating severe pain in target populations, they also contain addictive properties. Addictive potential is further compounded due to the potential for opioids to be both physically and psychologically addictive. Likewise, sudden cessation of an opioid can result in extremely distressing withdrawal symptoms. Thus, opioid medications should only be used when necessary in specific patient populations. There is research to demonstrate that individuals suffering from chronic, non-cancer pains have “improved pain, function and quality of life when opioid use is reduced.”
The introduction of OxyContin into the consumer market served as a very lucrative business opportunity for Purdue Pharma. OxyContin was initially marketed as a safe, effective and non-addictive drug, despite evidence to the contrary. Purdue Pharma engaged in a zealous and highly ethically questionable advertising and marketing regime, which sought to promote the use of OxyContin in patients with various ailments. Purdue falsely claimed the risk of developing an addiction to OxyContin was negligent, at less than one per cent. However, subsequent studies have yielded various results on the risk of abuse, anywhere from three per cent to 45 per cent. Of course, the etiology of Canada’s opioid crisis is far more nuanced than simply OxyContin entering the consumer market, but it did represent the beginning of a shift towards a more liberalized and laissez-faire approach to prescription opioids.
However, increased quantities of opioid prescriptions result in an increase in the availability of opioid drugs, which in turn further perpetuates the risk of abuse and addiction. Moreover, the recent crackdown on prescription opioids resulted in some opioid prescriptions being ceased abruptly. Thus, without a legitimate prescription, patients who developed a dependency sometimes turned to illicit drugs, such as heroin.
Statistics and demographics
While Canada employs stronger laws regarding the regulation of prescription medications and the ability of pharmaceutical companies to advertise their products, such safeguards were not wholly effective at preventing the crisis. The statistics regarding opioid use in Canada is staggering. Canada, after the United States, is the second largest consumer of prescription opioids in the world. Since the early 1980s to the present day, there has been a 3,000 per cent increase in prescriptions for opioids. In 2016 alone, over 20 million opioid prescriptions were distributed. To put that in perspective, this means every adult in Canada could have an opioid prescription.
As with any crisis, marginalized and vulnerable segments of our society are more susceptible to being impacted by the opioid crisis. Certain socioeconomic disadvantages result in such populations being disproportionally impacted by opioid overdoses and opioid related deaths. One group that is disproportionally affected is Indigenous peoples. Indigenous peoples are five times more likely to overdose and three times more likely to die from an opioid overdose than their non-Indigenous counterparts. Likewise, Indigenous peoples are twice as likely to be prescribed an opioid than their non-Indigenous counterparts. Furthermore, Indigenous peoples are on average at least five years younger than their non-Indigenous counterparts at the time of prescription. Reasons for such disparity can be linked to poverty, intergenerational trauma, family separation, colonization and greater difficulty with accessing various components of the health-care system. Thus, meaningful systemic reform is required to address such disparities in health outcomes.
State of the law
In November of last year, several provinces joined in a class action against Purdue to recoup the public health-care costs associated with the opioid crisis. British Columbia is suing for over $9.1 billion, Ontario for $26.1 billion and Quebec for $15.3 billion. British Columbia had previously filed a lawsuit in 2018 against Purdue (along with 40 other pharmaceutical companies), but the case was frozen due to Purdue filing for bankruptcy protection in 2019. On Nov. 24, 2020, Purdue pleaded guilty in U.S. federal court to several charges in relation to its role in the opioid crisis. An admission of guilt is essential as it makes it easier for Canada to take legal action, as certain facts have been admitted into the record. However, where such legal action will go is uncertain for now.
In conclusion, there is a strong nexus between the pharmaceutical promotion of opioids in the 1980s and 1990s and the contemporary opioid crisis. When greed is prioritized over the well-being of society, it yields tragic results. As such, increased transparency and tighter restrictions on prescription medications are critical to prevent a similar crisis in the future.
Serena Eshaghurshan is 2021 J.D. candidate at the University of Calgary. Prior to law school, she received a bachelor of arts in psychology at the University of Calgary.
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