The Problem with Pain: A Look at Canada’s Opioid Epidemic

One of the greatest health threats in North America is the opioid crisis. Since 2015 it has caused about five thousand deaths in Canada alone. Indigenous communities have been ravaged by the epidemic. National and provincial governments are being forced to take the matter in hand.

The fight has manifested itself in changes to healthcare policy, and class action lawsuits against Purdue Pharma, the drug company that allegedly pushed OxyContin™ and OxyNEO™ via marketing tactics that minimized the risks associated with the drug. In the US authorities have launched criminal investigations into Purdue’s marketing tactics and many Canadians are demanding that our leaders follow suit.

Purdue Pharma has offered settlements to plaintiffs across Canada. The suit made the news recently because a judge in Saskatchewan rejected the settlement in March. This article is going to give an overview of the opioid crisis in Canada, what this has meant for victims, and for chronic pain sufferers. I will also go briefly into the nature of addiction based on the newest available research on the subject and talk a bit about how class action lawsuits and corporate criminal liability work with regards to this particular case. Please note that I am not a doctor or a psychologist or a crisis worker, and I welcome comments from them on how best to address this epidemic.

In 1996 Purdue Pharma released its new painkiller OxyContin™. Purdue used an aggressive marketing campaign to encourage doctors to prescribe it, calling it a safe and effective means of treating pain with minimal problems. Unfortunately the drug is highly addictive and overdose deaths began to climb steadily over the next three decades. In February 2018 Purdue finally announced that they would stop “promoting opioids to prescribers” in the United States, but sadly that policy does not extend to Canada, the branch of which- Purdue Canada – operates independently.

Most opioid addicts like Ben Miller, one of the plaintiffs suing Purdue, became addicted to OxyContin™ by being legally prescribed it for pain. His doctor prescribed the drug while he was living in Ontario in 2007 and he became addicted. According to court transcripts from 2013, Miller was addicted to OxyContin™ until the end of 2011 but continues to struggle with the risk of relapse into addiction. Most accidental opioid poisonings in Canada happen with seniors, many of whom were taking the medication as prescribed.

That said, there has been another group suffering under Canada’s opioid epidemic, and it’s one that is seldom talked about: chronic pain sufferers. These are people with long term back problems, bad knees, fibromyalgia, non-fatal forms of MS and other pains the sources of which are difficult or impossible to treat and with pain levels that can spike under cold or humid weather conditions.

For many, opioids like hydromorphone are the only effective drugs to treat acute pain episodes, but with new awareness about the dangers of opioids, attempts to get a prescription are met with suspicion and often disdain. Safer medicines like marijuana and other cannibinoids, which have proven effective for treating pain with low addiction risks, are still treated like dangerous drugs due to their criminalization and physicians often refuse to prescribe them. Those who succeed in getting a referral to Montreal’s only cannabis clinic have to pay up to two hundred and fifty dollars just for the consult.

Daisy suffers from chronic back pain exacerbated by cold, humid conditions. Despite the opinion of two physicians and her psychologist that she is not an addiction risk, attempts to renew her pain medication when she needs it are often met with suspicion. Though she takes it as prescribed, pharmacists in the past have treated her like a junkie when she seeks a renewal. Unfortunately many people going to emergency rooms for pain across Canada are often pumped full of opioids and sent home without the necessary referrals or tests to find out the source of the problem.

New research into the nature of addiction indicates that it is a complex disease with social and biological traits. There is a scientific consensus that addicts have underactive dopamine systems – the system of neurotransmitters that control the pleasure and reward centers in the brain – and have a lesser capacity to enjoy their everyday lives. They suffer from anxiety and depression and have poor support systems and resources to cope.

Most drugs act by filling the brain with pleasurable dopamine. As a person continues to use the drugs, the brain adapts and produces less dopamine, forcing the addict to take more. That said, studies have confirmed that recovering addicts that do so in a supportive, loving community environment are less likely to relapse.

The lawsuit against Purdue Pharma contends that:

  • From 1996 to 2001 the company claimed that OxyContin™ was safer than other prescription opioids
  • Prescribed usage of the drug leads to addiction requiring more frequent and higher doses
  • Discontinuing use of the drug causes severe withdrawal symptoms that can last weeks or more
  • Concerns about addiction have been known to Purdue Pharma since 2003 when the Government Newfoundland and Labrador launched an OxyContin Task Force to deal with the rising number of deaths from the drug

Purdue Canada has offered to settle the class action lawsuit for twenty million dollars, a pathetic sum when you take into account the cost of legal representation for the plaintiffs and the fact that provincial health insurers tasked with dealing with the epidemic will be getting a large part of this.

Ontario, Quebec, and Nova Scotia approved the settlement. Judge Barrington-Foote of Saskatchewan rejected it, pointing out that for the court to approve a class action settlement, it must be satisfied that the settlement is “fair, reasonable, and in the best interests of the class as a whole.” Judge Barrington-Foote felt the settlement was too small to be considered as such.

If the government launches a criminal investigation into Purdue Pharma, it will have to decide whether to seek indictments of individuals within the company or of the company itself. If the latter, the prosecution will have to meet the criteria for corporate criminal liability set out by the Supreme Court in Canadian Dredge and Dock Co. v. The Queen [1985], specifically:

“that the action taken by the directing mind (a) was within the field of operation assigned to him; (b) was not totally in fraud of the corporation; and (c) was by design or result partly for the benefit of the company. ”

The opioid crisis is a complex problem that needs addressing to avoid further loss of life. Our governments are coming up with action plans to fight it. Here’s hoping that their plan doesn’t hurt those in pain.

Featured image by Psiĥedelisto via WikiMedia Commons

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