Did opioid overprescribing trigger BC's overdose crisis?
Despite Purdue's $150 million payment, BC's provincial health officials say our system avoided the catastrophe seen in the US
When Purdue Pharma agreed in June 2022 to pay BC $150 million in relation to its Oxycontin prescribing practices, then-Attorney General David Eby declared the victory an acknowledgement of “their part in allegedly engaging in deceptive marketing tactics to increase sales, which led to increased rates of addiction and overdose.”
The use of the word “allegedly” was not accidental. Although Purdue wrote the cheque, it did not admit to the charges.
In fact, the degree to which overprescribing laid the groundwork for BC’s overdose crisis, making the toxic illicit drug supply the province’s leading cause of death, is not a settled matter in the minds of provincial health officials.
In their view, BC’s long history with heroin addiction, combined with a world-class criminal infrastructure that was quick to move to fentanyl, were at least as responsible for the crisis that besets the province.
The specific allegations in BC’s Purdue case and the terms of the settlement remain wrapped in non-disclosure agreements. Lawyers for both sides are hard at work preparing for the sequel and main event: a lengthy class action suit involving Canada’s federal, provincial and territorial governments.
The fact that Purdue’s development and marketing of OxyContin helped pave the way for a massive increase in substance use disorders among Americans is no longer debatable, nor does anyone doubt that the sudden US clampdown on OxyContin in 2015 forced tens of thousands of users into the illicit market. (Patrick Raddan Keefe is just one of the journalists who has laid this bare.)
Did British Columbia have the same experience? Public health officials say no.
Former provincial public health officer Perry Kendall, who declared the overdose emergency in 2016, made this point to an all-party committee of MLAs studying the opioid crisis in 2022, just as Purdue was preparing its cheque.
The clampdown on OxyContin “wasn’t, as it was in the United States, associated with an increase in overdose deaths,” Kendall testified. “Even when we stopped that massive prescribing, we didn’t see, immediately anyway, increase in overdose deaths.
“The extent to which that excessive prescribing is relevant to the toxic drug supply — in Canada, anyway, or in BC — is not nearly as clear as it is in the United States, where, when the prescription opioid numbers came down, nothing was really done to replace them in terms of people who had pain management.”
Provincial Health Officer Bonnie Henry went further in her recent report on alternatives to prescribed safe supply.
“While over-prescribing of opioid pain medications has been identified as a past driver of increasing rates of opioid use disorder and opioid-related deaths in some jurisdictions, primarily the United States,” she wrote, “it is not a major contributing factor in BC’s unregulated drug emergency. Prescribed opioids rarely contribute to unregulated drug deaths.”
As Attorney General, Eby steered the Opioid Damages and Health Care Costs Recovery Act through the Legislature in 2018, giving the province the same tools to seek redress that it has used against tobacco companies.
In 2020, BC’s lawyers joined 600,000 other claimants in Purdue’s New York bankruptcy proceeding, seeking $9 billion to compensate for Purdue’s behaviour in this province alone.
Altogether, Canadian governments hope to claw $69 billion in damages from the ashes of Purdue.
"The Canadian number looks large and it is large because it's a significant problem,” Reidar Mogerman, the Vancouver lawyer steering BC’s legal team, told the CBC. “I believe if you add in claims from U.S. entities you get numbers in excess of $2 trillion US. It's really staggering.” (Mogerman could not be reached for comment for this article.)
BC lawyers were back in court last November, joined by their counterparts from the federal government, seeking certification for a class action suit in this country that they believe could recover billions in additional payments from Purdue and 40 other opioid producers.
(The Supreme Court of Canada has also agreed to hear a challenge to the validity of the 2018 legislation brought by four drug companies.)
While health officials do not deny that overprescribing of pharmaceuticals like OxyContin did occur in British Columbia, they argue that public health measures here helped moderate the wave of overdose deaths that resulted in the United States.
The distinction is critical for understanding both the roots of BC’s overdose emergency, now the leading cause of death in the province, and the ability of health care professionals, given the right tools, to manage the prescribing of opioids in a safe way.
The unique dynamics in this province were recently outlined in this piece by Insight Crime, which includes an interview with addictions specialist Jaime Arredondo Sanchez Lira of the University of Victoria.
On the one hand, British Columbians were never prescribed opioids at the enormous volumes seen in the United States, nor were physicians ordered to cut back as deeply and sharply. BC’s public health emergency declaration in 2016 ushered in responses, such as widespread distribution of naloxone, long before such measures were common elsewhere.
Eby’s legal victory, four years in the making, was the largest single harms-related payment in Canadian history. It opened the door to a class action suit by all Canadian federal, provincial governments and territorial governments to gain even more compensation.
“The aim of the class action and legislation is to recover health-care costs,” Eby said in his 2022 news release “that resulted from wrongful conduct of opioid manufacturers, distributors and their consultants.”
”This settlement was reached very early in the litigation process,” the news release continued, “before the allegations against Purdue Canada have been proven in court.”
The settlement paved the way for the class action suit, which is now being argued in a B.C. courtroom. This accelerated the provision of documents and other aspects of this complex case.
Of course, it’s quite possible that both BC’s lawyers and its public health officials are correct.
The lawyers may ultimately convince a court that their allegations are sound, and that inappropriate marketing practices led to dangerous and harmful use of prescription opioids.
Public health officials, whose studies are public, have evidence to back their view in the court of public opinion. Not only did the Canadian health care system never overprescribe in the way experienced in the United States, but it managed the withdrawal without the catastrophic consequences we saw south of the border.
The fact that we got our own overdose crisis our own way is no consolation to the thousands of families grieving the loss of loved ones. It does raise the hope that we have a health care system that will help us find a way out of this deadly emergency.
It also underlines the role of organized crime in driving a crisis that the health sector might have managed.
Despite decline in overdose deaths, Whiteside focuses on the losses on election eve
With drug policy certain to be a major issue in the upcoming election, Mental Health and Addictions Minister Jennifer Whiteside wisely avoided a victory lap on Aug. 30, the day before Overdose Awareness Day, when commenting on the latest overdose death numbers.
“While we’ve seen some progress with fewer deaths this year, we cannot allow ourselves to become indifferent to this crisis.,” Whiteside said. “Every life lost is one too many. We must not, and will not, accept this as normal.”
Although another 192 British Columbians died in July, according to provincial coroner Jatinder Baidwan, the death rate was 15 per cent lower than a year earlier. The annualized death rate is the lowest in four years.
The decline of overdose deaths in Alberta was even more pronounced, setting the stage for an inevitable BC election debate on the two province’s approaches to the overdose emergency.
Clearly, both provinces are doing something right. Let’s hope the election debate focuses on the common ground, where the largest gains are likely being made.