Crisis of withdrawal looms as Oxy removed from NIHB

First Nations leaders in Ontario are calling on the government for assistance in handling what they predict will be a health crisis following Health Canada’s decision to cut First Nation funding for the addictive opiate painkiller OxyContin.

Purdue Pharma Canada, the maker of OxyContin, will stop manufacturing the drug in Canada at the end of the month, and, as of March 1, OxyContin will be replaced with a new formulation of oxycodone called OxyNeo, which is formulated so that it is more difficult to crush, and therefore less likely to be abused through injecting or snorting.

Health Canada confirmed that as of Feb. 15 OxyContin had been pulled off the Drug Benefit List from the Non-Insured Health Benefits Program, which provides drug coverage for more than 800,000 registered First Nations and recognized Inuit. However, they say the NIHB will consider requests for long-acting oxycodone on a case-by-case basis and coverage may be granted in exceptional circumstances such as cancer or palliative pain management.

While many First Nation leaders applaud steps taken toward ending the cycle of painkiller addiction, they are also requesting government help to put support systems in place to handle the potential mass withdrawal that could ensue from sudden market elimination of the drug.
“Potential for a mass involuntary opiate withdrawal is looming,” said Deputy Grand Chief Mike Metatawabin of the Nishnawbe Aski Nation in a statement Feb 16.

Metatawabin said the number of NAN First Nation community members in Ontario who are addicted to OxyContin and at risk for painful withdrawal is “staggering.”

“The problems are intensified in the remote northern communities for those who are addicted to OxyContin and do not have access to drug treatment programs,” he said.

“It is time for both levels of government to respond with programs and services that are urgently required to implement emergency strategies.” Without OxyContin available, individuals could experience withdrawal symptoms ranging from stomach upset, muscle and bone pain, anxiety, restlessness, increased heart rate and blood pressure to depression and suicide.

The NAN Prescription Drug Abuse (PDA) Task Force, chiefs and NAN executive council say they have been applying pressure on Health Canada and the Ministry of Health and Long-Term Care to respond to requests for assistance since the November 2009 NAN Chiefs-in-Assembly declared a State-of- Emergency regarding the drug.

This Jan. 23, Chief Matthew Keewaykapow of Cat Lake First Nation declared a State-of-Emergency due to widespread opioid addiction affecting 70 per cent of his community members. On Feb. 6, Matawa First Nations, a tribal council of nine Northern Ontario First Nations, reported that almost 2,000 people have an Opioid addiction in their communities.

Doris Slipperjack, a member of the Eabametoong First Nation, sometimes known as Fort Hope, 350 kilometres north of Thunder Bay, claims that about 80 per cent of the community of 1,200 has an opioid addiction. What’s more disturbing is that Slipperjack admits to knowing of children as young as 12 who are addicted to Oxycodin.
Slipperjack, a 23-year-old mother of three and a recovering opiate addict, said she knows first-hand the powerful hold addiction can have on a person.

“I started off with Percocet and then Tylenol 3s and in 2006 I started doing Oxys [OxyContin],” she explained.
“I was so used to depending on Oxys to function. They became the centre of my life. They were more important than my children,” she said quietly.

Recently Slipperjack brought national attention to the issue of OxyContin addiction by sharing her story in a short documentary released in 2011 titled ‘The Life You Want: A Young Woman’s Struggle Through Addiction.’

Slipperjack admits there were days when she would easily spend between $50 to $100 on ‘oxys,’ getting them through street dealers in and around her community. It wasn’t always easy to afford the costly fix, she said.
“There were days when I didn’t have money and I would go through withdrawal.” She said the street value of one 80 mg OxyContin pill is as much as $400.

While Slipperjack said she is happy the drug is now off the market, she admits her initial reaction was one of anxiety.

“The drug addict in me flipped out,” she said. “I felt like a part of me was going to die. I thought ‘I should be happy.’”

“I’m happy, but also I’m worried,” she said, pointing to the hoard of addicts in her community and others that will be affected by the swift removal of the drug.

First Nation leaders say more must be done to prevent potential mass narcotic withdrawal in their communities.
“The need for emergency planning to develop Withdrawal Management Strategies by First Nations, tribal councils, NAN and Health Canada staff, Ontario Ministry of Health and hospital networks is vital,” said Metatawabin.

Heath Canada said they have no plan to turn their back on the issue and they maintain that they will continue their support of existing addiction programs as well as provide provisions for withdrawal concerns.

“Health Canada does have support available for issues of withdrawal,” said Leslie Meerburg, Health Canada spokesperson.

“Health Canada will continue to work with First Nations leadership and provinces to provide appropriate primary care supports for short-term stabilization and monitoring of individuals going through opiate withdrawal,” she said.
“The department will continue to fund community-based programming to address prescription drug abuse through its addictions programming ($90M annually), which supports a network of 58 treatment centres for First Nations, as well as drug and alcohol abuse prevention services in over 550 First Nations and Inuit communities across Canada,” she explained.

But leading addictions experts say withdrawal is not the only concern associated with removal of OxyContin from the market.

“In the absence of any regular treatment, a public health catastrophe is imminent, as there are thousands of addicted individuals with rapidly shrinking supplies – likely leading to massive increases in black market prices, use of other drugs, needle use/sharing, and crime,” warned Dr. Benedikt Fischer, a senior scientist and director of the Centre for Applied Research in Mental Health and Addiction at Simon Fraser University in Vancouver.

Black market drug dealing is something Heath Canada said it is aware of among Ontario First Nation communities.

“NIHB data shows that NIHB is not the main supplier of OxyContin to First Nations clients in the Nishnawbe Aski Nation (NAN),” said Meerburg. Fewer than 100 NAN members registered with NIHB claimed for OxyContin through the NIHB Program in 2011, she noted.

Health Canada said there is “little concern of withdrawal for clients switching therapy from OxyContin to OxyNeo when taken as prescribed by a physician.”

First Nation leaders in Ontario remain vigilant in their fight to solidify more than just existing programs, however. They want specialized help to combat the potential for crisis.

“We must act now to care for these very vulnerable people,” said Metatawabin. “We require funding for the PDA Task Force to implement the NAN Prescription Drug Abuse framework. We must also resolve jurisdictional issues between Ontario and Canada for Opioid Treatment programs and funding,” he said. “We require medical and nursing professionals, appropriate mental health services, and aftercare programming. In addition, security and increased policing resources will be needed within NAN territory,” he added.