Some of the pharmaceutical companies selling prescription opioids that have caused thousands of deaths are looking to profit from the antidote for overdoses, according to a VICE News analysis of drug approval records from Health Canada.
One emergency room doctor in Toronto who regularly reverses opioid overdoses with naloxone said the revelations show “companies [are] cynically profiting from both ends of the crisis” that claimed an estimated 4,000 lives in Canada last year.
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“The companies who over-marketed the opioids like Purdue Pharma have largely gotten away without having to pay significant penalties,” said Joel Lexchin, a health policy professor at York University who also works in Toronto emergency rooms.
“This is an example of companies choosing to make money in whatever way they can,” Lexchin told VICE News. He compared the opioid situation to tobacco companies selling both cigarettes and nicotine replacement therapy.
VICIOUS CYCLE
Purdue Pharma Canada, the privately held maker of OxyContin, the world’s top selling prescription opioid painkiller, is developing its own version of naloxone and hoping to market it in Canada. Purdue Pharma Canada is a separate legal entity from the company’s U.S. operations.
“KL-00514 (Naloxone Buccal Film) … is designed for use in non-healthcare settings by laypersons to rescue patients experiencing life-threatening effects of an accidental or intentional opioid overdose while awaiting emergency medical attention,” Purdue Canada spokesperson Sarah Manley Robertson told VICE News in an email.
The drug is “early in its development” and discussions with regulators on approving it are ongoing, Robertson said.
When asked about a possible conflict of interest in trying to market both prescription opioids and naloxone, Manley said: “The appropriate management of pain and addressing the effects of misuse, abuse and diversion of prescription pain medications are both serious public health problems.” She would not elaborate further.
Purdue Pharma Canada paid $20 million dollars in 2017 to settle following a national class action lawsuit that accused the company of “over marketing” OxyContin and helping to stoke addictions. Purdue made no admission of liability, a company spokesperson told reporters at the time.
The U.S. division of the company has faced similar costly litigation south of the border after being accused public health officials of over-promoting opioid use, leading to skyrocketing rates of addictions and overdoses.
The state of New Jersey sued Purdue in October arguing there is a “direct link” between the company’s marketing strategy for OxyContin and the state’s opioid crisis.Similar lawsuits have been launched in Alabama, Mississippi, Oklahoma, Missouri, New Hampshire, Ohio and other U.S. states.
Since its release in 1995, OxyContin has reportedly generated about $35 billion in revenue for Purdue, the New Yorker reported.
Having the same companies selling both opioids and the overdose antidote can lead to a vicious cycle where firms have an economic interest to sell more opioids in order to increase naloxone sales, said Lexchin.
‘I NEVER THOUGHT I’D SEE SO MANY DIE’
Generic drug company Mylan Pharmaceuticals also sells both naloxone and opioids in the U.S., although health advocates say the company hasn’t promoted opioid sales nearly as aggressively as Purdue and other pharmaceutical companies. It also sells medications, including life-saving naloxone, at lower prices than other companies.
In 2016, Mylan manufactured approximately one percent of opioids sold in the U.S., “which placed Mylan 17th among pharmaceutical companies,” company spokesperson Lauren Kashtan told VICE News in an email. “Despite being a small manufacturer in the U.S. opioid marketplace, Mylan is firmly committed to helping in the fight against opioid abuse and misuse.”
Mylan has government approval to sell prescription naloxone injections in Canada, although Kashtan says the company doesn’t sell the product in the Canadian market.
While the opioid epidemic largely began with the over-prescription of painkillers produced by major companies, many overdose deaths are linked to bootleg versions of highly potent opioids like fentanyl and carfentanil tainting the illicit supply, as opposed to prescriptions.
“Right now the biggest existential threat to people who use drugs aren’t prescription opioids but street fentanyl,” Jordan Westfall from the Canadian Association of People who use Drugs (CAPUD) told VICE News in an email. “I never thought I’d see so many people die.”
‘APPROPRIATE PRESCRIBING’
It is legal for companies to sell both opioid drugs and naloxone used to treat opioid overdoses in Canada and the U.S. and regulators say there is nothing problematic about firms profiting on both ends.
“Health Canada is of the view that it should not be considered a conflict of interest for companies that sell approved opioid products to also sell approved naloxone products,” Rebecca Purdy, a spokesperson for federal department, told VICE News.
“Access to naloxone is generally considered an added safety measure, and is unlikely to result in additional prescription opioid sales for the companies who market them.”
Federal and provincial health authorities say one of their priorities is making sure naloxone is accessible and affordable for people who use drugs and health professionals and they have provided funding to make this happen.
“I see this problem (with opioid overdoses) continuing to get worse,” Lexchin said. “This means the need for naloxone is going to continue to grow.”
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