Transcript: Ontario's Opioid Problem | Sep 22, 2015

Steve sits in the studio. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a grey suit, pale blue shirt, and striped red tie. Behind him, a wall screen reads “The Agenda, with Steve Paikin.”

Steve says BIG CITIES ARE NO
STRANGERS TO DRUG BUSTS BUT IT'S
NO LONGER JUST BIG CITY PROBLEM.
IN FACT, OPIOID ABUSE IS
ADDICTION BIG PROBLEM WELL
BEYOND ONTARIO'S URBAN CENTRES
AND JOINING US NOW TO DISCUSS
WHAT'S BEHIND THIS SURGE IN
SAN DIEGO, CALIFORNIA
IS DAN WERB, HE'S DIRECTOR
AND SCIENTIFIC BOARD CHAIR OF
THE INTERNATIONAL CENTRE FOR
SCIENCE IN DRUG POLICY.

Dan appears with the San Diego skyline as a background. He’s in his forties, has brown hair and a goatee. He wears glasses, a yellow shirt, and a black blazer.

Steve continues AND WITH
US HERE IN STUDIO, ADA
GIUDICE-TOMPSON, VICE PRESIDENT
OF THE ADVOCATES FOR THE REFORM
OF PRESCRIPTION OPIOIDS,
AND TARA GOMES, PRINCIPAL
INVESTIGATOR FOR THE ONTARIO
DRUG POLICY RESEARCH NETWORK AND
DETECTIVE CONSTABLE MIKE HOWELL
WITH SARNIA POLICE SERVICE AND
MICHAEL PARKINSON, COMMUNITY ENGAGEMENT
COORDINATOR WITH THE WATERLOO
REGION CRIME PREVENTION COUNCIL

Ada, Tara, Mike and Michael appear in the studio.

Steve continues AND IT'S GOOD OF ALL FOUR OF YOU
HERE IN STUDIO, AND DAN DOWN IN
CALIFORNIA, FOR JOINING US TODAY
AND WE THANK YOU VERY MUCH.
LET'S SET UP DISCUSSION WITH
SOME -- IF YOU HAVEN'T FOLLOWED
THIS RATHER ASTONISHING FACTS.
WE'LL GET THESE ON THE TABLE
RIGHT AWAY.

A panel pops up on screen. It reads “CANADA RANKS SECOND IN PER CAPITA OPIOIDS USE. ONTARIO RANKS FIRST IN CANADA IN PER CAPITAL OPIOID USE. PEOPLE AGE 25-34, 1 IN 8 DEATHS WERE RELATED TO OPIOID USE THOSE FIGURES FROM (2010). IT IS THE THIRD LEADING CAUSE OF ACCIDENTAL DEATH.”

Information from The Globe and Mail, Municipal Drug Strategy Co-Coordinator’s Network of Ontario.

Steve continues THAT'S MORE THAN DOUBLE THE
NUMBER OF DEATHS
CAUSED BY MOTOR VEHICLES
ACCIDENTS. THOSE ARE SOME PRETTY
UNUSUAL AND ASTONISHING
REVELATIONS.
DAN I WANT YOU AND
DETECTIVE CONSTABLE HOWELL
TO START US OFF IN THIS DISCUSSION
WILL START WITH YOU TOO WERE SEEING A
LOT OF HEADLINES LATELY OF WHY PEOPLE
ARE DYING FROM USING DRUGS LIKE
FENTANYL AND OTHER OPIOIDS AND I
WANT TO KNOW WHY THIS IS LOT OF
PEOPLE WHO DON'T KNOW ABOUT THIS
AND WHY IS IT NEWS SO MUCH
LATELY.

A split screen shows Steve and Dan.

The caption reads, “Dan Werb. International Centre for Science In Drug Policy.”

The caption changes to “Ontario’s Opioid Problem. An Illicit Problem.”

Dan says WELL, YOU KNOW I THINK PART
OF THE REASON IS THIS IS
SOMETHING THAT HAS BEEN
HAPPENING FOR OVER A DECADE NOW.
AND THERE HAS BEEN STEADY
INCREASE IN PATTERNS OF
OVERPRESCRIPTION OF PRESCRIPTION
OPIOIDS LIKE OXYCONTIN AND
PERCOCET AND IN ONTARIO'S NO
STRANGER TO THAT PHENOMENON, SO WE'RE SEEING
THESE HEADLINES NOW ABOUT
OVERDOSE
DEATHS, IT IS REALLY BEEN
SOMETHING THAT HAS BEEN
OCCURRING FOR 10 - 15 YEARS.
AND UNFORTUNATELY, WE HAVE
REACHED A POINT WHERE
GOVERNMENTS HAVE RESPONDED,
POLICIES HAVE BEEN CHANGED TO
RESTRICT ACCESS TO SOME PRESCRIPTION OPIOIDS
THAT WERE PREVIOUSLY OVERPRESCRIBED
AND NOW WE'RE SEEING A MARKET
THAT IS REALLY IN FLUX IN A
LOT OF WAYS, AND PEOPLE ARE THEREFORE
RESORTING TO MORE DANGEROUS
DRUGS.

Steve says DAN, LET ME FOLLOW UP ON THAT BECAUSE YOU WERE ON THE PROGRAM A YEAR AGO AND WE TALKED ABOUT IN
SOUTH WESTERN ONTARIO OUTBREAK
OF OXYCONTIN USE, AND THAT
BROUGHT US UP TO SPEED ON OXY
BEING THE DANGEROUS DRUG AND NOW, IT’s
NOT OXY, NOW IT IS FENTANYL.
WHAT HAPPENED?

Dan says RIGHT WELL, I THINK A LOT OF THIS
ISSUE IS RELATED TO THE GOOD
INTENTIONS AND INTENTIONS TO TRY
TO REDUCE ACCESS TO OXYCONTIN
AND PERCOCET, WHICH PEOPLE WERE
FLAGGING AS THE DANGEROUS DRUG
AS TWO OPIOID THAT WERE BEING OVER PRESCRIBED TO
PEOPLE AND THEN AFTER THAT
RESULTING IN SOME HIGH LEVELS OF
OPIOID DEPENDENCY AND DRUG DEPENDENCY
WHICH WAS OBVIOUSLY PROBLEMATIC AND
THERE HAVE BEEN EFFORTS TO REDUCE
ACCESS TO PRESCRIPTION DRUGS
LIKE OXYCONTIN AND PERCOCET AND
PURDUE PHARMA STOPPED PRODUCING OXYCONTIN,
REPLACED OXYCONTIN WITH A TAMPER
RESISTANT FORMULATION OF THE DRUG
CALLED OXYNEO AND PROVINCIAL
GOVERNMENT IN ONTARIO SOUGHT TO
RESTRICT ACCESS ALONG WITH THE
ONTARIO COLLEGE OF PHYSICIANS
AND SURGEONS TO CHANGE THE WAY
THAT, TO REDUCE BASICALLY THE
HIGH LEVELS OF PILLS THAT WERE
BEING PRESCRIBED TO PEOPLE, AND
NUMBER OF CONTROLS WERE SET UP
IN PHARMACIES, TO ENSURE THAT
PEOPLE WEREN'T DOUBLE DIPPING
GOING TO DIFFERENT PHARMACIES TO TRY TO
GET THE SAME PRESCRIPTION FILLED
TWICE SO IN LOT OF WAYS, THIS
WAS REALLY EFFECTIVE OVER THE PAST
FEW YEARS AND THESE SYSTEMATIC
EFFORTS TO REDUCE ACCESS BUT
UNFORTUNATELY THE PRESCRIPTION
DRUG MARKET DOES NOT EXIST IN A
VACUUM.
IT IS INEXTRICABLY LINKED TO A MARKET OF
DIVERSION, UM, OF PHARMACEUTICAL
DRUGS AND ALSO THE BLACK MARKET
OF STREET HEROIN, STREET OPIOIDS LIKE HEROIN.

Steve says OKAY, LETS UNPACK THAT IF WE CAN.
I’M GOING TO GO TO MIKE NOW
AND SARNIA IS NOT TORONTO
OR NEW YORK CITY. ITS NOT ONE OF THE BIG CITY’S IN NORTH
AMERICA AND YET I'M TOLD YOU
SPEND LOT OF YOUR TIME DEALING
WITH THIS SUBJECT. HOW MUCH OF YOUR
TIME WOULD YOU ESTIMATE IS WRAPPED
UP IN THIS ISSUE?

The caption changes to “Mike Howell, Sarnia Police Service.”
Mike is in his late thirties, with short brown hair and a trimmed goatee. He’s wearing a black suit, pale blue shirt, and matching striped blue tie.

He says PRIMARILY WE ARE SEEING CRYSTAL METHAMPHETAMINE OR WE ARE SEEING PRESCRIPTION OPIOIDS. WE SEE VERY
LITTLE COCAINE AND WE DON’T SEE ANY HEROIN IT REALLY DOESN’T EXIST IN LARGE QUANTITIES IN OUR AREA
AND PRIMARILY THAT’S WHAT OUR
INVESTIGATIONS ENTAIL, EITHER
PRESCRIPTION OPIATES THAT PEOPLE ARE DIVERTING AND
SELLING OR CRYSTAL
METHAMPHETAMINE OR COMBINATION
OF THE TWO, WE SEE DRUG DEALERS WHO WILL
SELL WHATEVER GENERATES THEM
LARGEST PROFITS AND WHATEVER THE NEED IS IN
THE COMMUNITY AND UNFORTUNATELY THAT’S PRIMARILY
OPIATES.

Steve says WHERE WERE
YOU BEFORE SARNIA?

Mike says I WAS WITH PEEL REGIONAL POLICE AND I HAVE BEEN
ALSO WITH DURHAM REGIONAL POLICE- I WAS A DRUG
ENFORCEMENTS OFFICER OUT THERE SO
THAT WAS 2008-2011 AND I WAS USED TO
LARGE SCALE DRUG INVESTIGATIONS
AND I WAS USED TO CRYSTAL METHAMPHETAMINE- NOT NECESSARILY CRYSTAL. I WAS USED TO CRACK COCAINE,
COCAINE, SOME ECSTASY, MOSTLY
MARIJUANA AND THEN WHEN I SWITCHED OVER TO
SARNIA IN 2011, IT WAS ALL
CRYSTAL METHAMPHETAMINE AND IT
WAS ALL PRESCRIPTION OPIATES? I HAD N
NEVER SEEN SO MANY NEEDLES IN MY WHOLE
LIFE – IT WAS JUST NO AN EXPERIENCE I WAS USED TO. IT TAKES A BIT OF
AN ADJUSTMENT AND UNFORTUNATELY IT SEEMS LIKE SARNIA IN
OUR PARTICULAR AREA IS REALLY
HARD HIT BUT THESE TYPES OF
OPIATES.

Steve says WHY DO YOU FIGURE?

Mike says IT IS HARD THE EXPLAIN.
SOME PEOPLE SAY IT IS BECAUSE
SARNIA IS RIGHT ON BORDER WITH PORT
HURON AND MICHIGAN BUT IT REALLY HAS
NOTHING DO WITH IT.
FOR US, I DON'T THINK WE'RE
QUITE IN DRUG PIPELINES THAT
SOME LARGER COMMUNITIES MIGHT BE
SO WHEN IT COMES TO HEROIN OR MOSTLY CRYSTAL
METHAMPHETAMINE OR I CAIN THAT
IS GOING TO LARGER URBAN CENTRES
LIKE GTA AND FOR US, THERE IS
SUCH AVAILABLITY OF PRESCRIPTION
DRUGS THAT IS A DRUG OF CHOICE REALLY
IN OUR AREA AS WELL AS THE CRYSTAL
METHAMPHETAMINE. CRYSTAL METHAMPHETAMINE IS COMING
FROM OTHER AREAS: LONDON, HAMILTON, TORONTO THAT TYPE OF THING- OR WINDSOR AND BEING BROUGHT BACK TO OUR
COMMUNITY BUT ITS PRIMARILY OPIATES NOW
WE'RE HAVING TO DEAL WITH ON A
CONSISTENT BASIS.

Steve continues DAN I’M GOING TO GO BACK TO YOU IN CALIFORNIA. THERE IS THIS- I GUESS CONVENTIONAL
IMPRESSION THAT WE HAVE THAT LOT OF
THIS KIND OF THING HAPPENS IN BACK
ALLEYS OR SHADOWS AWAY FROM
PRYING EYES, THAT KIND OF THING. MAYBE JUNKIES
GETTING LOST IN THE BIG CITY.
HOW ACCURATE IS THAT IMPRESSION
THAT WE MAY HAVE OF HOW THINGS REALLY
ARE?

Dan says CERTAINLY THAT STILL EXISTS
AND THERE IS NUMBER OF PLACES IN
MAJOR METROPOLITAN AREAS WHERE THE BACK
ALLEYS IS THE ONLY PLACE WHERE PEOPLE CAN
AVOID POLICE, AVOID PRYING EYES
AND THAT'S WHERE THEY ARE GOING TO DO THEIR
DRUGS. BUT IN THE CASE OF SMALLER
RURAL PERHAPS AGRICULTURAL
AREAS, ACROSS ONTARIO THAT IS
ISN'T CASE AND WHEN IT COMES TO PRESCRIPTION
OPIOIDS A LOT OF IT ACTUALLY STARTS AT HOME AND
THAT’S WHAT IN MY INVESTIGATIONS, OF
THIS ISSUE, WHEN I WAS DOING SOME
REPORTING IN CHATHAM COUNTY A
LOT OF PEOPLE WERE TALKING ABOUT
THE FACT THAT THEY FIRST
DISCOVERED PRESCRIPTION OPIOIDS IN THEIR PARENTS
MEDICINE CABINETS OR A SPOUSE STARTING USING
THE OPIOIDS THAT HAD BEEN PRESCRIBED TO THEIR PARTNER AND BECAME
DRUG DEPENDENT THAT WAY SO IT’S A LOT MORE INTIMATE ITS NOT JUST SOMETHING
THAT’S HAPPENING IN BACK ALLEYS
AND IN FACT, YOU KNOW, ITS
HAPPENING IN PHARMACIES.
FRANKLY AND IN DOCTOR'S OFFICES
AND WHERE THESE DRUGS ARE
SOMETIMES OVER PRESCRIBED.

Steve says I DON’T KNOW MIKE IF THIS QUESTION IS ANSWERABLE. IS
THERE IN YOUR TRAVELS, A TYPICAL
USER OF THESE KINDS OF OPIOIDS.

Mike says NO.
NO, IT CAN BE ANYONE.
THERE IS NO-
IT DOESN'T DIFFERENTIATE BETWEEN YOUR
SOCIAL CLASS IT DOESN’T MATTER WHERE YOU ARE ON THE TOTEM POLE OF
LIFE, YOU CAN BE AT THE BOTTOM OR ANYWHERE UP TO
TOP AND WE HAVE DEATHS THAT ARE
IN MILLION DOLLAR HOMES IT
DOESN'T MATTER. THESE DRUGS
ARE SO AVAILABLE TO ANYONE.

Steve says MORE MALE THAN FEMALE.

Mike says MORE MALE THEN FEMALE YES. AND IN OUR AREA SPECIFICALLY WHEN WE ARE
TALKING ABOUT THERE HAVE BEEN RECENT STATISTICS THAT HAVE BEEN
RELEASED BY LAMBTON PUBLIC HEALTH AND STATED ABOUT OPIOID
PROBLEM SPECIFICALLY FOR LAMBTON COUNTY SO THAT INCLUDES SARNIA AND SOME OF THE
OUTLINING AREAS AND WE HAVE FOR
NUMBER OF EMERGENCY ROOM
DEPARTMENT VISIT, IN RELATION TO
SOME SORT OF OPIOID, UM, DIAGNOSIS OR
COMPLICATION, OR OVERDOSE, FOR
OUR STATISTICS, WE HAVE 80 PERCENT HIGHER
THAN THE PROVINCIAL AVERAGE
FOR OUR MALE POPULATION.
55 PERCENT FOR OUR FEMALE POPULATION WE SEE A HUGE
DIFFERENCE- AS BAD IT
IS IN ONTARIO OR AREA
UNFORTUNATELY IS MUCH WORSE.
IT JUST SEEMS WITH THIS TYPE OF
PROBLEM.
AND WE ARE ALSO FINDING THAT THE AGE
GROUP THAT TYPICALLY IS AT RISK
IS 20-29 YEARS OLD. AND THEY ARE THREE TIMES MORE
LIKELY TO HAVE TO GO TO THE HOSPITAL FOR
OVERDOSE OR SOME SORT OF TREATMENT OR
RELATION TO OPIOIDS.

Steve says WHY IS THAT?

Mike says IT IS HARD TO EXPLAIN IN OUR AREA. I’M NOT
SURE IF IN OUR AREA IT MAY HAVE TO DO WITH SOME OF OUR GEOGRAPHICAL
LOCATIONS THAT WE ARE A LITTLE BIT MORE
REMOTE, LIKE I SAID FROM THE MOST OF MAJOR
PIPELINES BUT THERE REALLY IS NO
RHYME OR REASON ABOUT WHY IS THIS AFFECTING US SO BADLY.

Steve says YOU ARE A 24 YEAR OLD MAN YOU THINK YOU'RE
INVULNERABLE TO ANYTHING. SO NO DOUBT OVERINDULGE.

Mike says SURE IT JUST SEEMS THAT THE POPULATION IN OUR AREA WE HAVE THE MOST PROBLEMS WITH WHEN IT COMES TO THESE ISSUES.

Steve says IS IT THIS EPIDEMIC NOW?

Mike says IT IS, IT IS FOR SURE.

Steve says EVEN THE SMALL CITIES
AND TOWNS IN ONTARIO.

Mike says YES, YES
OUR FENTANYL DEATH RATE IS FOUR
AND HALF TIMES THE PROVINCIAL
RATE WHICH IS SHOCKING AND A BAD
AS IT IS ACROSS THE PROVINCE,
LIKE I HAVE STATED AND CANADA,
WE HAVE FOUR HALF TIMES THE RATE
WE HAVE THE SAME NUMBER OF FENTANYL
DEATHS AS LARGER CITY LIKE
LONDON HAS WHICH IS THREE TIMES THE
POPULATION THAT WE HAVE. SO THERE IS VERY HIGH AMOUNT OF
CONCERN THAT WE HAVE AS NOT ONLY ON BEHALF
OF SARNIA POLICE BUT ALL THE
PARTNERS THAT ARE INVOLVED IN TRYING TO TACKLE THIS ISSUE.

Steve says TARA AND MICHAEL LET ME GET YOU NOW TO TRY AND
JOIN IN ON THIS DISCUSSION AND WANT TO
START WITH YOU, WHERE WE FINISHED UP WITH
MIKE AND DAN AND DO YOU THINK
THIS IS EPIDEMIC ACROSS THE
PROVINCE OF ONTARIO? WHAT WE ARE TALKING ABOUT TONIGHT?

The caption changes to “Tara Gomes. St. Michael’s Hospital.”
Tara is in her thirties, with long wavy brown hair. She’s wearing a black cardigan over a black top.

She says YEAH I ABSOLUTELY DO.
SOME OF THE WORK WE HAVE DONE AND
REALLY ECHOES WHAT DAN AND MIKE HAVE ALREADY SAID
AND THAT THIS IS A HUGE ISSUE THAT HAS BEEN
RISING OVER THE PAST TWO
DECADES ACROSS THE PROVINCE. BUT
ALSO WHEN WE LOOK AT THE INDIVIDUALS
COUNTIES AND REGIONS WE SEE HUGE
DIFFERENCES IN THE RATES OF
PRESCRIBING AND THE RATES OF PEOPLE GOING
TO HOSPITAL WITH OVERDOSE AND
RATES OF DEATHS FROM OVERDOSES. AND IT’S REALLY
DIFFICULT TO TRY AND UNDERSTAND WHAT IS
DRIVING THAT IS IT,
PROXIMITY TO THE BORDER, IS IT THE
TYPICAL AGE RANGE OF PEOPLE,
SOME DIFFERENT AREAS MIGHT HAVE
MORE OLDER PEOPLE VERSUS YOUNGER
PEOPLE LIVING IN THE REGIONS OR IS IT
SOMETHING ELSE? IS IT THAT THERE ARE
CERTAIN PRESCRIBERS IN SOME
REGIONS WHO ARE MORE COMFORTABLE
PRESCRIBING THESE AND WE MIGHT EVEN HEAR SOME
CONCERNING STORIES OF PRESCRIBERS WHO
ARE INVOLVED IN THE
OVERPRESCRIBING THESE
INTENTIONALLY FOR THE PURPOSE
OF DIVERSIONS AND CAN HAVE
COUPLE OF PROBLEMATIC --

Steve says EXPLAIN OVERPRESCRIBING FOR
A DIVERSION MEANS WHAT?

Tara says SO WRITING LARGE NUMBER OF
PRESCRIPTIONS FOR PATIENTS --
THAT THEY KNOW ARE GOING TO BE
TURNED AROUND AND SOLD ON THE
STREET AND PERHAPS
GETTING PAID FOR THAT SERVICE.

Steve says I DON'T MEAN TO SOUND NAIVE
BUT PHARMACISTS DO THIS. DOCTORS DO THIS?

Tara says PRESCRIBERS HAVE BEEN SOME
CASES OF THIS AND I MEAN YOU PROBABLY
KNOW BETTER THAN I DO, BUT IN THE
WORK I'VE DONE I HAVE HEARD
FROM DIFFERENT POLICE SERVICES WHO
SAID THAT THIS HAPPENS AND IT CAN BE
PRESCRIBER, IT CAN BE THE
PHARMACIST OR A COMBINATION OF THE
TWO WORKING TOGETHER WITH PEOPLE
AND YOU PROBABLY KNOW THIS BETTER THAN I
DO-

Mike says I BELIEVE THERE WAS A BARRIE
FAMILY PHYSICIAN OR DOCTOR THAT
GOT CAUGHT UP IN THIS DIVERSION
OF FENTANYL AND IS GOING TO JAIL
FOR A NUMBER OF YEARS I BELIEVE AND THESE
WERE HUGE AMOUNTS OF
PRESCRIPTIONS THAT WERE BEING WRITTEN AND I
BELIEVE THAT VALUE WAS CLOSE TO
FOUR HUNDRED THOUSAND DOLLARS
WORTH OF THIS PRESCRIPTION DRUG THAT WAS
BEING DIVERTED ON THE STREET.

Steve says JUST TO GET A SENSE OF THAT IF YOU BUY A TYPICAL PRESCRIPTION PILLS IN BOTTLE HOW MUCH DOES
THAT COST?

Mike says VERY LITTLE, ESPECIALLY IF YOU'RE COVERED
UNDER A DRUG BENEFITS PLAN.

Steve says SO FOUR HUNDRED GRAND IS LOT.

Mike says ABSOLUTELY.

Michael says OK, CAN I GET TO YOU MICHAEL ON
THAT ISSUE ABOUT WHETHER OR NOT IN
YOUR TRAVELS YOU SEE THIS AS AN
EPIDEMIC.

The caption changes to “Michael Parkinson. Waterloo Region Crime Prevention Council.”
Michael is in his late thirties, with short straight blond hair and bangs. He’s wearing a gray suit and a white shirt.

He says WELL, IT HAS BEEN DESCRIBED
AS LEADING PUBLIC HEALTH AND
SAFETIES CONCERN, IT’S BEEN DESCRIBED AND AS PUBLIC
HEALTH CRISIS, WHETHER ITS AN EPIDEMIC I DON'T KNOW
WE LOOSE ONE PERSON EVER 1 4
HOURS IN ONTARIO TO AN OPIOID RELATED OVERDOES AND IF THAT’S NOT A CRISIS WE NEED TO REDEFINE WHAT A CRISIS REALLY IS.

Steve says WE LOOSE MEANING SOMEONE DIES?

Michael says SOMEONE DIES EVERY 14 HOURS IN ONTARIO, USING 2013
DATA SO IN TOTAL 625 PEOPLE
ACROSS ONTARIO IN 2013 THAT IS
UP 463 PERCENT SINCE 2000 THAT’S ALMOST
FIVE THOUSAND DEAD ONTARIANS AND
MANY OF THOSE DEATHS WERE
ABSOLUTELY PREVENTABLE AND MANY
OF THEM AS MIKE SAID STARTED IN
A PHYSICIANS OFFICE BUT BEFORE
THEY GOT TO PHYSICIAN THEY WERE
APPROVED BY REGULATORS AND THEY
WERE APPROVED BY PROVINCES AND THE FEDERAL GOVERNMENT ON THEIR
DRUG PLANS AND HERE WE ARE, I
OFTEN THINK FROM A CRIME
PREVENTION PERSPECTIVE YOU KNOW,
WHAT WOULD HAPPEN IF WE DUNKED
BILLIONS OF DOLLARS WORTH OF
PHARMACEUTICAL GRADE HEROIN TO TRUSTED HEALTH PROVIDERS
TO A LARGELY
UNSUSPECTING PUBLIC I MEAN WHAT COULD
GO WRONG? EVERYTHING.

Steve says EVERYTHING!

Michael says WE HAVE THE KNOWLEDGE NOW AND
DATA THROUGH GOOD WORK IN ONTARIO
FROM TARA AND OTHER RESEARCHERS
AND WE KNOW ENOUGH TO KNOW BETTER.

A bar graph pops up on the screen under the title “Ontario Opioid-related Deaths.” It reads: In 2010-499 deaths, 2011-553 deaths, 2012-580 deaths, and 2013-652 deaths.

Steve says HERE IS I PROPOSE THE NUMBER YOU’VE JUST SAID. LETS BRING UP THIS BAR GRAPH BECAUSE WE HAPPEN TO HAVE THIS
STANDING BY, ONTARIO OPIOID
RELATED DEATHS GOING BACK THE
YEAR 2010 UP TO 2013, WHICH IS THE LATEST YEAR
FOR WHICH STATISTICS ARE AVAILABLE, AND
UP AND UP AND UP AND UP.
AND I DON'T SUSPECT WE HAVE ANY
REASON TO ASSUME THAT OVER THE
LAST COUPLE OF YEARS, THIS CHART IS
GOING TO CONTINUE TO GO UP.RIGHT?

The caption changes to “Ontario’s Opioid Problem. Use and Misuse.”

Michael says NO I MEAN, IT HAS BEEN RISING
AND I WOULD EXPECT IT WILL CONTINUE TO RISE
AND OPIOIDS PRESCRIBING LEVELED OFF A LITTLE
BIT BUT CONCERN IS HYBRID OPIOIDS PRESCRIBING LIKE FENTANYL AND LIKE OXYCONTIN THAT IS UP.
AND SO WHAT’S INTERESTING ABOUT THOSE NUMBERS LIKE THOSE 2010-2013; IT IS ABOUT A 20 PERCENT RISE IN OPIOID
OVERDOSE DEATHS AND THE SAME
PERIOD, THERE IS BEEN DECLINE IN
SELF REPORTED OPIOID MISUSES AND
SO I THINK YOU REALLY NEED TO ASK YOURSELF WHAT IS
DRIVING OPIOID OVERDOSE DEATHS
AND WHAT IS DRIVING OTHER
INDICATOR OF MORTALITY LIKE
ADDICTION TREATMENT AND
EMERGENCY ROOM ADMISSIONS AND
VISITS – AND MANY PEOPLE WHO ARE
SMARTER THAN ME SUGGEST PEOPLE
USING AS PRESCRIBED THAT IS DRIVING THIS
EPIDEMIC. WE OFTEN FOCUS ON THAT
STEREOTYPICAL NOTION OF JUNKY ON THE STREET
AND ALLOWS US TO IN THE MAIN,
PASS MORAL JUDGMENT ON PEOPLE'S
CHARACTER AND BE DISMISSIVE OF
SERVICES I THINK WHAT WE REALLY NEED TO LOOK AT PEOPLE WHO ARE USING AS EXACTLY AS PRESCRIBED BY THEIR PHYSICIANS AND
PARTICULARLY PEOPLE WHO ARE GETTING
MENTAL HEALTH MEDICATIONS LIKE ANTI-DEPRESSANTS OR SEDATIVES AND START TO REDUCE THE DEATHS
ATTRIBUTABLE IN THOSE CIRCUMSTANCES AS WELL.

Steve says THAT IS A BRILLIANT SEGUE TO
YOU ADA, BECAUSE THIS IS NOT AN
ACADEMIC EXERCISE FOR YOU BUT
THIS IS VERY PERSONAL. TELL US ABOUT YOUR SON.

The caption changes to “Ada Giudice-Tompson. Advocates for the Reform of Prescription Opioids.”
Ada is in her fifties, with shoulder-length wavy brown hair. She’s wearing glasses, a sparkling black top and a feathered burgundy shawl.

She says YES, MICHAEL MY SON HAD SOME
PAIN ONE MORNING AND HE WAS
DOUBLED OVER, I TOOK HIM TO THE
EMERGENCY.

Steve says HE'S HOW OLD?

Ada says 27 AT THE TIME.
AND SO WE WENT TO EMERGENCY
AND THEY SAID HE HAD RENAL COLIC
KIDNEY STONES AND THEY GAVE HIM
MORPHINE AND GRAVOL, INSERTED
A CATHETER BECAUSE HE COULD NOT VOID HIS
BLADDER AND SO WHEN ALL THAT WAS
DONE, HE WAS FEELING REALLY GOOD
AND UM, I SAID TO THE DOCTOR,
WHAT HAPPENS IF THIS PAIN COMES
BACK AGAIN? WHAT DO I DO?
HE SAID DON'T WORRY, AND GAVE
US THIS SCRIPT FOR PERCOCET BUT
IN 2002 I DIDN'T KNOW WHAT
PERCOCET WAS AND THE DOCTOR SAID
NOTHING. I TOOK IT AND WENT DIRECTLY TO
THE PHARMACY, HAD IT FILLED AND
AGAIN NOTHING SAID ABOUT THE
FACT THAT IT WAS OPIOID AND
HIGHLY ADDICTIVE, NOTHING AT ALL AND I GAVE IT TO HIM.

Steve says DOCTOR DIDN'T SAY THAT,
PHARMACIST DIDN'T SAY THAT.

Ada says DIDN'T SAY THAT AT ALL AND I GAVE IT
TO MICHAEL. OF COURSE I HAD TOLD MICHAEL
ABOUT STREET DRUGS AND WHAT HAVE
YOU BUT TRUSTED THIS SYSTEM AND
TRUSTED THE DOCTOR THE
PHARMACIST, AND IT WAS TWO YEARS
FROM THAT FIRST PRESCRIPTION,
UM, MICHAEL WAS GONE IN BED AND
AT HOME, UM, I WENT OFF TO
SCHOOL TO WORK, AND HE NEVER
WOKE UP.
I UNKNOWINGLY LEFT HIM TO
DIE, BECAUSE I WENT TO TURN OFF
HIS ALARM CLOCK AND I THOUGHT HE
PROBABLY GOT TO BED VERY LATE
AND I THOUGHT I'LL LET HIM SLEEP
SOME MORE HIS GIRLFRIEND OR SOMEBODY WILL
COME BY AND I WENT TO WORK.

Steve says DIFFICULT CONVERSATION
OBVIOUSLY AND WE'RE GRATEFUL
YOU'RE HERE TO HELP US
UNDERSTAND THIS BETTER.
DID YOU HAVE ANY REASON TO
SUSPECT WHILE MICHAEL WAS TAKING
THE MEDICATION THAT HE WAS
ADDICTED TO IT OR TAKING IT
IMPROPERLY?

Ada says NOT AT ALL AND HE WAS GIVEN
THIS IN 2002 AND HE HAD
RECURRING BOUTS OF KIDNEY STONES
AND WE WENT BACK TO THE SAME
EMERGE AND GIVEN THE SAME
PRESCRIPTION AGAIN AND AFTER THE
WHOLE TREATMENT, AND I NOTICED
ONE YEAR BEFORE HE DIED, THAT HE
WAS DIFFERENT.
UM, I COULDN'T QUITE PUT MY
FINGER ON IT, BUT HE HAD A
PARTNERSHIP, BUSINESS THAT HE
WAS DOING REALLY WELL IN AND
THAT DETERIORATED AND UM, HE
WAS EXTREMELY CLOSE TO FAMILY AND RELATIVES,
AND THAT'S SORT OF STARTED TO
FIZZLE AND I THOUGHT, WHAT IS
GOING ON HERE?
AND HE SAID TO ME, DON'T
WORRY MOM I'M SEEING A DOCTOR SO I SORT OF
LEFT IT AT THAT.
AND I REALLY DIDN'T KNOW THE
DETAILS UNTIL THE DAY HE DIED.
AND THE POLICE WERE AT THE HOUSE
AND THE CORONER WAS THERE.
BUT I WANT TO SORT OF ADDRESS SOME OF
THE ISSUES THAT YOU RAISED
EARLIER, THE PROBLEM WITH THE
ILLICIT DRUGS THIS FENTANYL THE
PROBLEM THAT WE'RE EXPERIENCING
NOW FROM ALL OF MY READING AND
RESEARCH, IT IS FROM THE
MEDICAL COMMUNITY PRESCRIBING
LIKE MICHAEL INDICATED EARLIER,
PHARMACEUTICAL GRADE HEROIN AND
THAT WHAT OPIOIDS ARE THEY COME
FROM THE OPIUM POPPY.

Steve says YOU KNOW IF HE WAS NOT USING IT AS PRESCRIBED?

Ada says HE WAS TAKING IT AS PRESCRIBED I LEARNED THROUGH
GIRLFRIEND HE TOOK IT AS PRESCRIBED AND
DIDN'T CRUSH HE DID NOT SNORT, HE DID NOT INJECT
AND THIS IS WHERE THE PROBLEM IS
AS IF MAGICALLY A DOCTOR WILL GIVE YOU
PILL AND YOU WILL TAKE THE PILL AND IT
WON'T AFFECT YOU ANY WAY.
AND THEY HAVE DONE STUDIES AT
COLUMBIA UNIVERSITY WHERE THEY
HAVE TAKEN PEOPLE WHO INJECT
HEROIN AND PEOPLE WHO WILL
INJECT OXYCONDON AND THE RESULT
IS THE SAME AND THEY PREFERRED
IN THIS STUDY CODONE.

Steve says BECAUSE IT WAS MORE ADDICTIVE
AND BIGGER BUZZ.

Ada says YEAH, BUT WHATEVER, YEAH,
THEY LIKED IT MORE.
I THINK FROM MY EXPERIENCE WHAT
I HAVEN'T SEEN IS WE CAN'T DEAL
WITH ILLICIT DRUGS WITHOUT
LOOKING AT THE SYSTEM, THAT
ALLOWS THESE DRUGS, THAT
SANCTIONS THESE DRUGS OUT TO THE
DOCTORS TO PRESCRIBE, HEALTH
CANADA HAS APPROVED SO MANY
OF THE OPIOIDS AND WE DON'T NEED
ANY MORE OPIOIDS AND WE NEED
INFORMED CONSENT, AND THAT
DOESN'T MEAN JUST SIGN ON THE
DOTTED LINE.
WHEN DOCTOR DECIDES- OK, YOU ARE GOING TO HAVE
THIS FOR CHRONIC PAIN AND WE SHOULD
BE TOLD FROM THE GET GO THAT THIS IS AN ADDICTIVE
SUBSTANCE.

Steve says MICHAEL I WANT TO FIND OUT,
THE TEMPTATION WILL BE TO
STEREOTYPE THIS SITUATION BY
SAYING THAT’S A ONE OFF ITS NOT TYPICAL. YOU HAVE MORE EXPERIENCE AND I WANT TO GET BETTER SENSE FROM YOU IF
THAT TRUE, IS THIS ONE OFF OR
MORE TYPICAL THEN WE THINK?

Michael says THAT’S WAY MORE TYPICAL THEN CANADIANS HAVE BEEN LED TO BELIEVE. ADA’S IS RIGHT THERE IS A SUBSTANCE OF
KNOWN DEPENDENCE AND SHOULD HAVE LEARNED
THAT A HUNDRED YEARS AGO WHEN BAYER INTRODUCED HEROIN AS A NON-ADDICTIVE ALTERNATIVE TO MORPHINE.
SO DOCTORS WERE PRESCRIBING
HEROIN AT THE TURN OF THE CENTURY AND ADDICTIONS WENT UP OVERDOSES WENT UP PRESCRIBING REGULATORY CONTROLS WENT UP
AND WE STOPPED THAT AND SKIP
FORWARD ABOUT A CENTURY LATER AND THERE IS
OXYCONTIN AND REGULATORS HAVE APPROVED
IT, PHYSICIANS HAVE PRESCRIBING IT AND
PHARMACISTS ARE DISPENSING IT AND
CONSUMERS ARE TAKING IT AND SOMETIMES
DEMANDING IT SO WE KNOW FROM THIS FANTASTIC QUARTER REVIEW
OF FILE IN BRITISH COLUMBIA AND
WE KNOW THAT AMONG PEOPLE TAKING
OPIOIDS AS PRESCRIBED THE DEATH
RATES WERE HUGELY SIGNIFICANT
AND 93 PERCENT WERE TAKING OTHER
MEDICATIONS AS PRESCRIBED BY THEIR PHYSICIANS SO THE FRAME
IS ONE OF FOCUSING SQUARELY ON
ABUSE OR TAMPER RESISTANT
FORMULATIONS, IT IS THE WRONG FRAME.
IT REALLY IS AND WHEN PEOPLE
MISUSE OPIOIDS, MOST OF TIME
THEY TAKE IT ORALLY SO HOW AN ABUSE CAN TURN FORMULATION TO
DETERS IS BEYOND ME MUST BE
MAGIC AND SECOND MOST COMMON
FORM OF MISUSE IS BY SNORTING
AND THIRD IS INJECTING. SO ALL OF THOSE PEOPLE
ARE IMPORTANT BUT WE'RE MISSING
IT IF WE FRAME SQUARELY AS ONE
OF ABUSE.

Steve says LET ME GO BACK TO CALIFORNIA AND DAN YOU
HAVE DONE A LOT OF RESEARCH ON THIS AS WELL SO I WANT TO FIND OUT FROM YOU
WHETHER YOU THINK YOU HAVE ADEQUATE DATA
COME TO A CONCLUSION AS TO WHETHER OR NOT THIS IS A BIG PROBLEM OF ILLICIT USE VERSUS USE AS
PRESCRIBED AND JUST NOT WORKING
PROPERLY. WHAT IS YOUR VIEW?

Dan says WELL, I ABSOLUTELY AGREE WITH
THE OTHER PEOPLE ON THE SHOW THAT THIS
PROBLEMS WE ARE SEEING ARE GENERATED OUT OF
A TOTALLY LEGITIMATE, UM, OR SORT OF LEGITIMATE
PRESCRIBING SYSTEM.
AND THE ISSUE HERE LIKE ADA SAID
WAS THAT WE HAVE HAD INFLUENCED BY
BIG ORGANIZATIONS LIKE PURDUE PHARMA WHO PRODUCE THE
TEXTBOOK ON PAIN MANAGEMENT
THAT WAS INSERTED TO PAIN
MANAGEMENT CLASSROOM FOR U OF T
MEDICAL STUDENTS AT THE
UNIVERSITY OF TORONTO WHICH
DOWNPLAYED THE ADDICTIVE
POTENTIAL OF DRUGS LIKE
OXYCONTIN AND PERCOCET WHICH
WERE CONVENIENTLY PRODUCED BY
PURDUE PHARMA THEMSELVES.
SO THERE IS BEEN MISINFORMATION, PURDUE FARMA
IN THE UNITED STATES HAS BEEN
SUCCESSFULLY SUED FOR FRAUD AND
OVER CLAIMS THAT THE PRODUCTS
AREN'T ADDICTIVE SO THAT IS
MAJOR ISSUE AND THAT THESE DRUGS HAVE BEEN ABSOLUTELY
MISCHARACTERIZED IN TERMS OF THEIR ADDICTIVE POTENTIAL. THE OTHER
ISSUE THAT I THINK IS RELEVANT AND IS
GAINING STEAM RIGHT NOW IS THE FACT THAT
WE'RE SEEING AS ACCESS TO DRUGS
LIKE OXYCONTIN IS DECREASING
THROUGH RESTRICTING OF
PRESCRIBING AND THERE IS
INCREASE IN THE LEVEL OF
ILLICIT USE OF DIVERSION OF MORE
DANGEROUS DRUGS LIKE FENTANYL.
FENTANYL IS PRODUCED AND
PRESCRIBED OR DIVERTED THROUGH
AGAIN THROUGH LEGITIMATE PRESCRIPTION PRACTICES BUT
ALSO NOW WE'RE SEEING COUNTER
FIT FENTANYL, ILLICIT FENTANYL PRODUCED OVERSEAS
AND SHIPPED TO CANADA AND DISSEMINATED INTO A
BLACK MARKET AND PEOPLE TAKING WITHOUT EVEN KNOWING WHAT IT IS.

Steve says TARA I DO REMEMBER, I DON’T KNOW IF IT WAS LAST YEAR OR
THE YEAR BEFORE THE ONTARIO
GOVERNMENT SAID, WE ARE BANNING
OXYCONTIN, NO MORE ALLOWED.
THINKING THAT WOULD PRESUMABLY REDUCE THIS
PROBLEM AND IT HASN'T REDUCED THE PROBLEM.

Tara says AND THAT'S EXACTLY THE SITUATION
WE'RE IN AND AS OTHERS ON THE PANEL HAVE SAID
AND ANY ONE POLICY THAT ADDRESSES ONE
SINGLE DRUG WITHIN THIS CLASS CAN
WORK AND THAT IS BECAUSE THERE IS SO MANY
DIFFERENT DRUGS IN THIS CLASS AND THEY CAN ALL BE ABUSED
AND SO YOU INTRODUCE THESE
RESTRICTIONS ON OXYCONTIN AND ITS
PULLED BY PURDUE AND OXYNEO THE OTHER
FARM CAME IN BUT PROVINCIAL
GOVERNMENT HERE DECIDED TO INTRODUCE
LOT OF RESTRICTIONS AROUND ACCESS TO
THAT THROUGH THE DRUG PROGRAM HERE BUT WHAT YOU SEE KNOW IS FENTANYL USE GOING UP AND HYDROMORPHONE
USE IS GOING UP AND THE SOLUTION CAN’T BE INTRODUCED
NOT TAMPER DETERRENT SOLUTIONS FOR ALL OF THESE PRODUCTS
BECAUSE EVEN ONCE OXYNEO
CAME IN WHICH IS TAMPER DETERRENT YOU IMMEDIATELY SAW CHAT ROOMS AND TRAFFIC ON THE INTERNET SAYING, WELL THIS IS HOW
YOU GET AROUND THE TAMPER DETERRENT PRODUCTS AND
SO PEOPLE HAVE VESTED INTEREST
IN EXTRACTING DRUGS FROM THESE
FORMULATIONS AND THEY'RE GOING
TO FIND A WAY AND SO I THINK YOU
NEED TO GO BEYOND JUST THINKING ABOUT A TAMPER
DETERRENT AND I THINK LOOKING BACK TO
DISCUSSION AROUND ILLICIT VS
PRESCRIPTION OPIOIDS I THINK THE
SITUATION IN, WHICH WE'RE IN
YOU CAN SEPARATE THE TWO.
I THINK THE TRUST THAT PEOPLE HAVE THAT THESE ARE
REGULATED AND THAT THESE ARE
PRESCRIPTION MEDICATIONS AND SO ARE
SAFE THEN TRANSLATES TO THESE ILLICIT MANUFACTURED DRUGS THAT ARE BEING MANUFACTURED TO LOOK LIKE
OXYCONTIN OR TO LOOK LIKE FENTANYL PRODUCT
AND THEN PEOPLE THEN THINK, WELL THIS
IS A DRUG I KNOW AND THIS IS
DRUG THAT IS PRESCRIPTION
MEDICATION AND I HAVE TAKEN IT BEFORE AND ACHIEVED A CERTAIN
HIGH AND WE IN FACT WE ARE FINDING THAT THESE FRAUDULENT OXYCODONE TABLETS CAN INCLUDE ONE OF
THE NUMBER OF DIFFERENT DRUGS
INCLUDING FENTANYL OR HEROIN OR
COCAINE OR ANY OTHER DRUGS AND SO
YOU DON'T KNOW ACTUALLY WHAT YOU'RE
GETTING AND THINK YOU'RE TAKING
PRESCRIPTION DRUG THAT WHILE YOU'RE MISUSING IT YOU HAVE EXPERIENCED IT AND HAVE HAD A CERTAIN EXPERIENCE BEFORE
AND IT COULD HAVE ANY NUMBER OF DRUGS
AND DOSES AND JUST TAKING ONE TABLET
AT DOSE THAT YOU'RE BODY IS NOT USED
TO, CAN LEAD TO AN OVERDOSE
FATALITY.

Steve says WELL THAT LEADS ME TO MY NEXT QUESTION-IS THE IMPACT ON EACH INDIVIDUAL BASICALLY THE SAME?
OR ARE SOME PEOPLE MORE SUSCEPTIBLE
TO HAVING PROBLEMS WITH THIS
THAN OTHERS?

Tara says IT CAN REALLY VARY WE HAVE SEEN
PEOPLE WHO HAVE PASSED ISSUE
WITH ADDICTIONS – SO PEOPLE WHO MIGHT HAVE PAST
ALCOHOL USE DISORDERS AND MAYBE
MORE PRONE TO BECOMING ADDICTED
TO OTHER DRUGS AND THAT’S WHY WHEN PEOPLE
ARE TALKING WITH PRESCRIBERS ABOUT WHETHER TO
START A PATIENT ON ONE OF THEM MEDICATIONS,
THEY REALLY NEED TO HAVE THAT
CONVERSATION AND TAKE THAT
PATIENT HISTORY TO UNDERSTAND IF
THEY MIGHT BE AT GREATER RISK OF
BECOMING ADDICTED TO ONE OF THESE
PRODUCTS.

Steve says HOW LONG CAN IT TAKE TO GET
ADDICTED?

Tara says IT CAN BE, IT CAN BE QUITE QUICK.
I MEAN IT WOULD VARY BY PERSON I THINK
PART OF THE CONCERN IS WHAT
DOSE YOU START ON.
HOW QUICKLY YOUR PRESCRIBER MIGHT ESCALATE THAT DOES AND
THOSE SIDE EFFECTS OF THOSE HIGH DOSES
SO THE WORK WE HAVE SHOWN IS PEOPLE
GETTING THESE DRUGS ARE QUARTER OR A
THIRD OF THEM EVEN ARE GETTING
HIGH DOSES WHICH IN THE CANADIAN
GUIDELINES AND U.S. GUIDELINES ARE
SUGGESTED TO BE UPPER DOSE AND
BEYOND WHICH YOU SHOULD BE EXTREMELY
CAUTIOUS OF PRESCRIBING THESE DRUGS THEM AND
QUARTER TO THIRD OF ONTARIANS
ARE GETTING DRUGS THAT DOSES
EXCEED THAT.

Steve says SORRY GO AHEAD MIKE.

Mike says ARE SEEING THAT THE SOME
PRESCRIPTIONS THAT ARE COMING
THROUGH AFTER WE HAVE DONE A DRUG
INVESTIGATIONS ARE WAY ABOVE
WHAT THEY SHOULD BE AND IT IS UNFORTUNATE THAT SEEMS TO BE A
TREND WITH SOME PEOPLE, WE HAD A
GENTLEMAN WHO WAS PRESCRIBED A CERTAIN AMOUNT OF
FENTANYL AND PILLS AND HE GOT HIS PRESCRIPTION
ONE DAY AND THE NEXT DAY WE DID
SEARCH WARRANT AND ALL OF THAT
MEDICATION BESIDES SOME PILLS
WAS GONE AND WAS ALREADY DIVERTED ON
THE STREETS AND EVERY TIME THIS
GENTLEMAN WAS GETTING A
PRESCRIPTION REFILLED IT WAS 20,000 DOLLARS
STREET VALUE OF THE DRUGS.
AND THERE IS SUCH HUGE MARKET
AND DEMAND FOR THIS STUFF THAT
PEOPLE ARE BEGGING TO TAKE THIS KIND OF
STUFF OFF THE PEOPLE THAT DO HAVE LEGITIMATE
PRESCRIPTIONS AND THAT ‘S PARTIALLY WHERE THE
DRUG DIVERSIONS ANGLE OF THINGS
COMES TO PLAY.

Steve says I PRESUME THOSE THAT BECAUSE THIS
ISN'T COCAINE OR HEROIN WHICH ARE CLEARLY ILLEGAL
THESE DRUGS ARE LEGAL AND THAT MAKES
YOUR JOB HARDER, YES?

Mike says YES, VERY MUCH SO.
SO YOU CAN WALK AROUND IF YOU ARE PRESCRIBED FENTANYL OR HYDROMORPHONE YOU CAN WALK AROUND WITH THAT IN YOUR POCKET
AND IT NOT BE ILLEGAL. IT ONLY BECOMES ILLEGAL
WHEN YOU ATTEMPT TO DIVERT IT TO TRAFFIC IT TO ANOTHER
INDIVIDUAL SO IT DOES PRESENTS
CHALLENGES FOR POLICING ESPECIALLY IN SMALL COMMUNITIES.

Steve says YOU HAVE TO CATCH THEM IN THE ACT?

Mike says PRETTY MUCH.
IT IS VERY DIFFICULT FOR PEOPLE WHO
DO HAVE LEGITIMATE PRESCRIPTION
FOR US TO PROVIDE SOME SORT OF ENFORCEMENT
AND OTHERWISE, THEN WE'RE ALMOST
GOING TO THE REVERSE ENGINEERING
OF DRUG INVESTIGATIONS SO LIKE I
SAID, PERSON WHO HAS A PRESCRIPTION AND ONE DAY
AFTER THEY HAD IT
FILLED THEY DON'T HAVE IT THEN WE
HAVE TO LOOK AT PRODUCTION ORDER MEDICAL RECORDS
AND REVERSE ENGINEER A DRUG
INVESTIGATION BASICALLY INSTEAD
OF JUST YOUR TYPICAL ONE THAT INVOLVES JUST PRODUCT
GOING OUT AND SOMEONE BEING
ILLEGALLY IN POSITION OF THESE
DRUGS.

Steve says ADA GIVEN WHAT WE
HAVE HEARD TONIGHT I WANT TO MAKE SURE I
UNDERSTAND YOUR POSITION.
ARE YOU SAYING THERE SHOULD BE
NO PRESCRIBING OF THESE DRUGS AT ALL?

Ada says NO THAT IS NOT WHAT I’M SAYING.
WHAT WE HAVE TO DO IS PULL BACK ON THE PRESCRIBING
OF OPIOIDS BECAUSE THEY ARE
ADDICTIVE, AND YOU DON'T LIKE I
SAID EARLIER YOU DON'T HAVE TO
ABUSE THEM AND THE DOCTOR CAN
GO THROUGH A QUESTIONNAIRE WITH YOU TO
SEE IF YOU CONSUME ALCOHOL OR YOU’RE A SMOKER
OR WHATEVER AND CAN USE OPIOID RISK
TOOLS AND THEY CAN DO ALL THESE THINGS
MONITOR YOU CLOSELY AND IT
DOESN'T MATTER.
AND THERE IS A NEW PARADIGM NOW
FOR DOCTORS AND THE UNITED
STATES, THEY'RE SAYING, WE NEED
TO STILL CONTINUE TO
PRESCRIBE OPIOIDS BECAUSE
PAIN THERE IS A HUNDRED THOUSAND OF A HUNDRED MILLION- I
THINK IT IS, PEOPLE IN PAIN AND
THEY'RE SUFFERING BUT THERE IS A
RELATIONSHIP BETWEEN THE INCREASES
IN SALES AND THE INCREASE IN THE
ADDICTION, AND IN OVERDOSE DEATHS.
AND I WANT TO ALSO COMMENT IN
THE UNITED STATES, THERE WAS A
STUDY DONE IN UTAH, 92 PERCENT OF
PEOPLE WHO DIED WERE PEOPLE WHO
WERE TAKING THEIR OPIOIDS AS
PRESCRIBED, THEY SPOKE TO FAMILY MEMBERS. THE FAMILY MEMBERS
THOUGHT THEY WERE ADDICTED BUT
THEY WERE TAKING THEIR PAIN
MEDICATION FOR THEIR CHRONIC
PAIN THAT THEY WERE EXPERIENCING
AND SO THIS IS A PROBLEM THAT
NEEDS TO BE SYNERGISTICALLY
ADDRESSED BY EVERYONE, ALL OF
STAKEHOLDERS.

Steve says SO WE ARE TALKING MINISTRY OF HEALTH WE ARE TALKING
DOCTORS AND PHARMACISTS.

Ada says HEALTH MINISTERS.

Steve says HEALTH CANADA.

Ada says EVERYBODY, OCP THAT’S RIGHT. BECAUSE
WHEN MICHAEL DIED I WENT TO
MEET WITH THE REGISTRAR AT THE
OCP, CPSO, THE CORONER'S OFFICE-

Steve says OKAY, HANG ON HANG ON ACRONYMS, and ACRONYMS.

Ada says ONTARIO COLLEGE OF PHARMACIES
THE COLLEGE OF PHYSICIANS
AND SURGEONS OF ONTARIO, AND THE
CORONERS OFFICE AND I GOT THE
SAME STORY.
THAT IF YOU TAKE THESE PAIN
MEDICATIONS CORRECTLY FOR PAIN
YOU DON'T BECOME ADDICTED BUT
THE PAIN AND ADDICTION ARE NOT MUTUALLY EXCLUSIVE THEY ALL
SAID TO ME WELL THAT’S NOT OUR PURVIEW YOU HAVE TO GO HERE AND
CORONER SAID WE CAN ONLY MAKE
RECOMMENDATIONS AND NOBODY WILL
LISTEN-

Steve continues SO SOMEBODY NEEDS TO GET ALL OF THE STAKEHOLDERS AROUND THE TABLE.

Ada says SO THEY'RE ALL DOING THIS.
IT IS ALL OF OUR RESPONSIBILITIES AND PATIENTS AS
WELL BECAUSE ONCE THEY'RE
ADDICTED, EVEN IF THEIR PAIN
PATIENTS YOU CAN'T TAKE THEIR
SUPPLY AWAY FROM THEM, IF THEY
STOP TAKING THAT OPIOIDS THEY GO
INTO WITHDRAWAL SO THEY THINK WHEN I
TAKE IT MY WITHDRAWAL MY PAIN
DISAPPEARS AND I'M I MUST NEED THESE MEDICATION
SO THEY ARE ONE OF THE
MAJOR GROUPS THAT REALLY ARE
DETERMINED DON'T TAKE MY MEDS
AWAY BUT WE DO HAVE TO THERE
ARE OTHER WAYS TO TREAT PAIN IN
ADDITION TO OPIOIDS AND THEY
SHOULD BE GIVEN ONLY IN SELECT
CLINICAL SITUATIONS WHEN IT’S
WARRANTED. WHEN RISK
IS NOT GREATER THAN-

Steve says UNDERSTOOD. LETS GET SOME FEEDBACK FROM AROUND
THE TABLE HERE ON WHAT KIND OF
IF I CAN MIX MY METAPHORS HERE
PRESCRIPTION FOR CHANGE MIGHT
IMPROVE THINGS. FOR EXAMPLE WHAT WOULD YOU
LIKE TO SEE HAPPEN?

The caption changes to “Ontario’s Opioid Problem. A Prescription for change.”

Mike says WELL CURRENTLY THERE IS BILL
33 FOR FENTANYL PATCH FOR PATCH
EXCHANGE PROGRAM.
BASICALLY IT’S A PARTNERSHIP WITH PATIENTS
PHARMACISTS AND PHYSICIANS AS WELL AS WITH OTHER PUBLIC PARTIES LIKE LAMBDON PUBLIC HEALTH IN OUR CASE AND SARNIE POLICE. IS TRYING TO HAVE THE RESPONSIBLE USE OF THESE
DRUGS AND TRYING TO ENSURE THAT
THESE DRUGS DON'T GET DIVERTED ONTO THE
STREET – AND THAT THE
PATIENTS THAT HAVE THEM NEED TO
RETURN THEIR USED PATCHES TO A PHARMACY
AFTER THEY HAVE SO THEY CAN GET
A NEW REFILL.
BECAUSE WHAT WE'RE FINDING IS THAT PEOPLE ARE
DIVERTING THEM ONTO THE STREET AND IN SOME CASES
THESE DRUGS FOR SOME PEOPLE THEY
CAN'T LIVE WITHOUT THEM AND I
DON'T WANT TO CLASSIFY
ESPECIALLY FENTANYL, THAT IT’S AN EVIL DRUG
THAT’S NOT THE CASE. FOR
SOME PEOPLE THIS IS ALL- ITS EVERYTHING
TO THEM AND BECAUSE THEY CAN
LIVE A GOOD QUALITY OF LIFE
WITHOUT THEM AND BUT FOR PEOPLE
THAT ARE POTENTIALLY ABUSING
THEM OR DIVERTING THEM THESE CAUSE ISSUES FOR US
SO BASICALLY TO ENSURE THAT PATIENTS DOES
RECEIVE THEIR ADDITIONAL SUPPLY, THEN THEY
HAVE TO RETURN THOSE PATCHES AND IF
THEY DON'T, THEN WHAT HAPPENS IS
THERE IS CONVERSATION BETWEEN
PHARMACIST AND THE PHYSICIAN
SAYING THAT FOR EXAMPLE MIKE HOWELL WAS SUPPOSED
TO RETURN TEN PATCHES AND ONLY
RETURNED TWO AND WE NEED THE
INVESTIGATE THIS AND LOOK INTO IT
AND IT PROVIDES CHECKS AND BALANCES
TO FIGURE OUT WHAT IS GOING ON
AND IS THIS ABUSE ISSUE FOR THAT
INDIVIDUAL OR IS DIVERSIONS
GOING ON BECAUSE THEY ARE WORTH
SO MUCH.

Steve says MICHAEL LET ME ASK YOU ABOUT
NOLOXONE, IS THAT HOW YOU SAY IT?

Michael says NOLOXONE!

Steve says OKAY TELL ME HOW THAT IS PART OF THIS PUZZLE?

Michael says WELL IF YOU WANT TO REDUCE
OPIOID OVERDOSE DEATHS, NOLOXONE WOULD BE KEY PART
OF THAT SOLUTION IT WON'T DROP OPIOID DEATH’S TO ZERO BUT-

Steve says WHAT IS IT?

Michael says WELL IT IS AN OPIOID ANTAGONIST SO IT
REVERSES AT LEAST TEMPORARILY OPIOID OVERDOSE
AND IT IS ON WHO AN ESSENTIAL MEDICINE LIST, WORLD HEALTH ORGANIZATION. ITS BEEN USED SUCCESSFULLY FOR 40 YEARS AMONG PARAMEDICS AND EMERGENCY ROOMS AND
ACROSS THE U.S.A. FROM
WHITEHOUSE TO STATE LEVEL TO
LOCAL LEVELS WE SEE A MASSIVE
RAMPING UP OF NOLOXONE MASSES EXPANDING NOLOXYLY
COVERAGE.

Steve says SO IF YOU TAKE ONE OF THESE
OPIOIDS AND YOU TAKE NOLOXONE AT THE SAME TIME
YOU SHOULD BE OKAY?

Michael says IF STEVE TAKES TOO MANY
OPIOIDS AND I'M HANGING AROUND
STEVE AND I NOTICE HE’S EXHIBITING SIGNS OF AN OVERDOSE, THEN NOLOXONE IS SOMETHING JUST LIKE AN
EPIPEN THAT I WOULD USE ON YOU TO SAVE YOUR
LIFE SO AN OPIOID OVERDOSE YOUR BRAIN I GUESS
TELLS YOUR LUNGS TO BREATHE AND ITS
RESPIRATORY FAILURE AND IT IS
PROVEN LIFE SAVER AND IT COSTS ABOUT 12 DOLLARS
AND IT IS NOT WIDELY SUPPORTED
BY GOVERNMENTS IN CANADA AT THE
NATIONAL OR PROVINCIAL LEVELS.

Steve says TARA, WHAT ABOUT DOCTORS
AND PHARMACISTS.

Dan says SORRY- CAN I.

Steve says YEA, ALRIGHT DAN COME ON IN, YOU COME ON IT THEN I’LL GO TO TARA RIGHT AFTER THAT.

Dan says I WANT TO JUST MENTION THIS
SITUATION WITH NOLOXONE, HERE IN SAN DIEGO COLLEAGUES OF MINE AT UNIVERSITY OF CALIFORNIA, SAN DIEGO HAVE WORKED WITH THE SAN DIEGO SHERIFFS COUNTY DEPARTMENT AND
NOW, SHERIFFS IN SAN DIEGO
COUNTY ARE ALL CARRYING NOLOXONE
SO THESE ARE THE FIRST
RESPONDERS, POLICE OFFICERS WHO ARE
CARRYING IT AND IN INTERESTINGLY THEY ARE CARRYING IT
EVEN BEFORE PEOPLE WHO ARE STAFFING THE LOCAL NEEDAL EXCHANGE ARE WILLING TO CARRY IT SO THEY HAVE BEEN SHOWN DOWN
HERE TO DRAMATICALLY REDUCE DEATHS AND I THINK THAT WE
COULD DEFINITELY SEE THE SAME
LEVEL OF PREVENTION IN ONTARIO
IF WE HAD BUY IN FROM LAW
ENFORCEMENT IN PARTICULAR.

Steve says WHAT ABOUT TARA
DOCTORS AND PHARMACIST DO THEY NEED TO HAVE THE RIOT
ACT READ TO THEM BY THE PROVINCE OR HEALTH CANADA OR SOMETHING LIKE THAT.

Tara says WELL I THINK THERE IS A GAINING
APPRECIATION AMONG DOCTORS AND PHARMACISTS
THAT SOME OF THE INFORMATION THAT THEY MIGHT HAVE LEARNED IN MEDICAL SCHOOL OR MIGHT HAVE LEARNED THROUGH THEIR TRAINING MAY NOT HAVE BEEN UNBIASED AND THEY MIGHT NEED TO
RETHINK THE WAY IN WHICH THEY'RE
PRESCRIBING OR DISPENSING OPIOIDS. BUT I ALSO THINK ONE OF THE
KEY THINGS WE'RE MISSING IN
ONTARIO IS GETTING THAT
INFORMATION PARTICULARLY INTO
PRE-SCREEN PRESCRIBER HANDS AND THE
PROVINCIAL GOVERNMENT INTRODUCED
LEGISLATION AND WE NOW HAVE NARCOTIC
MONITORING SYSTEM IN THE PROVINCE WHICH CAPTURES ALL OF THE
PRESCRIPTION DRUGS THAT ARE DISPENSED IN PHARMACIES.
ONE COMPONENT OF THAT ALLOWS PHARMACISTS TO KNOW
IF THE PERSON MIGHT BE DOUBLE
DOCTORING THEY MIGHT HAVE JUST GOT YOUR
PRESCRIPTION FILLED AT YOUR PHARMACY BUT THEY JUST
YESTERDAY GOT THE SAME PRESCRIPTION
FILLED AT A DIFFERENT PHARMACY OR FROM A
DIFFERENT DOCTOR AND THAT’S ONE OF
THOSE CHARACTERISTICS OF OPIOID
MISUSE THAT WE LOOK FOR BUT THE
PROBLEM IS THAT INFORMATION’S
NOT IN THE HANDS OF THE PRESCRIBERS AND
WE DON'T HAVE ELECTRONIC HEALTH
SYSTEM OR DATABASE ACCESSIBLE TO PRESCRIBERS
WHEN THEY HAVE SOMEONE COME IN
AND THINK THEY MIGHT BE IN EXTREME
PAIN AND TRYING TO DO THE BEST
THEY CAN, TO ACTUALLY LOOK AND SEE
THIS PERSON WENT TO THIS
DIFFERENT EMERGENCY DEPARTMENT
YESTERDAY OR GOT A PRESCRIPTION
FILLED BY A DIFFERENT DOCTOR THE DAY BEFORE THAT AND
IF WE CAN GET THAT INFORMATION
INTO THEIR HANDS I THINK THAT IT WOULD PUT A LOT MORE
POWER IN THE PRESCRIBERS OFFICE AND IN
TERMS OF IDENTIFYING POTENTIALLY
PEOPLE WHO MIGHT BE ABUSING OR MISUSING THESE DRUGS VERSUS
PEOPLE WHO HAVE LEGITIMATE PAIN CONDITIONS AND
IF THEY DO IDENTIFY PEOPLE WHO
MIGHT BE ADDICTED TO THESE DRUGS OR MISUSING THEM THEN HAVING THEM UNDERSTAND HOW THEY CAN GET THOSE PEOPLE HELP
BECAUSE YOU CAN’T JUST ABANDON THEM AND
HOW DO YOU THEN GET THEM HELP?
AND I THINK THAT- THAT IS A PIECE OF
INFORMATION THAT REALLY WE'RE
MISSING IN ONTARIO AND I THINK
WOULD BE A GREAT TOOL IN TRYING
TO DO JUSTICE.

Steve says DAN I’M DOWN TO MY LAST MINUTE HERE, JUST TAKE THAT
MINUTE AND TELL US WHAT YOU
THINK THE GENERAL PUBLIC NEEDS
TO KNOW ABOUT THIS RIGHT NOW?

Dan says WELL I THINK THAT IT HAS BEEN STRESSED BEFORE
THAT THE PHARMACEUTICAL MARKET-THAT FIRST OF ALL THESE DRUGS CAN BE DANGEROUS, I DO THINK THERE IS A PLACE FOR PAIN MANAGEMENT THROUGH OPIOID DRUGS WITHIN OUR MEDICAL SYSTEM BUT THESE DRUGS ARE ADDICTIVE AND I WOULD AGAIN STRESS
THAT EXPANSION OF THE
DISTRIBUTION OF NOLOXONE COULD DRAMATICALLY
REDUCE THE NUMBER OF PEOPLE IN
ONTARIO WHO DIE OF PRESCRIPTION OPIOID OVERDOSES.

Steve says DOES THAT SUGGEST THAT IT OUGHT TO BE ON THE FORMULARY FOR THE ONTARIO DRUG BENEFIT PLAN OR THAT KIND OF THING?

Dan says ABSOLUTELY- I MEAN CURRENTLY ITS CLASSIFIED AS A NOXIOUS
SUBSTANCE A CONTROLLED SUBSTANCE,
AND HEALTH CANADA IS UNDERTAKING A
REVIEW BUT WE NED TO ADVOCATE
AROUND BETTER ACCESS TO NOLOXONE AND I REALLY THINK
WE NEED LAW ENFORCEMENT TO TAKE UP
NOLOXONE AS PART OF THEIR TOOL
KIT AND I THINK WE COULD SEE A
MAJOR DECLINE IN THE SHORT TERM
AND THEN MOVE ON TO THE LONGER TERM POLICIES ISSUES.

Steve says UNDERSTOOD THAT’S DAN WERB, DIRECTOR OF THE INTERNATIONAL CENTER FOR SCIENCE AND DRUG POLICY ON THE LINE FROM SAN DIEGO CALIFORNIA. DAN THANKS FOR BEING ON THE PROGRAM AGAIN. AND HERE IN OUR STUDIO IN
TORONTO, MIKE HOWELL, THE DETECTIVE CONSTABLE WITH THE VICE UNIT SARNIA POLICE SERVICES, TARA GOMES,
PRINCIPAL INVESTIGATOR FOR THE
ONTARIO DRUG POLICY RESEARCH
NETWORK AND ON THE OTHER SIDE OF
THE TABLE, MICHAEL PARKINSON
COMMUNITY ENGAGEMENT
COORDINATOR WITH THE WATERLOO
REGION CRIME PREVENTION COUNCIL
AND ADA GIUDICE-TOMPSON.
ADA THANK YOU FOR COMING IN AND SHARING
A HELACIOUS STORY WITH US AND I HOPE
YOU GET PEACE AND SOME PROGRESS ON
THIS TO HELP YOU GOING FORWARD.
VP ADVOCATES FOR THE REFORM OF
PRESCRIPTION OPIOIDS.
AND THANK YOU ALL VERY MUCH.

Everyone says YOU'RE WELCOME.

Watch: Ontario's Opioid Problem