Why won't Canada stand up to Purdue Pharma?

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By Nav Persaud
and Andrew S. Boozary
EvidenceNetwork.ca

Canadians are paying dearly for government inaction over the opioid crisis.

Purdue Pharma recently announced that it will stop advertising opioids to doctors in the United States after pleading guilty to misleading marketing more than a decade ago. This is a major, albeit belated, departure from the company’s playbook of marketing opioids aggressively to physicians. A recent U.S. Senate report excoriated Purdue Pharma and other opioid manufacturers for funding patient advocacy groups for years.

Several states have already successfully sued Purdue Pharma and others may follow. Purdue has already paid hundreds of millions to American governments.

Nav
Persaud

We have the same tragic opioid crisis in Canada – 3,000 deaths per year in this country compared to 30,000 in the United States – and trail only the U.S. when it comes to opioid prescribing rates. But unlike our neighbours, Canadian governments have not taken similar actions against Purdue Pharma.

Although the hundreds of millions of dollars in penalties paid in the U.S. aren’t trivial, they’re still a small fraction of Purdue Pharma’s profits from the opioid crisis. And many companies now sell the types of products that Purdue flogged at the start of the crisis. Drug manufacturers are sure to do the simple arithmetic: huge sales minus small penalties equals lucrative profits.

The math is even simpler in Canada. There are no government penalties here.

Health Canada regulates drug manufacturers but has never sanctioned Purdue Pharma. The federal Competition Bureau enforces the Competition Act, which prohibits false and misleading marketing, but it has shown no interest in the opioid crisis. The Patented Medicine Prices Review Board has also been silent on the issue.

Andrew
Boozary

Provincial governments continue to publicly fund high-dose opioid products made by Purdue Pharma and other companies. The Ontario government even awarded Purdue Pharma a $4.9-million grant in 2007, the same year the company pleaded guilty in the U.S. And in advance of Ontario’s leading push toward increasing transparency for drug company payments to prescribers, Purdue Pharma ended up disclosing $3 million in payments to health providers in Canada in 2016 alone.

The message sent by Canadian governments to Purdue Pharma and other drug makers is clear: we’re not prepared to hold you accountable for a crisis you helped manufacture. That message is surely received by other drug manufacturers as well.

To be sure, this is an extreme example of a company that has already pleaded guilty in another country. If Canadian governments can’t muster the strength to respond in this case, with hundreds of deaths each month attributed to opioids, will they ever prosecute self-admitted misbehaviour by a pharmaceutical company?

The settlement in the 2017 Canadian class-action lawsuit against Purdue Pharma shows why Canadian governments must act quickly. The people harmed by the opioid crisis decided to accept a small settlement rather than try to take on a behemoth in the courtroom. That makes perfect sense.

Stunningly, Canadian governments left those harmed by the crisis to fend for themselves and agreed to a settlement of just $2 million in total for all of the harms associated with the opioid crisis. Both Purdue Pharma’s revenues and the toll of the opioid crisis in Canada are measured in the billions.

A criminal investigation should be launched into the marketing of opioid products in Canada, as the Ontario minister of Health has openly recommended.

Purdue Pharma may decide not to risk an open airing of the evidence and instead plead guilty, as it did in the U.S. But even an unsuccessful prosecution will remind Purdue Pharma and other opioid manufacturers that there are laws in this country, too, and it will provide at least a semblance of justice.

In the meantime, both the marketing to physicians that Purdue Pharma voluntarily stopped in the U.S. and the funding of advocacy groups must also be halted in Canada.

Too many lives have already been lost. As Canadian communities continue to feel the brunt of the opioid crisis, it’s well past time that Canadian governments finally stand up to Purdue Pharma.

Nav Persaud is a family physician and an assistant professor at the University of Toronto and an expert adviser with EvidenceNetwork.ca. Andrew S. Boozary is a resident physician at the University of Toronto and visiting scientist at the Harvard T.H. Chan School of Public Health.