Canada plans cigarette-style warning stickers for painkillers

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As deaths from powerful painkillers continue to rise, Canada is pursuing unprecedented measures to curb their use, including requiring cigarette-style warning stickers on every prescription, Health Minister Jane Philpott is quoted as saying.

According to a Reuters Health report, Health Canada plans to publish a detailed proposal for the stickers, which Philpott said would warn that opioid painkillers can cause addiction and overdose. In March, an advisory panel is set to consider a second measure, revising the official label definition of how opioids should – and should not – be used, officials said.

Any revision would affect marketing efforts by manufacturers, including privately held Purdue Pharma and Pharmascience, as well as publicly traded Teva Pharmaceuticals Industries, Mallinckrodt Plc, Novartis’s Sandoz and Johnson & Johnson’s Janssen Pharma.

Warning stickers would be a first and could serve as an example. The measures would follow other strategies that failed to stem addiction and death involving prescription opioids, such as OxyContin and Hydromorph Contin, as well as illicit ones, including heroin and powerful fentanyl smuggled from China.

The report says fatal overdoses have increased across Canada, mirroring the much larger epidemic in the US. In Ontario, the most populous province, prescription opioid deaths rose 40% in six years; in the western province of Saskatchewan, they more than doubled since 2010. An influx of illicit variations of fentanyl fuelled an 80% increase in deaths last year in British Columbia to a record 914.

Philpott has called the opioid epidemic the nation’s greatest public health crisis and pledged to use every tool at her disposal to fix it. “We’re concerned when opioid prescriptions are on the increase,” she said in the report. “We need to understand what’s behind that and make wise recommendations.”

Drug companies have said they support measures to increase patient safety. Several companies and industry groups declined to comment until the government lays the new proposals.

But, the report says, some doctors and public health experts who have long clamoured for safeguards said the new measures may be too little, too late. “Stickers may have been helpful in 2006, 2007,” said Edmonton, Alberta, addiction doctor Hakique Virani. “But when we’ve created this huge demand for opioids that is now being met by powder from China, and you can traffic a million doses of that stuff in a 10-gram greeting card envelope, I’m sorry, but stickers on pill bottles is not going to solve this problem.”

Philpott said she recognises the challenge. “You don’t want to drive people to use even more harmful street drugs and illicit substances,” Philpott said. “So it needs to be done with a tremendous amount of wisdom and thoughtfulness, and we are certainly consulting widely to make sure we don’t have any unintended consequences from our actions.”

Officials declined to provide a timetable. Health Canada plans to put the warning sticker proposal to focus groups and gather public comment before Philpott makes a decision.

The report says according to spokesperson Grant Perry, OxyContin and Hydromorph Contin maker Purdue “supports providing the most relevant and up to date information” to doctors and patients, as well as evidence-based updates.

It said representatives for Mallinckrodt, Teva and Sandoz did not respond to queries and Pharmascience representatives did not return calls or emails. Spokesperson Jennifer McCormack said Janssen would “continue to work with Health Canada to help ensure the safe and appropriate use” of prescription opioids and it was “important to carefully balance anti-abuse efforts” with patient needs.

Reuters Health report

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