Outdated branding of opioid raises concerns
When Kyle Bye is trying to score the prescription narcotic Percocet, he looks for three letters: TEC.
The letters are engraved in bold capitals across the dime-sized white pill, a mix of oxycodone and Tylenol. The TEC name is among the most desired brands of prescription drugs in Canada’s opioid epidemic. The letters are also the marking of a drug company that has not existed in nearly 20 years.
Harm reduction advocates are concerned the outdated TEC branding is being used by the drug’s current manufacturer only because of the prescription pill’s popularity on the streets, a charge the company says it not true. Some are calling on the government to investigate why the pills still have the old marking.
A recent Star investigation obtained an email chain showing that the company that now makes these oxycodone pills has offered to pay an Ontario pharmacy group to stock its prescription medications, including TECs. The health minister said he takes the allegations of “illegal” rebate payments seriously and ordered the government to investigate. In a statement, the company said it follows Ontario’s laws and will co-operate with the probe.
This story is about the controversial, outdated branding on these pills — and why they are so attractive to illicit users.
“I know what I’m getting when I ask for TECs,” said Bye, who lives in Toronto. “That’s the only thing I would buy. If it didn’t say TEC on it, I probably wouldn’t buy it.”
The pills are officially known as Oxycocet and are a generic version of Percocet. They make their way from pharmacies to the streets in different ways, from fake prescriptions to robberies to patients selling their medication.
Once there, a single TEC pill can fetch anywhere from $5 to $20 — and probably sells a lot easier than the same drug with different markings.
“It’s brand recognition,” said Matt Johnson, the harm reduction outreach co-ordinator at the Queen West Central Toronto Community Health Centre.
“The people looking for that TEC brand are the ones buying them in ones and twos on the street.” The drugs are popular among young people and casual users because its lower dosage means a more manageable high.
Many TEC users believe it gives a better high than other generic versions of Percocet, and that the product is less likely to be adulterated with a more potent narcotic such as fentanyl.
These pills are the first taste of opioids for many people.
TECs, which used to be made by a drug firm called TechniLab Pharma, are now distributed by Teva Canada. In a statement to the Star, Teva Canada said it markets its generic pharmaceuticals to licensed pharmacies and hospitals — not illicit users.
“Teva denies that the retention of the TEC marking on this product is motivated by any preference illicit users may have for the product (and in fact, had no knowledge of any such preference prior to your inquiry),” a spokesperson said.
“Teva Canada prides itself on being a responsible distributor of controlled products.”
In Ontario, TECs are the most commonly dispensed generic form of oxycodone covered by the public drug plan, according to Ontario Drug Benefit Program data. Since 2012, the province has paid more than $50 million covering the cost of pills with that marking. The Star was unable to obtain similar data for those prescriptions covered under private health plans.
Some of the prescription opioids, with costs footed by the government, are making their way into the hands of drug dealers.
Toronto police recently arrested more than 20 people in an ongoing investigation into people selling Oxycocets (TECs), fentanyl and other prescription opioids that were “provided and paid for by” the Ontario Disability Support Program, said Det. Sgt. Michael Richmond of 51 Division.
“The taxpayers are ultimately paying for some of these illegal drugs on the street,” Richmond said.
Teva said it works with Canadian law enforcement “to identify and prevent diversion of pharmaceutical products for the illicit market.” The company said it also helps with investigations and prosecutions of counterfeit opioid products.
The fact that the black market is producing counterfeit pills with the TEC marking is proof the brand is desired by people who use drugs, said Amy Graves, founder of the nonprofit Get Prescription Drugs off the Street. In May, the RCMP in Newfoundland issued a public alert after finding fake pills with the TEC branding that actually contained fentanyl, which police warn can be up to 100 times more potent than morphine.
“This is a popular brand that people seek out on the streets for illicit use. Organized crime is tailoring their products to meet the demand of the prescription drug market,” said Graves, whose brother died in 2011 after taking a different prescription opioid — hydromorphone — at a house party.
Graves said there should also be a government probe into the TEC markings.
“I think it should be further investigated why the company has continued to use the imprint,” Graves said.
Each TEC pill contains five milligrams of oxycodone. By comparison, an Oxy 80, known to some as “Green Monsters” because of their emerald hue and potency, has 16 times more.
For heavy opioid users, a TEC pill isn’t strong enough, said harm reduction worker Johnson.
But they are popular among young people and those who prefer to mix different pills — sometimes with alcohol — to get stoned.
“With TECs, there are a lot of suburban, middle-class people who are binge users,” Johnson said. Many others, he said, simply use it to selfmedicate chronic pain because the medication they can legally access just isn’t strong enough.
Bye, a Toronto man who uses drugs, said he takes TECs to ease the aches and pains that come from withdrawal from binge drinking or other narcotics.
Bye works in a paid position with the Queen West Health Centre’s outreach team to help people learn safer ways to use drugs to avoid overdoses or infectious diseases.
“If you’re going to use (drugs), use safely,” he said.
Oxycocet first came on the market in 1984, according to Health Canada product records. Montreal-based TechniLab Pharma had launched 10 years earlier and was quickly becoming one of the country’s prominent generic drug companies.
By 2000, a crowded drug marketplace had devoured its profits. The company accepted an $80-million takeover bid from a German drug company and became part of the generic brand Ratiopharm.
Shortly after that, Ratiopharm launched an internal initiative in Canada to get newly acquired products under its own brand, said a source who worked with the company at the time.
Over the next few years, the markings on most of the former Technilab drugs were changed to “rph” for Ratiopharm, said the source, who asked not to be named because the person still works in the industry and fears reprisal. The Oxycocet pills stayed the same, however.
In 2010, TECs changed hands again when generic drug giant Teva bought Ratiopharm for nearly $5 billion (U.S.). But Canada’s Competition Bureau quickly intervened.
Both Teva and Ratiopharm each had their own versions of oxycodone-acetaminophen and morphine sulphate. A merger of the two companies would “likely lead to a substantial lessening of competition in the supply” of these tablets, the Competition Bureau said.
Teva ultimately sold off its version of the oxycodone drug, the Competition Bureau said, and kept the one under Ratiopharm’s branding.
Today, the pills arrive at pharmacies in a canister labelled ratio-Oxycocet, with Teva’s logo along the bottom. Inside, each pill is still stamped with the letters TEC.
A Teva spokesperson said the company has a practice of not modifying products’ markings “in order to avoid unnecessary changes to products with an established stability profile, unless a change is triggered by a regulatory requirement.”
Many Teva-distributed drugs, including Oxycocet, are still branded under the names of their former companies such as “rph” for Ratiopharm or “Novo” for Novopharm, the company said.
According to Health Canada, a company can change the markings on a drug at any time without permission. It just has to notify Health Canada annually if it has made any changes.
“Changes in markings on tablets and capsules should not affect the stability of the product,” said a Health Canada spokesperson, adding that as a precautionary measure, the drug regulator requires a company to monitor that the new marking hasn’t affected the medication’s expiry date.
Toronto addiction specialist Dr. Alexander Caudarella said some of his patients have a perception that TEC pills “produce a more significant high than other ones,” especially when crushed up.
The perception that one brand is safer or more effective can be dangerous, he said, as most of the illegal drug supply has been adulterated by illicit labs that are increasingly good at mimicking the appearance of prescription opioids.
A pill that looks like a TEC could actually be something much more potent. Because TECs are fairly lowdose, many of its users haven’t developed high tolerance.
“If they come across one that’s been manipulated and contains fentanyl, it makes it that much more likely that they’re going to die,” he said.
“If they come across one that’s been manipulated and contains fentanyl, it makes it that much more likely that they’re going to die.” DR. ALEXANDER CAUDARELLA TORONTO ADDICTION SPECIALIST