A comprehensive approach is needed

Re: “Tamper- proof Oxy didn’t curb abuse” ( Opinion, March 24)

As a leader in developing safe and effective pain medications for patients, we agree with Christopher Labos’s comment that making prescription drugs safer and more tamperresistant is a good idea.

Tamper- resistant or ADF products are just one component of a comprehensive approach — involving industry, government, prescribers, social service agencies, law enforcement and patients — needed to address prescription drug abuse. While not a silver bullet ADFs do repre- sent an important contribution industry can and should make to help address this issue. Other important contributions must come from correct diagnosis, responsible prescribing, proper use, storage and disposal by patients, as well as effective education, prevention, surveillance and law- enforcement efforts.

The Journal of the American Medical Association ( JAMA) Psychiatry article to which Labos refers reported that abuse of reformulated OxyContin ( known as OxyNEO in Canada) dropped significantly, from 45 to 26 per cent of all users following its introduction, a 42 per cent reduction. While OxyNEO and all opioids remain subject to abuse, this result provides substantial evidence that replacing a product with an ADF version can positively impact clinical outcomes in a real- world setting.

The shift of some opioid abusers to heroin and other prescription pain medicines following the introduction of an ADF is an unfortunate reality, and is often referred to as a “balloon effect.” Labos essentially identifies this as the real problem to tackle. We agree. To address this outcome, governments need to ensure that all manufacturers of prescription opioids, brand or generic, be required to ensure that new opioid medicines ( and those already available) be equipped with features intended to deter their abuse.

This policy change, coupled with other complementary harm- reduction initiatives and law- enforcement efforts to deal with illegal and illicit drugs such as heroin, merits full public support. The government of Canada and Health Minister Rona Ambrose are to be commended for their recent issuance of Draft Guidance to Industry for Tamper- Resistant Formulations. The supportive position of the Canadian Medical Association on this Draft Guidance is equally noteworthy. We now look forward to the timely release of new regulations under the Controlled Drugs and Substances Act to make ADFs/ tamper- resistance a new standard for all manufacturers of opioids, in addition to demonstration of safety and efficacy. Grant Perry ( Vice- President, Corporate and Government Affairs, Purdue Pharma Canada), Pickering, Ont.