Tags: gpdots, leo glavine, news 957, nova scotia, prescription drugs, prescription monitoring program, rick howe
Tags: gpdots, Nadine Wentzell, news 957, nova scotia, oxycontin, prescription monitoring program, Ray Wagner, Rob Mulloy, sheldon macleod
Rob Mulloy – GPDOTS enforcement consultant
Ray Wagner – Lawyer heading class action suit against Purdue Pharma
Nadine Wentzell – Consultant & former narcotics inspector
Tags: canada, college of physicians and surgeons, Dr. Sarah Jones, gpdots, leo glavine, minister of health, nova scotia, prescription drugs, prescription monitoring program
On March 7th 2016 GPDOTS wrote the Nova Scotia Minister of Health & Wellness , College of Physicians & Surgeons , and the Prescription Monitoring Program regarding our concerns with the programs ability to identify over prescribing. Shortly after our letter Minister Leo Glavine announced he would be ordering a full review of the program. The letter is as follows:
As you know in May 2012 the Auditor General released a report on the Nova Scotia Prescription Monitoring Program. The report contained numerous concerns and noted many deficiencies within the program. The report opened with “While some aspects of the Nova Scotia Prescription Monitoring Program are effective, there are significant weaknesses in the Program’s control and monitoring processes that can allow abuse or misuse of prescription drugs to continue undetected. Improvements are needed to address these issues.” A small portion of the concerns referenced included:
- Lack of consistency – The Auditor General’s office analyzed the data from the drug utilization reports during the audit period and found there was no consistent pattern to the situations for which letters were sent. They identified many instances in which a letter was sent when someone was one to two percent over the threshold; conversely, there were also many instances in which letters were not sent when an individual was prescribed 10 to 20 times the dosage threshold. While Program staff were able to provide possible explanations, there was no documentation to confirm this was the rationale considered when the cases were reviewed. Given these inconsistencies and the absence of any documentation supporting why cases were identified for follow-up, it is impossible to know whether all situations were followed up or whether the action taken was appropriate.
- Enforcement processes – The Program may send letters to prescribers following the review of a drug utilization report. Prescribers are required to provide a response. The Program’s medical consultant may also contact prescribers to discuss the specifics of a situation or may request additional information. If the prescriber does not reply before the deadline, a second letter is sent. If a response is still not provided, a final letter is sent indicating the matter will be referred to the College of Physicians and Surgeons of Nova Scotia if a reply is not received. The Auditor General’s office tested 24 initial letters to prescribers and identified three instances in which the file was closed even though the prescriber failed to respond to letters from the Program. While additional evidence may dictate a case can be closed, it is important the Program require all prescribers to respond to its requests for information. The Program should also document decisions made in these cases.
- Timeliness of medical consultant review – The sample selected from drug utilization review reports included three cases which were referred to the medical consultant for review. While all three situations were reviewed, there is no evidence of when the review was actually completed. The review results were entered in the Program’s system between 44 and 92 days after the initial referral to the medical consultant. The contract with the medical consultant establishes review timeframes of between seven and 30 days, although Program management told the Auditor General’s office these deadlines are not used in practice. Timely review by the medical consultant is important to address potentially inappropriate prescribing practices and prevent misuse or abuse of monitored drugs from continuing for longer than necessary.
- Thresholds – Currently, both drug utilization review and multiple prescriber reports are very large. The drug utilization review reports averaged 2,000 situations identified as exceeding thresholds; only 2% of these cases resulted in letters to prescribers and further analysis. The multiple prescriber reports averaged 215 situations identified, with notification letters sent in 13% of these cases.
February 24th, 2016 we learned various charges were laid against Dr. Sarah Jones practicing in Tantallon Nova Scotia. Those charges included trafficking Oxyneo and Oxycodone. Reports allege 50,000 pills were prescribed to a single patient then diverted by Dr. Sarah Jones over 20 months.
On March 2nd 2016, former Auditor General Michael Pickup was interviewed and stated as of June 2015, thirteen out of the seventeen Auditor Generals recommendations had been implemented. Some of the recommendations that have yet to be implemented relate to the concerns listed above in this letter.
Due to the severity of Dr. Jones trafficking allegations and the Auditor General’s recommendations that have yet to be fulfilled almost four years later GPDOTS would like to request the following information from Nova Scotia Prescription Monitoring and its partners cc’d in this letter:
- Did the extremely large quantity of medication that Dr. Jones allegedly prescribed and diverted alert the Nova Scotia Prescription Monitoring Program by raising red flags? What action did the program take if alerted?
- Were there any letters from the Nova Scotia Prescription Monitoring Program or the College of Physicians & Surgeons sent to Dr. Jones following the review of drug utilization reports?
- Did the Nova Scotia Prescription Monitoring Program alert the Nova Scotia College of Physicians & Surgeons at any time before a pharmacist called PMP about Dr. Jones’s prescribing? If so, did the College contact or have any follow up with Dr. Jones?
- What corrective actions do your organizations plan on taking to prevent future negligence and over prescribing?
Get Prescription Drugs off the Street Society (GPDOTS) is committed to creating awareness, education, and most importantly accountability when it comes to the prescription drug use epidemic. In order to prevent future diversion and encourage responsible prescribing there needs to be an understanding of how such a large amount of controlled drugs could be prescribed for 20 months without intervention. GPDOTS would like to encourage the Nova Scotia Department of Health & Wellness to seriously consider executing a full review of the Nova Scotia Prescription Monitoring Program and fast track the implementation of any outstanding Auditor General recommendations.
We look forward to hearing from your various organizations as we piece together how such a shocking amount of dangerous medication could make it from a prescription pad to the street without intervention for so long.
Tamara Ballard from GPDOTS discusses the recent trafficking case of Dr Sarah Jones – Global News N.S.Posted: March 7, 2016 in Interviews by GPDOTS, Video
Tags: Dr. Sarah Jones, global news, gpdots, leo glavine, nova scotia, prescription drugs, prescription monitoring program, Tamara Ballard, trafficking
Tags: addiction, Alberta, canada, fentanyl, gpdots, harm reduction, Naloxone, nova scotia, ontario, opioids, overdose
In the first 9 months of 2015 fentanyl killed 215 Albertans. Public health officials, enforcement, and government have sounded the alarm , created task forces, and public awareness campaigns. The sudden spike in fentanyl related deaths has put pressure on the government to make naloxone more accessible, often described as the “fentanyl antidote” in media reports even though it is effective for all opioid overdoses. While it is nice to see new developments in regards to the accessibility of naloxone it is disappointing that government and policy makers dragged their heels until illicit fentanyl began ravaging Western Canada to act.
Opioid related deaths are not a new phenomenon in Canada. In 2011 my little brother was one of 53 opioid deaths in Nova Scotia. In 2010 there were 421 opioid related deaths in the province of Ontario, this number jumped to 513 in 2013. Of those 513 opioid related deaths in 2013, 111 were fentanyl implicated.
What is a new phenomenon? Organized crime has identified there is a large market of opioid users in Canada and manufactured their own opioid products to supplement this market. Quite frankly I am surprised this had not occurred earlier. What perplexes me is the fact that government agencies have been very hesitant to acknowledge the risk of prescription opioids and their contribution to addiction and overdose over the past decade. However when organized crime produced their own opioid products there was very little hesitation in sounding the alarm about its danger and risk.
I fully understand that one of the dangers of illicit fentanyl is that there is little consistency with these tablets and the potency is unknown. The fact still remains that pure does not equal safe. Although prescription opioids are considered pure they can have the same effect on an individual as illicit fentanyl.
I have seen opinions reported in the media that the reformulation of OxyContin to make it tamper resistant is one of the contributors to the Fentanyl crisis as people are turning to fentanyl to replace OxyContin. I have a hard time accepting this theory as there are dozens of prescription opioids without tamper resistant technology that could be supplemented. Opioid prescriptions have almost doubled and Hydromorph Contin prescriptions have tripled since 2009 in Alberta. Recently I spoke with Dr. Graham Jones, Chief Toxicologist at Alberta Medical Examiners Office where I learned that deaths where oxycodone was found have continued to increase in Alberta since the introduction of tamper resistant OxyNeo.
In a recent Edmonton drug bust enforcement seized illicit fentanyl pills being manufactured to look like Percocet (a prescription opioid painkiller still on the market). Fentanyl was also found in counterfeit Viagra and Cialis pills, which were pressed on the same machine as the fake Oxycodone and Percocet. Again this leads me to believe that organized crimes motive was not only to supplement the Oxycodone market but the opioid market as a whole which was created by big pharma and our healthcare system. Pressing the fentanyl into tablets resembling other prescription drugs is just an attractive way to distribute the fentanyl. In many parts of Canada the demand for prescription opioids is as high on the streets as illicit drugs, organized crime decided it would be much more profitable to manufacture their own products rather than divert pharmaceuticals.
I applaud the increased awareness created by government agencies, investigations by enforcement, and an effort to increase access to harm reduction since illicit Fentanyl hit the streets but lets not forget a very key part to addressing this epidemic which continues to sit on the back burner: reducing unnecessary exposure to opioids through more responsible prescribing practices. Government and policy makers need to acknowledge that prescription opioids are not always “safe as prescribed” with current practices.
In 2007 Purdue Pharma (an opioid manufacturer) pleaded guilty to criminal charges in the U.S. that they misled doctors, regulators, and patients about Oxycontin’s risk of addiction and potential to be abused. To resolve civil and criminal charges Purdue Pharma agreed to pay a fine of $600 million. Since then other U.S. states and counties have filed their own lawsuits related to OxyContin. Orange and Santa Clara counties sued five of the world’s largest narcotics manufacturers in May 2014. The lawsuit alleges the drug companies have reaped blockbuster profits by manipulating doctors into believing the benefits of narcotic painkillers outweighed the risks, despite “a wealth of scientific evidence to the contrary.” In December 2015 Purdue Pharma agreed to pay the state of Kentucky $24 million over 8 years.
Purdue Pharma marketed their product OxyContin in a similar fashion north of the border in Canada but the Canadian Government has not taken any legal action to hold them accountable. It only seems logical to me that the pharmaceutical companies who helped create this epidemic be held accountable and any fines paid be used to fund treatment and prevention initiatives.
If the prescription opioid crisis was acknowledged and acted upon in a timely fashion hundreds of people would still be alive and organized crime might not have had the opportunity to capitalize off our societies opioid users, offering one of the most potent and dangerous opioids on the market.
It is easy to point the finger at organized crime for the fentanyl crisis but it is big pharma and our healthcare system who created this opioid monster, organized crime is feeding it, and people are dying.
-Amy Graves , President of GPDOTS
Tags: addiction, canada, fentanyl, Health Canada, Naloxone, opioids, overdose, prescription drugs
The WordPress.com stats helper monkeys prepared a 2015 annual report for this blog.
Here’s an excerpt:
The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 26,000 times in 2015. If it were a concert at Sydney Opera House, it would take about 10 sold-out performances for that many people to see it.
Little Brandon was born at 10:43am in the morning on a cold winter’s day. Our second child after the birth of our daughter Shannon, Brandon weighed 8 lbs exactly! He was a go getter right from the beginning and learned very quickly how to melt our hearts. As a child he was very active.He never did take naps in the afternoon which wore his mom out! I used to wonder if all little boys were as energetic as him. Brandon never got sick when he was small but we noticed he started having sleeping problems at the age of 8 or 9.I would come into his room and read to him, sing, tell him little made up stories about a tropical island, trying to get him to visualize the peace and tranquility to soothe his restless mind.
Brandon was good at all sports and a very talented artist. He loved school! and never wanted to miss a day, no matter how tired he might have been from dealing with these sleep issues. He was a fantastic baseball player and loved going to his games! I sometimes wondered how far he could have gone with that sport as an adult. He was that good!
At the age of 10 a young boy in our neighborhood died tragically. This was a a boy who was well known and well loved and both my children knew him in school. After the funeral Brandon started obsessing and worrying about death and losing us, he seemed to be consumed with worry and then he started having nightmares. During this time he had been taking karate lessons and would obsess about his body image and feelings that he needed to lose weight. He was not overweight. He was solid muscle. I tried to explain to him that children, once they reach the age of puberty go through a growth spurt and any little “baby fat” they might have disappears.
No matter what I said it did not calm his anxiety about this and soon he began ritualistic exercising. Every day after school he would do tons of sit up, jump on his trampoline and then go for a 45 min bike ride. At the time the style was “baggy pants” so I did not notice right away that he was losing weight until one day as he came out of the bathroom with no shirt on and I noticed how thin he had become. A week later as I was hanging clothes out on the clothesline I spotted him in the corner of our backyard sticking his fingers down his throat to vomit. I was completely shocked and stunned! Right away I thought eating disorder?! How could this possibly be?! Only girls get eating disorders! I was in for a very rude awakening.
Over the next few months our lives turned into a nightmare. I informed our doctor and he confirmed that Brandon did indeed have an eating disorder. He was diagnosed with severe Anorexia/Bulimia in the spring of 1995 at the age of 10. Bulimia was his main method of losing weight. He was put into a treatment program at a local hospital in pediatrics for 13 months. He was tube fed by a naso gastric tube feed and basically the program was a behavior modification one where they rewarded him for gaining weight and punished him for losing by taking away privileges.
Brandon only got sicker and sicker and developed intractable vomiting (physically he could not keep any food down). He was on IV’s constantly and was so thin it was heartbreaking for us as his family to watch and feel so completely helpless. We tried begging, pleading, nothing worked! In the end we went public.
A local newspaper did a story on Brandon and eventually his story was picked up by the Vancouver Province. Meanwhile in the hospital one night he stuffed his bed with a teddy bear and his small stereo (to make it look like someone was sleeping in it) then he climbed out the window, 3 floors up, slid down a pipe and went missing for 12 hrs. The hospital was frantic as he was at risk of a heart attack due to the dehydration from vomiting. Search and rescue was set up in the parking lot and everyone was looking for him. He told us later:”I just wanted to go home.”
Due to the severity of his illness and because of what happened he was then transferred to Children’s Hosp in Vancouver. By this time the doctors were desperate and asking us:”What do u want us to do?”. During a care team meeting we discovered that Brandon’s father had once had an eating disorder as a young teen, only his was no where near as severe as Brandon’s. Brandon was also diagnosed with moderate obsessive compulsive disorder, addictive personality, and anxiety.
In the Spring of 1997 a doctor from England who was helping set up an eating disorder unit at Children’s Hosp agreed to take Brandon into a residential treatment facility in England, just outside of London. He told us that we could expect to be in England for 6 months to a year. Local realtors started a trust fund in British Columbia and soon the people of B.C raised over $25,000 dollars to help get Brandon the treatment he needed.
We stayed in a small apartment close to the facility where Brandon was staying and we were there for 13 long months. In the end they had to drug Brandon for months and perform a “jejuostomy” where they bypassed the stomach and fed him directly into his intestines. That way he did not get that “full” feeling in his tiny tummy and there was nothing for him to vomit. Even while in England the doctors were worried that we would lose him. I always wondered if something had happened to Brandon that neither his father, myself, or the doctors were aware of. Despite being questioned by his doctors Brandon maintained he had never been hurt of molested by anyone. All we knew is that he had a happy healthy childhood and we needed him well again and with his family.
In 1998 we came back to Canada. Brandon looked the picture of health, they had pumped 4000 calories daily into his body and kept him sedated for months to “fatten” him up to a healthy body weight again. In the early summer of 2000 Reader’s Digest featured a story of Brandon and his struggles throughout his illness. Soon after we arrived back home he started experimenting with drugs, first with marijuana and then prescription drugs. His drug use continued until he died in September of 2013. We fought tooth and nail to save his precious life, in and out of rehabs.
Brandon suffered so much and carried tremendous guilt for all the pain that he knew we were going through worrying about him frantically every day and night. His father did absolutely everything humanly possible to help him, we both did, but in the end Brandon died of an accidental prescription drug overdose. My life feels so empty, I am shattered and although I know he is not suffering anymore, I don’t have my son. All the hopes and dreams I had for him to just be happy and healthy are gone. All he wanted was to feel normal, to have all the things we take for granted, a good job, friends, and maybe a nice girlfriend. Brandon wanted to be well but the addiction was just too strong, too powerful and he was so unhappy.
I would have traded my life in a heartbeat for my son. I remember when he was a little boy how he’d say:”I love u soooo much mom!”, I’d say “I love u more!” and then he would look at me with a big smile and say “I love you to eternity mom!”
-Created by Marie
Tags: canada, cbc, Hantsport, Health Canada, Michael Thompson, nova scotia, rcmp, ReChem, research chemicals