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B.C.’s opioid lawsuit win no cause for celebration, say advocates

Experts and advocates say the litigation ignores the fact that the increasingly toxic illicit drug  supply is what’s driving drug poisonings, not prescription medications.
“This isn’t an opioid crisis about pharmaceuticals,” said Karen Ward, a drug policy consultant with the City of Vancouver.

A British Columbia-led lawsuit against more than 40 pharmaceutical companies has resulted in a proposed $150-million settlement with Purdue Pharma Canada for health-care costs related to the company’s marketing  of opioid pain medications.

But advocates say the lawsuit is also an exercise in distracting the public from the  government’s failure to make changes — including introducing safe supply  — that would have saved thousands of lives lost to toxic drugs.

In the 2018 suit, B.C., on behalf of federal and provincial governments, claimed the company, which manufactures OxyContin, downplayed the risks and potential addictive  qualities of opioids in its advertising to doctors.

At the time of the lawsuit, Purdue denied any wrongdoing.

The proposed settlement, which still needs court approval, is the largest government health-care cost recovery in Canadian history, Attorney General David Eby said last week.

“We took this action to  recover health-care costs and to hold opioid companies to account for  their part in allegedly engaging in deceptive marketing tactics to  increase sales, which led to increased rates of addiction and overdose,” he said.

“Holding multinational pharmaceutical  companies and their consultants to account for their role in this public health emergency is the right thing to do.”

According to Eby and Mental Health and Addictions Minister Sheila Malcolmson, the litigation is just one tool  being used to address the province’s toxic drug crisis which now sees five or six people dying on average each day.

“We know the settlement will not make up  for the lives lost and the terrible loss of loved ones in our communities, so our government remains steadfast in its commitment to  end the public health emergency,” said Malcolmson.

But experts and advocates say the litigation ignores the fact that the increasingly toxic illicit drug  supply is what’s driving drug poisonings, not prescription medications.

“Right now, people are not dying from  prescription drugs… they’re dying from the street supply, which is  illegal and unregulated,” said Garth Mullins, a board member for the  British Columbia Association of People on Methadone. 

Karen Ward, a drug policy consultant with the City of Vancouver, agrees.

“This isn’t an opioid crisis about pharmaceuticals,” she said.

A recent death review panel convened by the chief coroner, which recommended urgently expanding safe supply  efforts, concluded the same.

Since 2016, nearly 10,000 people have died of toxic drug poisonings in British Columbia. According to a study of illicit drug overdose deaths in B.C. between 2015 and 2017 published in the Canadian Medical Association Journal, only around 10 per cent of people had prescriptions for opioids to manage pain when they died.

“What we found is that this overdose crisis is not driven by prescribed medications and de-prescribing initiatives alone won’t solve the overdose crisis,″ lead author Dr. Alexis Crabtree told the Canadian Press in 2020. 

Data from the BC Coroners Service shows that opioids other than fentanyl and its analogues were present in only  22.5 per cent of deaths since 2019 — the vast majority of which also  had illicit substances present.

Mullins and Ward say the lawsuits are a communications exercise, not an actual response to the crisis.

“This path of lawsuits is very convenient  for the governments because they get to shift the blame,” said Mullins.  “But the people to blame for the current overdose crisis are the  government. That’s who caused it with prohibition, that’s why people are  dying.”

The news of the settlement comes four years after The Tyee first reported  British Columbia was considering launching litigation against several  pharmaceutical companies, after a rash of similar suits in the United  States.

About 10 years ago, concerns about the  over-prescription of opioid pain medications rose as an opioid epidemic  swept through North America, leading to mass de-prescribing by  physicians. 

Many doctors in Canada also expressed concerns about how opioids had been marketed and urged governments to take action.

But Mullins said patients left without  their pain medications turned to the illicit, unregulated supply, right  around the time fentanyl was arriving on the scene.

The decision to cut off prescriptions “was a knee-jerk reaction that caused a lot of harm,” he said.

Eby said B.C. is poised for further legal  action and settlements against dozens more companies, in concert with  other provinces, territories and the federal government.

The province’s application to certify its  class action suit against several more companies will be heard by the BC  Supreme Court in 2023.

Once approved, the Purdue settlement money  will be split between all provinces and territories, as well as the  federal government. B.C.’s final share will be spent on services for  people who use substances, Eby and Malcolmson said.

Mullins is skeptical of any litigation  windfall being used as a source of support for people who use  substances. The money that is already being spent in the province, he  said, isn’t being directed to the most urgent responses needed, such as  safe supply, which would separate people from illicit toxic drugs.

“I find it deeply alarming that they still  don’t understand the simple, basic root causes of the mass overdose  deaths we’re seeing,” Mullins said.