Opioid abuse
============

* Joel Lexchin

I agree with Fletcher and Tsuyuki who, in their recent *CMAJ* editorial, caution against provincial drug formularies adding generic oxycodone to the list of products eligible for funding.1 However, the authors are far too generous in their treatment of Purdue Pharma Canada — the makers of the original and tamper-resistant forms of oxycodone. Purdue’s aggressive marketing campaign was partly responsible for the widespread use and subsequent abuse of oxycodone.2 The tamper-resistant version of oxycodone was available in the United States in April 2010. In Canada, Purdue only introduced it in March 2012 — just prior to the expiration of the patent on the original version.3 Restricting which version of oxycodone is covered on provincial formularies may not deter overall abuse of opioids. Tamper-resistant oxycodone may be less abused, but there is evidence from the US that people are switching to other opioids, with heroin being the drug of choice.4

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/185/5/418.2/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/185/5/418.2/F1)

Image courtesy of © 2013 Thinkstock

Some letters have been abbreviated for print. See [www.cmaj.ca](http://www.cmaj.ca) for full versions and competing interests.

## References

1.  Fletcher J, Tsuyuki R. Don’t tamper with oxycodone. CMAJ 2013;185:107.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxODUvMi8xMDciO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTg1LzUvNDE4LjIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  Lexchin J, Kohler JC. The danger of imperfect regulation: OxyContin use in the United States and Canada. Int J Risk Saf Med 2011;23:233–40.
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=22156088&link_type=MED&atom=%2Fcmaj%2F185%2F5%2F418.2.atom) 

3.  Diebel L. Critics allege OxyNEO was introduced in Canada because of impending patent expiry. Toronto Star 2012 Apr. 22; Sect A:1.
    
    

4.  Cicero TJ, Ellis MS, Surratt HL. Effect of abuse-deterrent formulation of OxyContin. N Engl J Med 2012;367:187–9.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1056/NEJMc1204141&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=22784140&link_type=MED&atom=%2Fcmaj%2F185%2F5%2F418.2.atom)