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Doctor Dave Juurlink, a staff physician at Sunnybrook Health Sciences Centre and an expert in drug safety, poses for a photo with OxyContin at the hospital's in-patient pharmacy in Toronto on Monday, Feb. 20, 2012, after the announcement that the prescription painkiller will be delisted from Ontario's drug benefit program.

Michelle Siu for The Globe and Mail/michelle siu The Globe and Mail

Nova Scotia has become the latest province to clamp down on OxyContin prescriptions, with Health Minister Maureen MacDonald announcing the province will only pay for the potent painkiller's replacement in extenuating circumstances – for cancer-related pain or palliative care.

Nova Scotia's move comes days after Ontario, with the highest rates of prescription-opioid addiction in the country, announced it is tightening rules for the painkiller. Physicians called the move a step forward, but warned that changing publicly funded drug plans won't be nearly enough to stem abuse from the prescription drug.

"There is a lot more that needs to be done," said David Juurlink, a drug-safety specialist at Sunnybrook Hospital in Toronto. "These drugs should be harder to obtain, harder to prescribe – and certainly at high doses."

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Provinces' intention to restrict long-acting oxycodone prescriptions only apply to people covered by public drug plans – and they're in the minority.

Fifty-five per cent of the cash spent on Canadians' prescription drugs comes from private insurance plans or individuals paying out of pocket. That makes for a total of $14.3-billion spent privately on drugs in 2010 – $350-million on narcotics alone, according to Mike Sullivan, head of Cubic Health, a Toronto-based company that advises insurance plans.

And tightening the rules on drugs paid for privately is far trickier.

"I don't know of a single plan out there that has restrictions out there for coverage of narcotics," Mr. Sullivan said. "I absolutely think they should."

About 80 per cent of the employers his company deals with Canada-wide have had instances of inappropriate narcotics use among their plans' beneficiaries.

Mr. Sullivan is hoping employers put dollar thresholds on the narcotics they pay for, with anything above requiring special authorization, and a doctor's note.

Helen Stevenson has been on both sides of the quandary: Formerly executive officer of Ontario's public drug programs, she now runs Reformulary, which is designing its own formulary for insurers and their clients. The company inked a deal with Sun Life Financial in December.

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Ms. Stevenson wouldn't say what its rules will be for narcotics like OxyNEO, but says she's looking at the same criteria facing Ontario and other provinces.

In the meantime, provinces are aiming to be proactive after being accused of inaction in the face of rising addiction rates and thousands of opioid-related deaths.

"We recognize the need to impose stronger restrictions on potentially addictive prescription drugs," Nova Scotia's Ms. MacDonald said in an interview. "We have particular pockets in the province where we've had difficulties."

The Annapolis Valley and Cape Breton are among them – areas rocked by spikes in prescription-opioid addiction, attendant crime and overdose deaths. The crisis prompted a rethink of the province's addiction treatment: Now, Ms. MacDonald said, they're focused on licensing methadone doctors to cover a broader, decentralized area.

Manitoba restricted the kinds of OxyContin prescriptions it pays for two years ago. It was the only study that saw an ever-so-slight drop in oxycodone use in 2010, notes University of Manitoba pharmacist Shawn Budgen. But he admits success is tough to measure.

"We know the use went down a little bit, but we're not really sure if it was steering people away from abusing this product," he said.

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"It's a very complex problem. We feel [the new regulation]has helped encourage rational use. And that's at least part of the solution."

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