The federal government and several provinces are exploring their options, including launching legal action against the pharmaceutical giant whose pain pill triggered Canada's deadly opioid epidemic after a proposed class-action settlement that reimburses only a fraction of their costs.
Ottawa and the provinces have never undertaken their own court action against Purdue Pharma, the maker of OxyContin, to recover hundreds of millions of dollars in health-care costs associated with treating people dependent on opioids. While the Stamford, Conn.-based company has acknowledged in the United States that its marketing of the drug was misleading, it has not made a similar admission in Canada. The company's marketing encouraged doctors to prescribe opioids more widely for everything from back pain to fibromyalgia. Canada is now the world's second-highest per capita user of prescription painkillers.
The absence of government action in Canada stands in stark contrast to the United States, where Purdue and three of its executives paid $634.5-million (U.S.) in 2007 to settle criminal and civil charges against them for misbranding OxyContin as less addictive than other pain medications.
Since then, several states and municipalities south of the border have sued Purdue for deceptive marketing. Purdue paid $24-million in December, 2015, to settle a lawsuit with the State of Kentucky. Ontario Health Minister Eric Hoskins said on Wednesday that he plans to speak to his federal and provincial colleagues about the fact that Purdue has accepted responsibility in other jurisdictions for its role in the crisis, marked by a growing number of people dependent on opioids and dying of overdoses.
No amount of compensation is going to end the crisis, Dr. Hoskins said in an interview on Wednesday. "But I think it's important that Purdue's responsibility, particularly their marketing, … be looked at in the context of the costs."
Federal Health Minister Jane Philpott acknowledged in a recent interview that Purdue has never faced any consequences in Canada. The company employed similar practices throughout North America to market its blockbuster drug.
"It hasn't been specifically addressed from the perspective of government," Dr. Philpott said, adding that she has had "some conversations" with other federal departments about the issue.
The governments' comments follow an agreement by Purdue to pay $20-million (Canadian) to settle a long-standing class-action lawsuit – compensation that medical experts said amounts to little more than a rounding error for a company that amassed revenues of $31-billion (U.S.) from OxyContin.
"It's in no meaningful way a real penalty or deterrent against future wrongdoing," said David Juurlink, head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto.
Nav Persaud, a family physician at Toronto's St. Michael's Hospital, said the proposed settlement is "the clearest recognition that there was a problem right here in Canada in the way that products like OxyContin were marketed by Purdue Pharma." But he said $20-million is much too small an amount to address a problem that has claimed the lives of thousands of Canadians.
The settlement, which must be approved by the courts, earmarks $2-million for all 13 provinces and territories. In 2014 alone, public drug programs in nine provinces spent $93-million on medications to treat patients dependent on opioids, a 60-per-cent increase over four years. Quebec has not made its numbers public.
Asked if the federal government would consider suing Purdue to recoup some more costs, Andrew MacKendrick, a spokesman for Dr. Philpott, said on Wednesday, "We are facing a public-health crisis and will continue to work with all of our partners across the country to explore any and all options in order to combat it."
The class action dates back to 2007 and accuses Purdue of knowing that anyone who took OxyContin would be at risk of becoming addicted to it and suffer withdrawal symptoms if they stopped. But at no time were these risks disclosed.
The settlement is not an admission of liability by Purdue. "The complaints stem from marketing activities that allegedly occurred primarily between 1996 and 2001," the company said in a statement. A spokeswoman declined to comment on the possibility of governments taking legal action.
The Manitoba government said it is examining the proposed class-action settlement "and what impact it may have on individual litigants and Manitoba Health." The government of Newfoundland and Labrador also said it is monitoring legal developments across Canada and elsewhere "respecting the drug's use and impact."
There is a precedent for the provinces suing corporations whose actions damage the health of residents. In 1999, the Ontario government launched a $50-billion lawsuit against tobacco companies, joining British Columbia and New Brunswick in what eventually became a national battle to recover health costs linked to smoking.
In the context of costs associated with opioids, Dr. Hoskins said, a "comparison with smoking is not necessarily a bad comparison to make."
OxyContin was the top-selling long-acting opioid in Canada for more than a decade. But it also became a lightning rod in the early 2000s as reports of opioid dependence and overdoses exploded. Purdue withdrew the drug from the market in Canada in 2012, shortly before the patent expired.
David Martell, a family doctor and addiction medicine specialist in Lunenburg, N.S., said some social costs associated with opioid dependence are impossible to measure. "I am not sure how you could recover the cost of a loss of life," he said.
Halifax lawyer Ray Wagner, whose firm launched the class action against Purdue, said it should not just be up to the private sector to seek redress.
"We just don't have the resources that governments have to be able to correct the whole opioid crisis through litigation," he said.