Canada Seeks Warnings on Prescription Painkillers Amid Rising Deaths

As deaths from powerful painkillers continue to rise, Canada is pursuing unprecedented measures to curb their use, including requiring cigarette-style warning stickers on every prescription, said Health Minister Jane Philpott.

Next month Health Canada plans to publish a detailed proposal for the stickers, which Philpott said would warn that opioid painkillers can cause addiction and overdose. In March, an advisory panel is set to consider a second measure, revising the official label definition of how opioids should – and should not - be used, officials said.

Warning stickers would be a first and could serve as an example. The measures would follow other strategies that failed to stem addiction and death involving prescription opioids, such as OxyContin and Hydromorph Contin, as well as illicit ones, including heroin and powerful fentanyl smuggled from China.

Fatal overdoses have increased across Canada, mirroring the much larger epidemic in the United States. In Ontario, the most populous province, prescription opioid deaths rose 40% in six years; in the western province of Saskatchewan, they more than doubled since 2010. An influx of illicit variations of fentanyl fueled an 80% increase in deaths last year in British Columbia to a record 914.

Philpott has called the opioid epidemic the nation’s greatest public health crisis and pledged to use every tool at her disposal to fix it.

“We’re concerned when opioid prescriptions are on the increase,” she told Reuters. “We need to understand what’s behind that and make wise recommendations.”

Drug companies have said they support measures to increase patient safety. Several companies and industry groups declined to comment until the government lays the new proposals.

  Too Little, Too Late

Some doctors and public health experts who have long clamored for safeguards said the new measures may be too little, too late.

“Stickers may have been helpful in 2006, 2007,” said Edmonton, Alberta, addiction doctor Hakique Virani. “But when we’ve created this huge demand for opioids that is now being met by powder from China, and you can traffic a million doses of that stuff in a 10-gram greeting card envelope, I’m sorry, but stickers on pill bottles are not going to solve this problem.”

Philpott said she recognizes the challenge.

“You don’t want to drive people to use even more harmful street drugs and illicit substances,” Philpott said. “So it needs to be done with a tremendous amount of wisdom and thoughtfulness, and we are certainly consulting widely to make sure we don’t have any unintended consequences from our actions.”

Philpott envisions stickers similar to those pharmacists put on pill bottles reminding patients to take a medication with food. 

Rewriting label definitions of evidence-supported opioid use would change how drug companies sell opioids in Canada, an $881-million-a-year market.

Doctors are allowed to prescribe “off-label,” tailoring prescriptions to patients’ individual needs. But pharmaceutical companies must follow the labels’ language in all marketing, including advertisements and sales calls on physicians.