Purdue Canada's Program To Reduce Misuse And Diversion Of Opioid Analgesic Medications - Without Compromising Proper Pain Control

Under-treatment of pain is a serious problem in Canada, including pain in patients with chronic conditions, and effective pain management is an integral and important aspect of quality medical care. For many patients, opioid analgesics - when used as recommended by their physician - provide far greater relief from severe pain than can be attained with non-opioid analgesics.

Because opioids are one of several types of drug substances that have the potential to be misused, they are carefully regulated by both provincial and federal agencies. However, in spite of various controls, drug abusers obtain these and some other prescription medications by diverting them from legitimate channels in several ways - including fraud, theft and forged prescriptions. It has also been reported that some legitimate patients may sell some of their medications to abusers.

Prescription drug misuse is a serious public health problem. Purdue Pharma, a leading manufacturer of prescription pain medications, has several activities that are designed to help reduce the misuse of opioid analgesics and other prescription medicines. The program includes the following initiatives:

1. Educating Healthcare Professionals About Proper Pain Management

   Purdue Pharma contributes substantially to the education of healthcare professionals through supporting the development and dissemination of programs for physicians, pharmacists, nurses and other healthcare professionals. These educational programs - led by experts in pain management - teach healthcare professionals how to properly assess, treat, document and follow patients suffering from pain. They also help with early identification of aberrant behaviours in individuals who may be at risk of abuse, which affords the physician time to take action to reduce the risk.

   Purdue also provides grants to hospitals, medical schools and other organizations to support the development of comprehensive courses on pain management, and to undertake research directed at improving pain control and/or reducing misuse/diversion of prescription drugs. Components of the courses are designed to inform both medical students and current practitioners about proper pain assessment, drug and non-drug treatments, and the detection/prevention of misuse, addiction and diversion.

2. Combating Prescription Fraud and Pharmacy Theft

   Prescription fraud - the alteration, forgery or counterfeiting of a prescription - is one source of diversion. Purdue is currently working with the province of Newfoundland and Labrador to introduce tamper-evident prescription pads, to be used whenever a prescription is written for an opioid analgesic. These pads, which are currently in use in the USA, include several security features intended to assist prescribers and pharmacists to recognize and thwart some common types of prescription fraud.

   Purdue is also working with the Canadian Pharmacists Association, the RCMP, and other law enforcement agencies, to help pharmacists prevent diversion, and protect their pharmacies by identifying fraudulent prescriptions and other suspicious activities.

3. Distribution of Medical Practice Guidelines and Other Resource Items

   Purdue regularly provides healthcare professionals with advances in information about the appropriate prescribing of opioid analgesics. Since 1986, Purdue's representatives have distributed thousands of copies of medical guidelines on the use of these products - guidelines published by Health Canada, the College of Physicians and Surgeons of Alberta, the College of Physicians and Surgeons of Ontario, and the Canadian Pain Society. All of these materials emphasize the need for a thorough evaluation of each patient, proper medical documentation and follow-up, and also alert healthcare professionals to be aware of the possibility of misuse and diversion.

   An array of educational materials that help healthcare professionals better assess and treat pain, as well as recognize and prevent misuse and diversion of opioid analgesics, have also been distributed.

4. Working with Law Enforcement

   Purdue is building a law enforcement liaison group, to assist law enforcement organizations with their drug diversion investigations. Purdue has developed, and will supply to law enforcement agencies across Canada, materials that will enable them to quickly identify any of the most commonly used opioid-containing products.

   Another part of this effort includes programs to help law enforcement organizations gain a better understanding of appropriate pain management practices versus inappropriate prescribing. In this effort, Purdue has had interactions with a number of agencies, including the Royal Canadian Mounted Police, Ontario Provincial Police, the Canadian Association of Chiefs of Police, and Health Canada's Office of Controlled Substances.

5. Security and Integrity of the Product Supply (Distribution) Chain

   Purdue, in close cooperation with suppliers, distributors and carriers, takes great measures to protect the product supply chain from theft and diversion. These security measures offer assurances that finished product destined for hospitals and pharmacies is very closely monitored, and there is close accountability throughout the entire process via supervision and appropriate documentation.

6. Developing Misuse-Resistant Medicines

   Purdue's International R&D Team has committed millions of dollars to test and develop new forms of pain relievers that will be more resistant to misuse, while still providing safe and effective pain control. This work is very challenging, but represents a major priority at the company's research laboratories. Drug research and development takes many years to complete, and Purdue is working with worldwide drug regulatory agencies, such as Health Canada and the US FDA, to solve the complex patient safety and efficacy issues associated with these products - prior to bringing them to market.

Solving the longstanding problem of misuse and diversion of prescription medications will require the cooperation of many elements of society - including healthcare professionals, patients and their families, law enforcement organizations, regulatory bodies and the pharmaceutical industry. Purdue Pharma is taking the lead within the pharmaceutical industry in addressing this problem - because it is important that the actions of those who illegally misuse these drugs do not result in patients with legitimate pain having to go without the relief they provide.

July 12, 2004