Switching from OxyContin to other drugs can be challenge

Date: Wednesday Mar. 7, 2012 7:16 AM ET

TORONTO The overdose death of a Northern Ontario man should be a red flag for primary care doctors who must switch patients from the now discontinued drug OxyContin to another opioid to control their chronic pain, experts say.

But knowing which drug to prescribe instead of OxyContin can pose a challenge for overly taxed family physicians, whose training in pharmaceutical equivalents may be inadequate or out of date, they say.

The man who died at some point during the last month cannot be identified for privacy reasons. He had been prescribed OxyContin for chronic pain and the drug was paid for under the Non-Insured Health Benefits program, the government plan for Canadian aboriginals and Inuit.

But because the intended replacement drug, OxyNeo, is not covered by the program, the man's doctor switched him to another long-acting opioid.

The replacement opioid had been prescribed at too high a dose and the man appears to have died from an overdose, which usually involves respiratory failure.

"There was an apparent inadvertent or unintentional dose escalation," Dr. Michael Wilson, regional supervising coroner for Northwestern Ontario, said Tuesday from Thunder Bay, Ont. "I spoke to the doctor and the doctor just basically said that it was a mistake."

Wilson has informed several professional medical bodies in Ontario about the case, with a warning to physicians to be cautious when swapping opioids.

Dr. Meldon Kahan, an addiction expert with the University of Toronto's family medicine department, said doctors have access to tables that show equivalent doses for different drugs, but physicians are not always trained in how to use them properly.

Other long-acting opioids for chronic pain include morphine, which is about half as potent as oxycodone, the active ingredient in OxyContin and OxyNeo. Two other opioids in the class, hydromorphone and fentanyl, are much stronger than oxycodone. The drug given the Northern Ontario man was not identified.

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Switching from OxyContin to other drugs can be challenge