The narcotic painkiller OxyContin will soon be pulled from pharmacy shelves across the country, and addiction experts warn the move will spark a public health crisis in Northern Ontario where thousands of people in remote communities face involuntary and potentially dangerous withdrawal from the addictive drug.

Purdue Pharma, the company that manufacturers OxyContin, is set to replace the controversial medication with a new formulation of the drug called OxyNEO at the end of February. The new drug is formulated in such a way that it is more difficult to crush, and therefore less likely to be abused through injecting or snorting.

Among the Nishnawbe Aski Nation, or NAN, which represents 49 First Nation communities in Northern Ontario, at least half of residents are addicted to OxyContin, said Grand Chief Stan Beardy.

“In some communities, it’s as high as 70 to 80 per cent of people addicted to OxyContin, including kids as young as 9 years old to people as old 65,” Beardy said.

“We are very concerned that if they cease manufacturing OxyContin and if there is no replacement or treatment or detox centres for these people, there is going to be a major catastrophe.”

He said health care in the communities is limited to nursing stations with visiting doctors coming to treat residents two or three days each month — not enough care to deal with the thousands of people who will be forced into withdrawal.

Benedikt Fischer, director of the Centre for Applied Research in Mental Health and Addictions at Vancouver’s Simon Fraser University, agrees the situation in Northern Ontario is dire.

“We are literally watching a public health catastrophe unfolding in slow motion,” he said, adding that the crisis is comparable to the spread of HIV among injection drug users in the 1980s and the overdose epidemic that hit Vancouver’s Downtown Eastside in the 1990s.

People forced off the powerful painkiller could replace it with heroin, crack cocaine and other dangerous drugs, and they will be more likely to inject drugs, increasing the spread of infectious diseases, said Fischer, who estimates 10,000 of the 45,000 NAN residents are addicted. And, he added, communities will likely see a spike in overdoses, a greater risk of miscarriage in pregnant women and a proliferation of crime.

On Thursday, Health Canada confirmed that as of Feb. 15 OxyContin had been pulled from the Non-Insured Health Benefits Program, which provides drug coverage for more than 800,000 registered First Nations and recognized Inuit.

However, a spokesperson for the agency said most of those addicted to OxyContin are not receiving the drug through government-funded legal prescriptions. Fewer than 100 NAN members get the drug paid for by the department, said Health Canada spokesperson Leslie Meerburg.

The Ontario Ministry of Health has not yet said how it will fund OxyNEO, nor is it clear how much OxyContin is stockpiled in the province.

“There is little concern of withdrawal for clients switching therapy from OxyContin to OxyNeo when taken as prescribed by a physician,” she said. “However, it is possible that some clients who obtained OxyContin through other sources may go into withdrawal when OxyContin is removed from the Canadian market and they are unable to find another source of supply.

“This is a concern for any individual who obtains and uses OxyContin outside of appropriate medical indications.”

Grand Chief Beardy acknowledged the vast majority of OxyContin abused by NAN residents is sold on the black market, with individual pills selling for between $300 and $600.

The potent painkiller has helped fuel an epidemic of opioid addiction in Canada. In Ontario, the rate of deaths involving narcotic painkillers went from 13.7 per million in 1991 to 27.2 per million in 2004.

On Feb. 6, the Cat Lake First Nation declared a state of emergency because 70 per cent of residents were addicted to OxyContin.

Beardy said he and others have called on the federal and provincial governments for help, but have received little response.

“We were asking for detox centres, treatment centres, frontline health professionals, including doctors, psychologists and psychiatrists,” he said.

Fischer said an emergency program needs to be put in place. Ideally, the rapid launch of prevention and treatment interventions should include, among other things, needle exchange programs to prevent the spread of infectious disease and providing addicts with substitution drugs, such as methadone or suboxone.

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“We need to find ways to get these treatments to these communities as widely and effectively as possible,” he said.

Health Canada said the NIHB program covers methadone and suboxone, but recognizes that access to the drugs is a “significant issue” for those in remote locations.

“In such instances, the NIHB Program reviews requests from health providers on a case-by-case basis and will provide coverage for suboxone to help ensure First Nations clients have access to this drug without leaving their community,” Meerburg said.