Purdue Pharma, the maker of OxyContin, paid Canadian doctors nearly three-and-a-half times more money than it doled out to U.S. prescribers, according to a Star analysis of the drug maker’s physician payments adjusted for the countries’ populations.

Purdue Canada gave just over $2 million to Canadian health-care professionals in 2016 for services such as consulting and delivering speeches on conditions and treatments.

That same year, U.S.-based Purdue Pharma L.P. paid American physicians $5.53 million (Canadian), according to a U.S. government database showing the financial ties between Big Pharma and prescribers. (2016 is the only year payment data is publicly available for both countries.)

That means for every 1,000 residents, Purdue spent $58 on Canadian doctors compared to $17 in the U.S.

Another way to look at it: Purdue gave $24 for every Canadian physician, while its U.S. operations handed out a little under $6 for every American prescriber.

The discrepancy between Purdue’s Canadian and U.S. physician payments has doctors and drug safety advocates raising an alarm that the drug maker may be focusing its marketing efforts on Canadian doctors.







“That Purdue spent more than four times as much per Canadian physician should shatter the myth that we are not exposed to the same level of aggressive marketing tactics as in the U.S.,” said Trudo Lemmens, a professor of law and bioethics at the University of Toronto.

Purdue did not challenge the results of the Star’s analysis and did not answer why the per capita payments to physicians are higher in Canada.

In a statement, a spokesperson said that while Purdue’s Canadian and U.S. operations are “both part of an independently associated network of companies, the companies are operated independently.”

The company did not provide details on what the payments were specifically for but said it funds educational programs for Canadian doctors on topics such as responsible opioid prescribing and risk reduction strategies.

“Canadians face a complex public health issue in which all stakeholders, including industry, have a role to play to provide practical and sustainable solutions. Unfortunately, misuse, abuse and diversion of pain medications can lead to tragic consequences, including addiction, overdose and death,” the company spokesperson said.

Drug industry-funded educational programs, sometimes hosted at upscale restaurants with free wine and dinner, have been criticized as marketing tools under the guise of education.

Purdue’s payment records do not say how many individual Canadian health-care professionals received payments. The company, while known for its opioid medications, also makes other drugs including an antinausea treatment and a stimulant to treat attention deficit hyperactivity disorder.

Purdue pulled OxyContin from the Canadian market in 2012 and replaced it with a tamper-resistant formulation OxyNeo.

In the United States, Purdue Pharma and three executives paid $634 million (U.S.) in 2007 after pleading guilty to misleading doctors and patients about OxyContin’s risk of addiction and ability to be abused.

The company has faced no government sanctions in Canada: the second largest per capita opioid consumer after the U.S.

“It doesn’t surprise me that (Purdue) would focus resources in a place where there is little accountability,” said Amy Graves, founder of the non-profit Get Prescription Drugs Off the Street.

“The Canadian government, historically to date, has proven there is no immediate effort to hold them accountable … and I think it’s given companies like Purdue Pharma an open invitation to focus their efforts here to increase prescribing.”

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Purdue’s fraudulent marketing of OxyContin in the U.S. likely did not stop at the border, the University of Toronto’s Lemmens said.

Lemmens was part of a team of academics that recently sent open letters to Prime Minister Justin Trudeau, the health minister and the attorney general, urging the government to launch a criminal investigation into the marketing of opioids they say helped fuel Canada’s deadly overdose crisis.

One of the letters details how Ontario physicians remember being told by Purdue sales reps that OxyContin was “less addictive,” and material distributed by the drug company suggested the drug had “lower abuse potential.”

“My response to the claims that things that happen in the U.S. do not necessarily happen here is to say that we think so only because there has been a remarkable lack of serious investigation and prosecution in Canada,” Lemmens told the Star.

The letters, whose authors included Canadian professors Nav Persaud, Janice Graham, David Juurlink, Joel Lexchin and others, also called on the government to directly compensate the victims of Canada’s opioid crisis with funds recovered from the drug manufacturers.

These victims have already sought justice from the courts. A $20-million settlement to the Canadian class action lawsuit against Purdue was put on hold in March after a Saskatchewan judge refused to sign off on the deal, saying the compensation was not fair and reasonable to the patients who got addicted to the prescription drug. Purdue has filed a notice with the court that it plans to appeal the judge’s decision. In agreeing to settle the suit, Purdue made no admission of liability.

Purdue said it has always marketed its products in Canada “in compliance with all relevant rules, regulations and codes.”

Health Canada said in a statement that it has closely reviewed the 2007 settlement between Purdue and the U.S. government. Had the Canadian drug regulator pursued charges “at the time of the alleged inappropriate marketing practices, the maximum penalty that the courts could have imposed upon conviction was a fine of $5,000 per offence,” the agency said.

Under beefed up regulations, that penalty is now up to $5 million per offence per day — and it could be more if the offence involves knowingly causing serious risk of injury.

“These penalties could not be applied to situations that arose before the changes in the law,” the regulator said, adding that it will not hesitate to use its new power to address any future marketing abuses that may arise.

In February, Purdue announced that its sale reps “will no longer promote opioids to prescribers” in the United States. Purdue Canada would not say if the policy change would be adopted here.

Instead, a Purdue spokesperson said all of its Canadian promotional material must be vetted by the Pharmaceutical Advertising Advisory Board, “who ensures rigorous evidentiary support for all claims” and checks “for balance between risk and benefit.”

Choosing not to discontinue promotion of opioids to Canada prescribers would be a “flagrant act” in a country with more than 3,000 opioid-related deaths last year, said Dr. Andrew Boozary, a resident physician at the University of Toronto.

“It’s a public health crisis across the country,” he said. “I think it’s incredibly offensive to the lives lost.”

Purdue was one of 10 brand-name pharmaceutical companies to voluntary disclose aggregated payments they made to health-care professionals in 2016. The company also gave out $980,000 to health-care organizations. The disclosure does not say which doctors or organizations received the money.