Worrying ease of buying regulated prescription drugs

OxyContin tablets purchased over the counter in a pharmacy in Nairobi on August 29, 2019. PHOTO | JEFF ANGOTE | NATION MEDIA GROUP

What you need to know:

  • Pharmaceutical firms have been accused of helping spark addiction by aggressively marketing opioids as low-risk solutions to chronic pain

  • Dangerous Drug Act regulates the import, export, manufacture, cultivation, sale and use of opium and other dangerous drugs. The drugs are always under lock and key.

  • But of course, some pharmacies will relax the rules and hand you the highly regulated drug without question.

When we finally got the prescription, it set us back Sh2,200. But we finally got them. Five small, round, pale-pink pills marked “20” on one side and “OC” on the other.

Usually, a single pill of OxyContin costs Sh455, but this pharmacist was kind and had mercy on the buyer and gave us a Sh15 cut. But to dispense the drug, the pharmaceutical technologist asked for a prescription.

ADDICTION

“Yes, we have the drug. Do you have the prescription?” they asked.

When we responded in the affirmative, he went on to tell us the cost of the drug. But here is the catch: we did not have the original prescription. We had a copy, and upon a little persuasion, he even let us walk away with it.

Ideally, for a drug like Oxycodone to be dispensed, you not only need a doctor’s prescription, but you also ought to leave it behind after the pharmacist has sold it to you.

This is because the drug is a highly regulated painkiller that can have addictive effects if consumed regularly.

In the second pharmacy, the procedure was the same. The only difference is that the pharmacist sold the five tablets for Sh2,480.

Referred colloquially as Oxy by pharmacists, OxyContin is a strong prescription pain medicine that contains an opioid (narcotic). It is used to manage pain severe enough to require round-the-clock, long-term treatment with an opioid, when other pain treatments such as non-opioid pain medicines cannot treat the patient’s pain well enough or cannot tolerate them.

Pharmaceutical firms have been accused of helping spark an addiction by aggressively marketing opioids as low-risk solutions for chronic pain.

DANGEROUS

However, they are anything but low-risk. Taken in excess, codeine can cause organ failure and trigger schizophrenia. While the International Narcotics Board provides data on the amount of legally required opioids by Kenya, there is less information on who is taking the drugs.

Because of their addictive nature, they are classified under the Dangerous Drug Act (DDA) by the Pharmacy and Poisons Board (PPB).

DDA regulates the import, export, manufacture, cultivation, sale and use of opium and other dangerous drugs. The drugs are always under lock and key.

But of course, some pharmacies will relax the rules and hand you the highly regulated drug without question.

In a first judgement of its kind against the drug industry, US pharmaceutical giant Johnson & Johnson learnt the hard way after being ordered to pay Sh59 billion ($572 million) for running a “false and dangerous” sales campaign that caused addiction and death as it drove America’s opioid epidemic.

In a damning 42-page decision, Judge Thad Balkman of the Cleveland County District Court in Norman, Oklahoma, ruled that the company bore a wide responsibility for helping to create the worst drug epidemic in US history.

EPIDEMIC

The US state had asked for $17 billion to cover treatment, overdose prevention and other costs of abating the epidemic in the coming years.

Some of the biggest abusers of these drugs are health workers. Opioid addiction is said to be the worst epidemic in US history. Drug overdose kills more than 64,000 people in the US every year, lowering the country’s life expectancy for two years in a row.

Almost 90 per cent of pharmaceutical opioids seized, mainly the painkiller Tramadol, were in African countries, mostly west, central and North Africa.

Codeine addiction has been reported in Kenya, Nigeria, Ghana, Niger and Chad.

Whereas the number of Kenyans addicted to painkillers pales in comparison with figures in the developed world, the problem is growing.

There were 1,338 drug-related deaths in Kenya in 2016, reveals a review of drug abuse data by Nation Newsplex. The leading cause of the deaths was opioid overdoses.

Globally, about 127,000 people die of an opioid overdose every year. Women are more likely to misuse prescription opioids and tranquillisers.

IMPRISONED

According to the 1994 Narcotic Drugs and Psychotropic Substances (Control) Act, a person found in possession of a narcotic drug or psychotropic substance, intended solely for their own consumption, will be found guilty of an offence, imprisoned for 20 years and slapped with a fine of not less than one million shillings or three times the market value of the drugs seized.

Opioids were involved in almost 400,000 overdose deaths in the US from 1999 to 2017, according to the US Centers for Disease Control and Prevention.

Since 2000, some 6,000 people in Oklahoma have died from opioid overdoses, according to the state's lawyers.

Earlier this year, Oklahoma settled with OxyContin maker Purdue Pharma for $270 million and Teva Pharmaceutical for $85 million, leaving Johnson & Johnson as the lone defendant, says a statement.

“Johnson & Johnson will finally be held accountable for thousands of deaths and addictions caused by their actions,” said Judge Balkman after the ruling.

He said prosecutors had demonstrated that Johnson & Johnson contributed to a “public nuisance” in its deceptive promotion of highly addictive prescription painkillers.

33 MILLION

“Those actions compromised the health and safety of thousands of Oklahomans. The opioid crisis is an imminent danger and menace to Oklahomans,” he said, adding that the payment would be used for the care and treatment of opioid addicts.

The judge argued that Johnson & Johnson’s marketing efforts created a public nuisance as doctors overprescribed the drugs, leading to a surge in overdose deaths in Oklahoma.

Johnson & Johnson vigorously denied wrongdoing, arguing that its marketing claims had scientific support and that its painkillers, Duragesic and Nucynta, made up a tiny fraction of opioids prescribed in Oklahoma and adding that it will appeal the judgment.

The outcome of the case is being closely watched by plaintiffs in about 2,000 opioid lawsuits due to go to trial in Ohio in October unless the parties can reach a settlement.

UNODC estimates that 33 million people use opioids prescription opioids and opiates such as opium and heroin. Two million of the users are in Africa, with East Africa having 260,000.

OPIOID CRISIS

However, according to a statement by Johnson & Johnson, since 2008, its painkillers had accounted for less than one per cent of the US market, including generics.

“The decision, in this case, is flawed. The State failed to present evidence that the company’s products or actions caused a public nuisance in Oklahoma,” it said.

“This judgment is a misapplication of the public nuisance law that has already been rejected by judges in other states.”

Sabrina Strong, the lawyer representing Johnson & Johnson, said the firm did not cause the opioid crisis in Oklahoma.

 “We have sympathy for all who suffer from substance abuse, but Johnson & Johnson did not cause the opioid abuse crisis here in Oklahoma, or anywhere in this country.

"We do not believe that the facts or the law support the decision today. We have many strong grounds for appeal, and we intend to pursue those vigorously."