Gaps found in opioid prescription oversight in Switzerland

Some 66% of drug overdose deaths in the US in 2016 involved an opioid. Copyright 2019 The Associated Press. All Rights Reserved.

In the wake of the opioid crisis in the United States, some medical professionals in Switzerland are warning about over-prescription of drugs containing oxycodone and are urging Swiss authorities to take measures to curb addiction risks.

This was revealed on Wednesday by a sweeping investigationExternal link into opioid addiction and pharmaceutical profits by the magazine Republik and news programme Rundschau on Swiss public television, SRF.

Opioid use and addiction are on the rise in Switzerland. According to Pharmasuisse, pharmacies and doctors’ offices prescribe three times more oxycodone – the active ingredient in various opioid drugs including OxyContin – than they did ten years ago. Between 2013 and 2018, sales of oxycodone in Switzerland doubled. 

+ Read more about the surge on opioid prescriptions

Swiss authorities and pharmaceutical experts have downplayed any risks of a crisis, arguing that regulations on the advertising and prescription of opioids are stricter in Switzerland than in the US.

However, according to the investigation, some in the medical profession describe the opioid situation in the country as “critical”, observing that a growing number of Swiss are dependent on oxycodone. 

“Patients want the drug in even higher doses. Until it’s almost lethal,” Martin Sailer, a doctor at the Bern Salem Hospital, told Republik.

Justifying the need

The Swiss Agency for Therapeutic Products, Swissmedic, which is responsible for drug approvals, argues that there are no new safety signals about adverse drug reactions related to opioids that would require additional measures to combat abuse.

Since 2014, Swissmedic has approved ten new oxycodone-containing drugs. This year, it approved the extension of nine drugs. It is estimated that 10-15% of patients who receive opioids for chronic pain develop an addiction, which is about the same addiction levels as alcohol. The authority reported two deaths from oxycodone in 2018.

Swissmedic also argues that this class of potent painkillers are used primarily in palliative care. 

However, doctors interviewed as part of the investigation indicate that more patients are coming in and asking for opioids for pain relief than in the past.

“In my consulting hours over the past six years significantly more patients than before have come to my office to take medication with this active ingredient. And the daily dose has increased in the past three years,” Sailer said. He worries that oxycodone is used too frequently and too quickly for mild pain.

There are currently 2,600 lawsuits against the pharmaceutical industry due to the opioid crisis underway in the US. Purdue Pharma alone has more than 1,000 trials for misleading the public regarding the risks related to OxyContin.

Shifting responsibility

According to Swissmedic spokesman Lukas Jaggi, “it is up to the treating physician to use opioids wisely and inform patients about the risks”.

This was reiterated by Stephan Krähenbühl from the University Hospital Basel and an advisor to Swissmedic. He said “patients need to be informed about how the drug works and that it has a high potential for dependence”.

To some in the medical profession, this puts too much responsibility on the shoulders of very busy physicians. Doctors often don’t have time to look for troubling medication problems, analyse them and write a report to Swissmedic. 

Some doctors interviewed said they took care to administer oxycodone only in the first few days after an operation and didn’t give patients packages to take home, for example. They noted though that many patients explicitly asked for oxycodone.

“I decided not to use oxycodone for my backpain patients,” Sailer said. “I can’t reconcile anything else with my conscience or with my Hippocratic Oath [to uphold specific ethical standards].”

The Swiss Society of Rheumatology recently recommended that doctors no longer prescribe opioids for chronic pain.

Sailer insists that if Swissmedic doesn’t react, it risks criticism from the public and politicians, arguing that one step is to create an oxycodone commission.

Krähenbühl also argues that guidelines for opioid prescription levels should be reviewed and adjusted if necessary, noting the risks of opioid prescription for chronic pain.

Sackler family Swiss links

The investigation also highlighted the Swiss connections of the Sackler family, which owns OxyConzin maker Purdue Pharma. In September, the New York Attorney General contended that the family used Swiss and other hidden accounts to transfer $1 billion (CHF990 million) to themselves. 

The Basel-registered Sackler Foundation also sponsors cultural events in Switzerland. 

Purdue subsidiary Mundipharma, with headquarters in Basel, has made major investments in the Swiss health system. Between 2016 and 2018, according to the website pharmagelder.chExternal link the company contributed CHF3.6 million in Switzerland including to hospitals in Geneva and Bern.