What killed 13-year-old Mercedes-Rae Clarke after she ingested an unknown drug she bought on the street? We won’t know until the coroner’s investigation concludes-if ever. But the day after her death in September, that didn’t stop our regional chief medical officer Dr. Richard Stanwick, Victoria police inspector Clarke Russell, and even coroner Lisa Lapointe from telling us all, anyway.They suspiciously fingered a spiked or ineptly-concocted amphetamine.
While speaking for Clarke’s family, Stanwick suggested to the Victoria T imes-Colonist that “she got some really bad stuff.”
“[Y]ou want every child to hear about it and hopefully learn about it,” added Lapointe. “Teenagers are so naÃ¯ve.”
Russell attacked: “They’re handling drugs that are extremely volatile and made with crap. When you take somebody’s life, your life should be taken.”
Basically, our authorities used the tragedy to sermonize wrathfully against seedy dealers of makeshift drugs.
It was an odd conclusion to reach, however; especially considering no one else reportedly even got sick from that mystery batch.
And even more odd considering that clean, factory-produced, pharmacy-distributed drugs are more common in our streets today, and kill many more people.
Indeed, though hard Canadian statistics don’t exist (see Substance Abuse in Canada, 2005), a new Columbia University study calls prescription drug abuse amongst children “epidemic”. Today, nearly 10% of teens admit to abusing prescription painkillers, sedatives like Ativan, and amphetamines like Ritalin and Adderall. Excluding marijuana, more people are now recreationally using prescription drugs than all other illicit, mind-altering drugs combined, natural and makeshift. This prescription drug abuse is responsible for one in five emergency room fatalities.
So what if it turns out Clarke actually took a psychotropic so frequently and loosely prescribed by doctors as a “safe medication” for children that it’s also become a commonly-resold, widely-used recreational drug for them? What, then, will be the lesson we should all learn?
It’s not far-fetched. Health Canada yanked Shire BioChem’s amphetamine Adderall XR off the market last February, citing sudden cardiac arrests, strokes and deaths in children.
Six months later, the popular attention-deficit hyperactivity disorder medication returned to market. Two weeks before Clarke’s death.
A coincidence? Probably. Nevertheless, examining the Adderall turnaround proves instructive about our differing attitudes towards dangerous drugs, depending on who’s pushing them.
Shortly after Health Canada issued its ban, the U.S. Food and Drug Administration protested, and reassured American media. According to Mary Raphael, a Health Canada Associate Director, Shire then invoked a decades-old, obscure clause in our Food and Drugs Act to force an unprecedented “independent” re-evaluation of the ban.
“Independent” sounds good-until we realize it means more independent from Health Canada, not from industry.
These “independent” evaluators were three scientists, one appointed and paid for by Adderall’s manufacturer, the second by Health Canada. Both organizations paid for a third scientist chosen by the other two evaluators.
It’s not a confidence-inspiring picture, especially when even leading medical journals have lately been publicly complaining about the growing coziness between scientists and pharmaceutical companies.
Nevertheless, what did these three find?
The evidence about Adderall, their final report stated, had “important limitations” and could be interpreted differently through different “nuances in ascertainment procedures”.
Of course, medicine is a complex, evolving science, and nuances and limitations are often what it’s all about. Cancer patients live for those uncertain, limited-percentage opportunities of radiation or chemotherapy. In the case of Adderall, Health Canada’s scientists conducted what they described as a “thorough review”, and concluded the drug’s dangers far outweighed any possible benefits. The independent evaluators, on the other hand, concluded that the possibility Adderall might be killing children at an alarming rate “has not been proven”, even though it was “biologically plausible” and “has not been ruled out”. And while the drug might be as dangerous as Health Canada scientists believed, these evaluators argued, it seemingly wasn’t more dangerous than other ADHD amphetamines, so there was no reason to single out Adderall.
Essentially, the people paid by us to protect public health evaluated the facts and banned a drug. Meanwhile, a team 50% chosen and funded by the drug’s manufacturer apparently couldn’t agree on which interpretive strategies should weigh most heavily, and therefore couldn’t support the ban. Then, through an enigmatic process which, Raphael advised, I’d have to submit an Access to Information request to learn about, Health Canada abruptly switched to the latter conclusion as well.
The negotiated compromise requires Adderall’s label warn about risks of cardiac arrest, stroke and death. Health Canada will, in addition, more closely monitor deaths amongst all ADHD-medication users.
Less a modern medical miracle, we seem to be beholding a miraculously modern seedy drug deal between high-powered lawyers.
So if we discover Clarke took an amphetamine routinely prescribed to “balance brain chemistry”, will our chief medical officer call the most common psychiatric medications given to our children “really bad stuff”? Will our coroner advise “naÃ¯ve” teens to be wary of the drugs doctors and pharmacists dish out to them? Will our police demand pharmaceutical executives and Health Canada bureaucrats be executed?
Not likely. And regardless of what Mercedes-Rae Clarke ingested, that’s the real moral of this story.
For many of us, it creates too topsy-turvy a world to even consider the possibility pharmaceuticals are becoming a scourge surpassing meth, heroin or crack. Evidently, even our expert authorities prefer to believe common prejudices, irrespective of facts, probabilities, precautionary principles, and rational thinking.
And that may be the darkest danger of all lurking out there.
Originally published in Focus, November, 2005.