In 2016, three decades after immigrating from Uganda, George Otto had the life he’d always wanted. He lived with his wife and four kids in a leafy, cushy gated community in Richmond Hill, Ont. He’d bought his stone mansion in 2011 for $2.5 million. The house had six bedrooms, 10 bathrooms and a double-level five-car garage, where he parked his black Lexus.
Otto, who was 58, had worked hard to build his reputation as a trusted doctor in one of Toronto’s marginalized communities. Many of the patients at his clinic, located in a strip mall near the intersection of Jane and Wilson, were new Canadians, and he spoke Swahili and Luo, which helped him forge personal connections. Otto treated any patient who passed through his doors, whether or not they had provincial health insurance. And he was compensated very well: over one 16-month period, his billings totalled $803,858.
To his patients, Otto was a hard worker who represented the embodiment of prosperity and generosity. He’d been a student activist in Kampala, Uganda. He had to flee to avoid the wrath of the military police, arriving in Canada as a political refugee in 1981. Later, once he’d established himself, he shared his success with others, granting free lodging to new immigrants arriving from Uganda. He shipped textbooks back to his alma mater, Makerere University. And at the Uganda Martyrs United Church of Canada, he and his family were leading benefactors and vital members of the community.
Yet he was also a show-off who liked to flaunt his fancy cars and entertain visiting Ugandan politicians and dignitaries at his impressive home. He seemed to thrive on ostentation—he was as gregarious as he was generous, and friends referred to the mansion as “Otto’s arena” because it was so big. None of them knew, however, that he’d built much of his wealth through inappropriate health insurance charges, or that he’d once fallen so behind on paying his income taxes that he’d declared bankruptcy to rid himself of debts.
Every day, he drove 30 minutes south from Richmond Hill to his clinic, located next to a payday loan outlet. He often treated as many as 80 people in a 10-hour shift. Then, after he was done seeing patients for the day, he’d begin his other work, the work no one could find out about, the work that would destroy his life, along with hundreds of others’. In 2015, Otto had found a way to earn as much as $9,000 a week under the table. All he had to do was write a few fentanyl prescriptions.
THE OPIOID CRISIS and the medical profession have been inextricably linked for the past 25 years. That’s one reason why, in April 2012, the Ontario Ministry of Health and Long-Term Care created the Narcotics Monitoring System, or NMS, an automated database developed to stem the number of opioid scripts coming out of doctors’ offices in the province. The system automatically collects dispensing data from all Ontario pharmacies, ostensibly enabling the ministry to spot over-prescribers. The ministry then alerts the Ontario College of Pharmacists, which disciplines the offending pharmacists, as well as the College of Physicians and Surgeons of Ontario (CPSO), which takes care of the doctors. The idea is admirable, but the system has a loophole: it didn’t anticipate what could happen when a bad doctor meets a bad pharmacist.
By 2014, doctors had gradually started prescribing transdermal fentanyl patches for their pain patients instead of other opioids, such as OxyContin, the drug that sparked the first wave of the opioid epidemic when it was introduced in the mid-’90s. A synthetic opioid, fentanyl is 50 to 100 times more powerful than morphine, heroin or oxy, but the transdermal patches release the drug into the bloodstream slowly. Theoretically, the risk of an overdose was lower—until, of course, people started placing several patches on their body at the same time, or even dismantling the patches and smoking, chewing or injecting what was inside.
Like other opioids, fentanyl binds to receptors in the brain that control the body’s pain and emotions; over time, the brain can rely on the drug in order to produce pleasure. Fentanyl’s sheer potency makes even the smallest exposure potentially deadly: a tiny amount of the drug could trigger an overdose in someone who’s never taken opioids before. As the drug took off on the street, dealers began selling both black-market prescription patches and fentanyl produced in underground labs. The high is so poisonous that even patients who’ve built up a hefty opioid tolerance frequently overdose. Between January 2016 and June 2020, the federal government recorded 17,602 apparent opioid-related deaths across Canada.
In Ontario, the medical profession has been reckoning with its role in the crisis for years. In 2016, the Ministry of Health and Long-Term Care used the NMS to identify more than 80 doctors whose prescription practices far exceeded the standard of care, and the CPSO launched an investigation into the over-prescribing crisis. The crackdown flushed out some of the bad doctors, and it terrified many others. Some physicians stopped prescribing opioids altogether, scared they’d get flagged by the system. Others, however, were, as one physician involved in the crackdown put it, “very out of control.”
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