Pubdate: Wed, 15 Aug 2001
Source: USA Today (US)
Copyright: 2001 USA TODAY, a division of Gannett Co. Inc
Author: David M. Sibell, M.D., Oregon Health and Science University, 
Portland, Ore


I thank USA TODAY for the well-balanced article on the benefits and risks 
of the use of opioid medication to treat chronic pain. As a pain management 
specialist, I am familiar with these issues.

I have seen a preponderance of bad journalism on opioid drug abuse 
recently. Some stories report the misconception that there is a substantial 
risk of addiction when opioid medication is used appropriately. In fact, 
fewer than 1% of patients taking opioids by prescription become addicted.

This leads to the question of which drugs cause more risk. Currently, the 
hot topic is OxyContin. In the past, there were similar problems with 
Duragesic, Dilaudid and morphine. Before this, opium and laudanum were 
abused. These are all controlled substances because of the potential for abuse.

Currently, abuse is largely restricted to those who obtain the drug 
illicitly. When a patient abuses his or her medication, there are safe and 
effective means to deal with these issues. A vigilant physician can 
practice medicine safely and effectively using current practice and 
regulatory guidelines.

So what medications are most frequently abused?

The most common prescription drug abused in the United States is 
hydrocodone/acetaminophen -- that is, such drugs as Vicodin, Lortab and

Lorcet. This medication combines a short-acting opioid with acetaminophen. 
It is considered Schedule III by the U.S. Drug Enforcement Administration, 
which means that physicians can phone in prescriptions and give refills. 
With Schedule II drugs -- OxyContin, Duragesic, Dilaudid, morphine -- this 
is not possible. The increased availability of hydrocodone/acetaminophen 
has led to widespread indiscretion in its use. For some physicians, this is 
the only medication they seem to know.

Lastly, I have communicated with the pharmacists in charge of drug recovery 
in Oregon and California on this issue. They have verified that much, if 
not most, of the current OxyContin abuse results from illegal trafficking 
of this drug across our borders with Mexico and Canada. Some diversion from 
patients has occurred, but this is thought to represent the minority of 
street abuse of this drug.

Therefore, while physicians and patients alike must exert caution with 
opioid medications, the current atmosphere of panic over these medications 
largely overestimates the public health impact nationally.

As USA TODAY's article states, the widespread tolerance of chronic pain by 
society leads to far more disability and mental health disorders than this 
abuse issue.

Therefore, as regulatory agencies investigate this problem, it is essential 
that they bear in mind the good that comes from the appropriate use of 
these medications. They must not prevent physicians from prescribing 
opioids, but should rather improve the education and safety of medical 
practice regarding these medications.

David M. Sibell, M.D.

Oregon Health and Science University

Portland, Ore
- ---
MAP posted-by: Jay Bergstrom