Pubdate: Sun, 26 Aug 2001
Source: St. Paul Pioneer Press (MN)
Copyright: 2001 St. Paul Pioneer Press
Contact:  http://www.pioneerplanet.com/
Details: http://www.mapinc.org/media/379
Author: Linda Marsa, Los Angeles Times
Bookmark: http://www.mapinc.org/find?186 (Oxycontin)

OTHERS' ABUSE OF OXYCONTIN ADDS TO PAIN OF THOSE IT HELPS

Riddled with pain from rheumatoid arthritis and a degenerative bone 
disease for years, Diana Rose rarely left the house. Then in 
November, a doctor prescribed the painkiller OxyContin, dramatically 
changing her quality of life.

"I can actually go shopping at the mall, play with my grandchildren 
and even swim in our pool," said Rose, a 57-year-old Kentucky woman. 
"This drug has enabled me to do things without being in pain."

OxyContin, a powerful drug that is a chemical cousin to opiates such 
as morphine and heroin, has enabled thousands of people, such as 
Rose, to resume the normal activities of life. But now some doctors 
fear that a backlash triggered by rampant street use of the drug 
dubbed "hillbilly heroin" will derail significant advances in the 
field of pain management. They worry that U.S. drug officials may 
respond to rising illicit use of OxyContin by yanking it from the 
market, place stricter limits on the use of all opiates, commonly 
used to treat cancer patients, severe back pain and other chronic 
pain conditions.

"This is not just about OxyContin," said John Giglio, executive 
director of the American Pain Foundation, a nonprofit consumer group 
in Baltimore. "This is about the potential for rolling back progress 
made in pain management. It's been an extremely hard uphill climb to 
get physicians to become more comfortable prescribing opiates and 
overcoming the stigma among patients about potential addiction and 
abuse."

OxyContin is a synthetic opiate that has fewer side effects than 
other potent pain medications, including morphine or codeine, which 
can cause nausea, constipation or drowsiness. What's more, OxyContin 
is formulated to keep steady levels of the drug circulating in the 
blood for as long as 12 hours. Patients don't experience the intense 
peaks and valleys of taking other narcotics, like Vicodin or Lortab, 
which can take an hour to provide pain relief and whose effects wear 
off in four hours.

Abuse, Addiction

Soon after OxyContin was approved in 1995, recreational drug users 
discovered that, rather than letting the pill dissolve in the 
gastrointestinal tract, they could produce an intense high by chewing 
the drug or crushing it into a power that can be snorted or 
intravenously injected. Within a few years, areas in rural Maine and 
Appalachian communities of Virginia, West Virginia and Kentucky 
reported a wave of users who had become addicted to the drug.

Since then, illicit use of the drug has spread throughout the 
country. It is estimated that more than 200,000 Americans have abused 
OxyContin, which also has been implicated in more than 100 deaths 
from suspected overdoses. Several doctors have been convicted of 
illegally dispensing the drug, while "Oxy" addicts increasingly turn 
to crime to feed their habits.

The growing alarm about illicit use is having a chilling effect on 
legitimate use of the drug. Six states -- Florida, Maine, Ohio, South 
Carolina, Vermont and West Virginia -- have set strict limits on the 
number of pills that can be prescribed for people on Medicaid. That 
means that doctors may not be able to increase dosages for patients 
who need stronger pain relief.

In the wake of several robberies at drugstores across the country, 
many pharmacies now refuse to stock it and physicians are reluctant 
to prescribe it.

"Since all this hysteria began, some patients have been abandoned by 
their doctors," said Dr. J.S. Hochman, executive director of the 
National Foundation for Treatment of Pain in Houston. "I had two 
patients, a mother and daughter with severe rheumatoid arthritis, who 
had to fly from Boston to Houston to find a doctor -- and were 
willing to do so be-cause they were so desperate. "

Patient Fears

Some patients are so concerned about the negative publicity, 
especially fears of addiction, that they've asked their doctors to 
take them off the drug.

"The day after an OxyContin story aired on one of the TV 
newsmagazines, I had two cancer patients come in the next day, 
telling me they wanted off the drug," said Dr. Neal Slatkin, director 
of supportive and palliative medicine at City of Hope National 
Medical Center in Duarte, Calif.

"Their pain was well-controlled, and they weren't having side 
effects," he said. "So I spent a lot of time reassuring them that 
this drug was OK. But the whole incident was very distressing."

Patients who continue taking the drug often face serious obstacles in 
getting their prescriptions. In Pulaski, Va., a small town in 
Appalachia, for example, police began fingerprinting patients who had 
OxyContin prescriptions. Under threat of a lawsuit by the American 
Civil Liberties Union, authorities later backed down.

"I've been refused treatment in the ER because they think I'm a drug- 
seeker," said Jeannette Murray. The 31-year-old nurse, who lives in 
an area of southwestern Virginia that is a hotbed of OxyContin 
addiction, takes the drug to relieve chronic pain from an injury to 
her right arm.

"It's been difficult finding a pharmacy to get my prescription 
filled," Murray said. "I've been cautioned not to carry my 
prescription on my person, which just adds more stress to an already 
stressful situation."

"Smart' Pill

In response to reports of OxyContin abuse, Purdue Pharma, a Stamford, 
Conn., pharmaceutical firm, in May stopped marketing the 160-mg 
version of the drug, then the strongest dosage available.

The company also recently announced plans to introduce a "smart" 
version of the pill, which will lose its potency if it's crushed or 
snorted; however, the new formulation won't be available for a few 
years.

And beginning in July, the FDA required that OxyContin boxes carry 
the agency's strongest warning: a black box label that calls 
attention to the drug's potential for abuse.

"But all this hoopla just exacerbates patients' underlying anxiety 
about taking opiates, which we know are really quite effective," said 
Dr. Richard Payne, chief of pain and palliative care service at 
Memorial Sloan-Kettering Cancer Center in New York.

"There is still a pervasive undertreatment of pain," he said, "and 
thousands of people are suffering needlessly."
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