Pubdate: Thu, 25 Jul 2002
Source: Charlotte Observer (NC)
Copyright: 2002 The Charlotte Observer
Contact:  http://www.charlotte.com/mld/observer/
Details: http://www.mapinc.org/media/78
Author: Gerald M. Aronoff
Note: Gerald Aronoff, M.D., chairs the Department of Pain Medicine at 
Presbyterian Hospital.

OBSERVER EXPLOITS DRUG FEARS

Gerald M. Aronoff - Special To The Observer

As chairman of the Department of Pain Medicine at Presbyterian Hospital and 
former president of the American Academy of Pain Medicine, I feel compelled 
to respond to The Observer's series on OxyContin. The story was skewed 
toward sensationalism at the expense of accuracy.

I spent considerable time with the writer in an attempt to put the issue of 
opioid use for chronic pain into perspective. I sent her two medical 
articles I wrote on opioid use in chronic pain, one specifically addressing 
"Recent Publicity on Widespread Abuse of Pain Medication" (Mecklenburg 
Medicine, May 2001). She apparently was not interested in the facts. I was 
then quoted out of context.

The Observer has done a major disservice to pain patients who require 
opioid analgesics, to physicians who appropriately treat these patients and 
to pharmaceutical companies who spend billions of dollars through research 
and development of pharmaceuticals to help pain sufferers and to support 
pain research.

Research shows that on any given day up to 30 percent of our population can 
be suffering from chronic pain. It is a major public health problem that 
not only inflicts enormous suffering, but has a major economic impact for 
society.

Recent publicity has targeted the sustained-action analgesic OxyContin as 
contributing to widespread drug addiction and abuse. These articles raised 
multiple points about the potential for abuse and diversion of potent 
analgesics. These facts are partially accurate. All potent drugs can be 
abused, whether they be narcotic analgesics, mood-altering tranquilizers, 
psychostimulants, sleep medication, medications that enhance growth, curb 
appetite or promote weight loss, etc.

All these medications were developed for specific uses, and each is 
vulnerable to being abused. This is not the fault of the pharmaceutical 
companies. Rather, it is a reflection of social problems and 
counter-culture influences. The psychopathology (with perhaps some help 
from genetics) that leads certain individuals to become drug 
abusers/addicts occurs in about 6 percent to 13 percent of the population, 
the highest number reflecting alcohol problems.

The Observer article exploits the public's fear of addiction. The public 
should be reassured that there are established guidelines for the use of 
opioids in chronic pain in most states, including North Carolina. These 
guidelines include careful monitoring of clinical effectiveness 
(improvement in pain and suffering), enhancement of function, improvement 
in quality of life. This monitoring also watches for side effects, risk 
factors for addiction and drug-seeking behaviors.

Opioids should be prescribed only after it is established that there is a 
significant underlying pain condition not adequately controlled by other 
treatments.

Pain medicine physicians have taken the lead in finding ways to improve 
patient care. As president of the American Academy of Pain Medicine, I 
convened a task force on end of life care. The task force addressed 
inadequate pain treatment that, at times, has led patients to 
physician-assisted suicide and euthanasia, rather than suffering 
overwhelming pain and a diminished quality of life. Had physicians trained 
in pain medicine evaluated them, many who chose suicide and euthanasia 
would be alive today.

Increasingly in the field of pain medicine, when opioids are indicated for 
chronic pain, those prescribed are the sustained-action type, which have 
fewer side-effects, are better tolerated and more compatible with resuming 
normal activities (including work and driving) without interfering with 
mental status. Unfortunately, as with analgesics that preceded it (and, I 
suspect, many that will follow), these have also found their way to the 
street drug population.

OxyContin is not a "wonder drug." It is, however, an enormously effective 
analgesic for chronic pain with a good safety profile and few adverse side 
effects (when taken appropriately). My patients who are taking it are 
grateful, have less pain and suffering and are able to have more normal lives.

On occasion, I have had patients who initially were felt to be appropriate 
for chronic opioid therapy and subsequently I felt were drug seeking. I 
stopped prescribing medication for them.

My clinical research is consistent with other evidence that there is a 
subgroup of chronic pain sufferers who can safely be maintained on chronic 
opioids. With them, these patients remain functional and productive; 
without them, they are inactive and become disabled. Patient selection is 
extremely important.

I believe we must attempt to better deal with problems of drug abuse, 
addiction and preventing drug diversion. However, I am opposed to 
withholding adequate pain treatment from patients who need and deserve that 
treatment.

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Gerald Aronoff, M.D., chairs the Department of Pain Medicine at 
Presbyterian Hospital. Write him at 1901 Randolph Road, Charlotte, NC 28207.
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