Pubdate: Mon, 27 Oct 2003
Source: USA Today (US)
Copyright: 2003 USA TODAY, a division of Gannett Co. Inc
Author: Sally Satel
Bookmark: (Oxycontin/Oxycodone)


Limbaugh's recent admission that he has an addiction to prescription
narcotics has thrust OxyContin back into the spotlight. The potent
painkiller has been in and out of the headlines for about two years,
ever since addicts began injecting it to get a heroin-like high.

A Newsweek headline blared, "Rush's World Of Pain: His Path To Pill
Addiction ... The Scourge of OxyContin." Elsewhere, the medication has
been demonized as "hillbilly heroin;" Fox's Bill O'Reilly called it
"liquid heroin."

It's an undeserved bad rap for OxyContin, which offers relief to
hundreds of thousands of patients with searing, prolonged agony due to
diseases such as cancer, neurological illness and degenerative discs.
OxyContin can literally make life livable again for such patients.

One never would know this from the hype that has been swirling around
the medication since Limbaugh's confession. It is important to get the
facts straight, or pain sufferers who might benefit from OxyContin
could be scared away.

Don't blame drug

The problem isn't with OxyContin itself, but with deliberate criminal
misuse. OxyContin is a controlled drug in the same category as
morphine. Available since 1995, the medication is now the most widely
prescribed narcotic, in large part because it is taken only twice a
day. Other narcotic painkillers have to be taken every three to six
hours, which increases their addictive potential. The 12-hour
controlled delivery keeps blood levels steady, an important feature
when pain is constant and severe.

But half-truths abound:

=95 OxyContin is very addictive.

When abused, it most certainly is. Addicts typically crush the tablet,
inactivating the slow-release feature, then snort the powder or inject
it with water for a euphoric, heroin-like rush. But pain patients who
take OxyContin as prescribed don't require increasingly higher doses
and don't feel a high.

=95 Long-term use for pain equals addiction.

There is a difference. Physical dependence happens to almost everyone
who takes a narcotic medication regularly for about two weeks. Your
body becomes used to the drug; if it is stopped abruptly, you
experience withdrawal symptoms. Doctors taper pain medication to avoid

Addiction, by contrast, is the compulsive use of increasing doses of a
substance to regulate mood. Most people who abuse OxyContin have had
problems with excessive use of alcohol, heroin or other habit-forming
pills. Those abusers who have not generally are struggling with
emotional demons.

Narcotics are an excellent short-term salve for depression, numbing
boredom, self-loathing or fear. This is why doctors should ask
patients about prior problems with drugs or alcohol before prescribing
potentially addictive pain medications and carefully supervise those
with histories of addiction.

=95 OxyContin is responsible for hundreds of overdose

Last month, The New York Times reported that a federal drug advisory
panel member said "OxyContin is responsible for 500 to 1,000 deaths a
year." Not so. A March article in The Journal of Analytical Toxicology
examined records of the 919 deaths related to oxycodone (the
painkiller in OxyContin) in 23 states over about three years. In only
12 cases was OxyContin alone found. The remaining victims had taken
either an overdose of other oxycodone-containing drugs (such as
Percocet) or a combination of drugs. Almost all had at least three
other drugs in their systems, mostly alcohol, Valium-type
tranquilizers, cocaine or other narcotics. These deaths overwhelmingly
occurred in drug-abusing individuals; rarely was OxyContin an
exclusive cause of death.

Fears surface

OxyContin, like other powerful medications, can be a godsend when used
correctly. Now, however, the American Pain Foundation has received
calls from patients who are doing well on the medication but are
afraid to continue. The foundation also has heard that some doctors
are nervous about prescribing it, lest patients risk addiction or sue

One of the worst things a doctor can hear a patient say is: "I'd
rather be in pain than have people think I'm an addict." We can't let
half-truths about OxyContin set back progress against horrible pain.

Sally Satel is the staff psychiatrist at the Oasis Clinic in
Washington, and anAmerican Enterprise Institute fellow.
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