Pubdate: Tue, 25 Nov 2003
Source: Sun Herald (MS)
Copyright: 2003, The Sun Herald
Contact:  http://www.sunherald.com
Details: http://www.mapinc.org/media/432
Author: Barry Meier

THIN LINE SEPARATES PAIN, DRUG ADDICTION

Over the past two decades, two conflicting medical ideas have surfaced 
about narcotic painkillers, the drugs that Rush Limbaugh blames for his 
addiction while he was being treated for chronic back pain. And both of 
them, not surprisingly, have centered on the bottom-line question: Just how 
great a risk of abuse and addiction do narcotics pose to pain patients?

Throughout much of the last century, doctors believed that large numbers of 
patients who used these drugs would become addicted to them. That incorrect 
view meant that cancer sufferers and other patients with serious pain were 
denied drugs that could have brought them relief.

But over the past decade, a very different viewpoint has emerged, one 
championed by doctors specializing in pain treatment and by drug companies 
eager to broaden the market for such drugs. It held that these medications 
posed scant risk to pain patients, and some experts now believe that it 
also had unfortunate consequences because it caused, among other things, 
physicians to develop a false sense of security about these drugs.

"The pendulum went in two opposite directions," said Dr. Bradley S. Galer, 
group vice president for scientific affairs at Endo Pharmaceuticals, which 
manufactures two widely used narcotics, Percodan and Percocet. "Luckily, 
now the pendulum is focusing where it should be, right in the middle."

The reassessment of narcotic risk comes at a time of skyrocketing rates of 
misuse and abuse of such drugs. Medical experts agree that most pain 
patients can successfully use narcotics without consequences. But the same 
experts also say that much remains unknown about the number or types of 
chronic pain sufferers who will become addicted as a result of medical 
care, or "iatrogenically" addicted. The biggest risk appears to be to 
patients who have abused drugs or to those who have an underlying, 
undiagnosed vulnerability to abuse substances, a condition that may affect 
an estimated 3 percent to 14 percent of the population.

It is not unusual for views about particular drugs and their hazards to 
change over time.

But a look at the shift in medical thinking about the risk of addiction 
shows a struggle that was waged both as a guerrilla war among doctors and a 
high-powered drug industry initiative.

It also was an effort that, while seeking a laudable goal, inaccurately 
portrayed science.

For its part, a spokeswoman for the federal Food and Drug Administration, 
Kathleen K. Quinn, said the agency believed that "the risk of addiction to 
chronic pain patients treated with narcotic analgesics has not been well 
studied and is not well characterized."
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