Pubdate: Thu, 25 Mar 2004
Source: Slate (US Web)
Copyright: 2004 Microsoft Corporation
Contact: http://fray.slate.msn.com/?did=1&id=3936&tp=medicalexaminer
Website: http://slate.msn.com/
Author: Maia Szalavitz
Note: Maia Szalavitz is a senior fellow at STATS.org. She is writing a book 
about behavior-modification programs for teenagers.
Bookmark: http://www.mapinc.org/find?232 ( Chronic Pain )
Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone)

THE ACCIDENTAL ADDICT

Clearing Away the Myths Surrounding the Oxycontin "Epidemic."

In a recent five-part series (Oct. 19-23), the Orlando Sentinel painted a 
stark picture of the opiate drug OxyContin: Prescribed for mild pain by a 
clueless doctor, the drug had destroyed a former policeman's life. 
Apparently, this story was typical: Thousands had been derailed by the 
deadly drug. Within weeks, however, the drug's manufacturer, Purdue 
Pharmaceutical, and the ex-cop's mother-in-law revealed that the man-called 
an "accidental addict" by the writer, Doris Bloodsworth-was a former 
cocaine abuser with a federal trafficking conviction.

This was not the only error the Sentinel had to account for in a 2,000-word 
correction: The paper had also omitted that an overdose victim profiled in 
the series had actually taken multiple drugs, along with OxyContin, and had 
previously overdosed on different medications. Even now, the Sentinel still 
hasn't clarified that most of the overdose deaths cited in the 
"investigations"- about 90 percent according to other research-were not, in 
fact, caused by OxyContin alone but by deadly combinations of drugs 
(OxyContin along with alcohol and/or other depressants like benzodiazepines).

If the Orlando Sentinel were the only news organization to run massively 
misleading stories on OxyContin, the misinformation could be chalked up to 
error.

But the first substantive column by the New York Times' ombudsman Daniel 
Okrent also dealt with OxyContin bias, albeit of a different sort-Okrent 
wrote that the paper shouldn't have allowed Times writer Barry Meier, 
author of the anti-OxyContin book Pain Killer, to cover the drug in an 
article in its "Science" section. Meier's article claimed that researchers 
now believe that "accidental" addiction is more common than previously 
thought-never mind the fact that there has been no new research suggesting 
this since OxyContin was introduced in 1995, only increased pressure from 
law-enforcement agents.

Indeed, various media outlets-from NPR to the New York Post-claim that 
numerous new OxyContin addicts have been created by doctors who cavalierly 
prescribe the drug. Articles or news segments assert that overdose 
frequently occurs among the innocent patients of careless doctors, but the 
profiled "victims" are overwhelmingly prior drug users who now get their 
fix by snorting or shooting OxyContin. The featured subjects almost always 
turn out-like the Sentinel's-not to be "accidental" addicts but just plain 
druggies. (In a 2001 story about the supposed "epidemic" in Appalachia, the 
New York Times Magazine didn't cite a single case of doctor-caused 
addiction; instead, it portrayed "casual" drug users who faked pain or 
otherwise illegally obtained OxyContin in a sympathetic light, claiming 
these "accidental addicts" didn't know that prescription opiates are 
addictive!)

All of which raises the question: If accidental addiction is so common, why 
aren't there any telling anecdotes about the phenomenon?

In fact, the entire OxyContin "epidemic" is based on a false narrative that 
asserts that the majority of OxyContin addicts begin as drug-naive pain 
patients.

The cop the Sentinel profiled was actually a typical Oxy addict-a prior 
drug user-but his real story wasn't what they wanted. If Bloodsworth had 
been looking for that, she would have noted that government data shows that 
90 percent of OxyContin abusers have also taken cocaine, psychedelics, and 
other prescription painkillers. Readers would have been informed that 
investigators specializing in prescription drug abuse say the typical 
OxyContin addict has a lengthy history of multiple-drug abuse.

The paper also would have highlighted that addiction is the exception, not 
the rule, among people exposed to opiates.

Studies consistently show that pain patients taking opiates are no more 
likely to become addicts than people in the general population (i.e., 
exposure alone does not cause addiction). That is to say, only between 1 
percent and 20 percent of people in the general population experience a 
period of addiction to some substance, depending primarily on 
characteristics such as age, stress, family history of addiction, and 
mental illnesses. (Depression, manic depression, and schizophrenia all 
dramatically affect one's risk of addiction.) If you rule out prior 
abusers, the rate settles at the low end, in single digits. (Rush Limbaugh 
may be one such example, though we still don't know anything about his 
possible prior drug use.) Even among people who try the most demonized 
opiate, heroin, for recreation or in a situation of extreme stress, only a 
minority will become addicted. While nearly half of U.S. soldiers in 
Vietnam tried heroin while abroad, only 20 percent of users became addicts.

And only 12 percent remained junkies-even though 60 percent of those 
addicted while in Vietnam tried heroin at least one more time back home. 
Research by the National Institute on Drug Abuse finds that most people 
simply don't enjoy the opiate "high," let alone want it daily.

Yet reporters don't like this narrative, so they ignore it. This tired, 
predictable story line leaves reporters with unsympathetic protagonists: 
Who wants to read about scummy addicts scamming doctors? Grandma's back 
pain making her into a pharmacy robber is much more compelling; 
unfortunately, it almost never happens.

In order to create their preferred story, reporters twist the facts.

The Sentinel, for example, noted that prescribing rates for other opiates 
like morphine and Demerol increased 23 percent between 1996 and 2000-while 
the prescribing rate for OxyContin rose 2,000 percent. But these numbers 
say nothing about drug abuse. An analysis of rates of abuse as reported in 
emergency rooms compared with prescribing rates would be more informative.

Such an analysis was published in the Journal of the American Medical 
Association in 2000. The study covered the period from 1990-96, analyzing 
national records of opiate prescribing rates and emergency room drug-abuse 
"mentions"-and found that as prescribing increased, abuse of these drugs 
did not rise proportionately. In fact, for fentanyl, a stronger opiate than 
heroin, medical use rose 1,168 percent, but abuse reports fell 59 percent. 
The Sentinel neglected to mention the study.

Interestingly, this research also found that while Oxycodone (OxyContin is 
simply a time-release preparation of this drug, designed to deliver a 
steady dose over 12 hours) use rose 23 percent during that time, 
Oxycodone-abuse mentions in emergency rooms fell 29 percent, despite the 
1995 introduction of OxyContin. Abuse accounts began to rise in 2001, only 
after the media-with help from prosecutors-discovered the "problem" and 
taught large numbers of drug users to defeat the drug's time-release 
mechanism by telling them that this could be accomplished by crushing the 
pill and snorting it. (Crushing maximized both overdose and addiction risk; 
a user can get 12 hours' worth of medicine in a minute.)

The fact is, if the media and the government were to acknowledge the 
truth-that OxyContin addiction occurs primarily among previous addicts-they 
would have to admit that easy solutions like prescription-drug registries 
and more physician prosecutions won't work. Multiple-drug users will switch 
substances, not quit, if one drug disappears. Pain patients will suffer or 
turn to street drugs when doctors refuse them. If duplicitous 
prescription-seeking, not accidental, addicts are the problem, the doctor 
we all want-the kind, empathetic, trusting one-will be incarcerated while 
the one who dismisses pain will thrive. (Barry Meier's article, for 
example, described what he called a South Carolina "pill mill" that sold 
prescriptions to addicts; the doctors in that clinic, however, claimed they 
were just treating patients' pain. One pleaded guilty to avoid decades in 
prison after being lambasted in the press; another committed suicide rather 
than testify against his colleagues.)

There have been some retractions and clarifications like those made by the 
Sentinel, but these have been aimed mainly at appeasing Purdue Pharma. The 
media haven't asked the forgiveness of its real victims: pain patients. 
Even after a decades-long fight by advocates, more than half of dying 
patients still don't get adequate relief, let alone chronic-pain sufferers. 
The Sentinel made much of Purdue's push to make OxyContin available for 
nonlethal pain, implying that this was cynical marketing, not sound 
medicine. (Apparently it's acceptable for people to have pain relief before 
death, but those with chronic pain will be forced to suffer for years.) The 
paper also failed to mention the fact that alternative drugs such as 
ibuprofen and similar medications are more likely to kill patients through 
side effects like bleeding if taken long-term as directed, while opiates 
are rarely deadly unless abused.

Pain advocates say there are 30 million to 50 million chronic-pain patients 
and the worse their pain, the less likely they are to find relief because 
doctors fear prosecution for giving enough of the right drugs to help.

There is a story that needs to be told about prescription opiates: Good 
drugs and good doctors are being defamed by reporters and prosecutors based 
on conventional-and discredited-wisdom about addiction.

Opiates don't grab most people. Addiction isn't an accident.

Drug companies aren't always wrong.

Unfortunately, America seems to be hooked on the 
bad-companies/bad-doctors/innocent-victims narrative: The Bush 
administration recently announced that this year's national drug strategy 
will focus on prescription drug abuse by pushing prescription registries 
and physician prosecutions. Where is big pharma's clout when we need it?
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MAP posted-by: Richard Lake