Pubdate: Tue, 15 May 2007
Source: Wall Street Journal (US)
Copyright: 2007 Dow Jones & Company, Inc.
Author: Sally Satel
Bookmark: (Oxycontin/Oxycodone)
Note: Dr. Satel, a psychiatrist specializing in addiction, is a resident
scholar at the American Enterprise Institute.


It is a bad time to be in pain. Last week, the maker of OxyContin, a
high-strength narcotic analgesic, agreed to pay $635 million to settle
charges of "misbranding" brought by the attorney general of West
Virginia. "Scores died as a result of OxyContin abuse and an even
greater number of people became addicted," said Attorney General John
Brownlee. The drug company, Purdue Frederick, admits that its sales
force underplayed the abuse potential of OxyContin. And, yes, the
company should have acted more quickly to clamp down on overpromotion
and to issue strong warnings in the face of overdose deaths.

But the real public-health damage here comes from the pitched campaign
conducted by zealous prosecutors and public-interest advocates to
demonize the drug itself. This is tragic because OxyContin has been a
godsend for millions of patients with searing, unremitting pain from
chronic back problems, rheumatoid arthritis, neurological disorders
and other dire afflictions.

This latest bad rap for OxyContin threatens to inflict more pain.
Doctors already wary of scrutiny by the Drug Enforcement
Administration will become even more skittish about giving adequate
doses of OxyContin or prescribing it at all. And patients will be
rightly scared of losing access to the medication that made their
lives livable again.

OxyContin was approved in 1995 for treatment of moderate-to-severe
pain. Unlike its opioid cousins, such as morphine or codeine which
wear off in four to six hours, OxyContin is slow-release and lasts up
to 12 hours. Longer action means steadier blood levels, an important
feature when pain is constant and severe.

Problems started in 2000 when drug abusers discovered that they could
crush the pill -- thereby inactivating the slow-release feature -- and
snort or inject the powdery contents for a euphoric rush that hits the
brain like heroin. West Virginia was one of the first states to report
people dying from abuse of "Oxy," dubbed Hillbilly Heroin.

Then in July 2001 the New York Times Magazine ran a cover story, "The
Alchemy of OxyContin." The author described how addicts -- not severe,
chronic pain patients -- ground an intact pill into quick-acting
pharmaceutical grade opiate. "It takes five seconds to effect the
transformation -- and not much longer to create an addict." The
startling implication was that unwitting people were stumbling
headlong into a powerful addiction. Two years later the Orlando
Sentinel ran a series headlined "Pain Pill Leaves Death Trail." The
expose reported that 205 overdose deaths in Florida in 2001 and 2002
were linked to OxyContin. The victims "put their faith in their
doctors," said the Sentinel, "and ended up dead, or broken."

These portrayals were deeply flawed. The typical "Oxy" abuser is not a
pain patient taking medication as prescribed, but rather a committed
substance abuser. The 2002 National Household Survey on Drug Abuse
found that among those who took OxyContin without a prescription, 98%
had used other addictive pain relievers for nonmedical purposes and
more than a quarter had used heroin. When the Kentucky medical
examiner's office recorded 27 oxycodone-related deaths in 2000; in all
but two, other drugs, including cocaine, heroin and other prescription
painkillers and alcohol, were found in the bodies (oxycodone is the
pure narcotic found in OxyContin and other pain killers). In 2003, the
Journal of Analytical Toxicology reported that in less than 2% of 919
oxycodone-related deaths OxyContin was the only drug found at autopsy.

The Orlando Sentinel recanted its story in 2004 after autopsies on
two-thirds of the victims uncovered other drugs (e.g., alcohol,
heroin, other painkillers) that alone or in combination with oxycodone
could have been fatal. In the remaining one-third, no one could tell
how often OxyContin itself was involved because name-brand drugs were
not identified in the autopsies.

Thus, the problem isn't OxyContin, but its misuse by people abetting a
desire to get high. In fact, according to the National Institute on
Drug Abuse, abuse of narcotic analgesics is rare among legitimate pain
patients taking adequate doses as prescribed. This is not to absolve
physicians. Well-meaning doctors sometimes prescribe large numbers of
pills to those who may not need such high-strength medication and then
refill prescriptions reflexively. Some are easily hoodwinked by
"patients" who doctor shop to maintain a habit or to accumulate drugs
for underground sale at $1 per milligram (the most commonly sold pill
being the 40mg strength). A vast amount of OxyContin on the black
market also comes from pharmacy robberies and diversion of drug
shipments bound for large distribution chains. Was the penalty for
Purdue Frederick out of line? I don't know. But the price for those
already in pain promises to be steep. Pharmaceutical development of
improved slow-acting opiate medications may be derailed by fresh
paranoia. More law-abiding physicians wary of litigation and
regulatory scrutiny may withdraw from prescribing potent painkillers.
It is hard enough for pain patients to get treatment. This newest
injection of malignant hype is the last thing they need.

Dr. Satel, a psychiatrist specializing in addiction, is a resident
scholar at the American Enterprise Institute.
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