Pubdate: Tue, 21 Aug 2007
Source: Charlotte Observer (NC)
Copyright: 2007 The Charlotte Observer
Author: Frank Bass, Associated Press
Bookmark: (Chronic Pain)
Bookmark: (Oxycontin/Oxycodone)


90% Increase Seen 1997- 05, Including OxyContin, Vicodin

WASHINGTON -- Retail sales of five leading painkillers nearly doubled 
over an eight-year period, reflecting a surge in use by patients 
nationwide who are living in pain, according to a new Associated 
Press analysis of federal drug prescription data.

The analysis reveals that oxycodone usage is migrating out of 
Appalachia to areas such as Columbus, Ohio, and Fort Lauderdale, 
Fla., and significant numbers of codeine users are living in many 
suburban neighborhoods around the country.

The amount of five major painkillers sold at retail establishments 
rose 90 percent between 1997 and 2005, according to Drug Enforcement 
Administration figures. More than 200,000 pounds of codeine, 
morphine, oxycodone, hydrocodone and meperidine were purchased at 
retail stores during 2005, the most recent year represented in the 
data. That is enough to give more than 300 milligrams of painkillers 
to every person in the country.

Oxycodone, the chemical used in OxyContin, is responsible for most of 
the increase. Oxycodone use jumped nearly six-fold between 1997 and 
2005. The world of pain extends beyond big cities and involves more 
than oxycodone. In Appalachia, retail sales of hydrocodone -- sold 
mostly as Vicodin -- are the highest in the U.S. Nine of the 10 areas 
with the highest per-capita sales are in mostly rural parts of West 
Virginia, Kentucky or Tennessee. Dr. Jeffrey Gordon, director of the 
blood and cancer center at Day Kimball Hospital in Putnam, Conn., 
said Vicodin is a popular painkiller to give patients after surgery, 
and many doctors are familiar with it. "Over the past 10 years, there 
has been much better education in the medical community to ... ask if 
people are having pain and to better diagnose and treat it," Gordon said.

Suburbs are not immune to the explosion. While retail sales of 
codeine have fallen by one-quarter since 1997, some of the highest 
rates of sales are around Kansas City, Mo., Nashville, Tenn., and 
Long Island, N.Y. The DEA figures analyzed by the AP include 
nationwide sales and distribution of drugs by hospitals, retail 
pharmacies, doctors and teaching institutions. An AP investigation 
found these reasons for the increase:   The population is getting 
older. As age increases, so does the need for pain medications. In 
2000, there were 35 million people older than 65. By 2020, the Census 
Bureau estimates the number of elderly in the U.S. will reach 54 million.

Drugmakers have embarked on unprecedented marketing campaigns. 
Spending on drug marketing has zoomed from $11 billion in 1997 to 
nearly $30 billion in 2005, congressional investigators found. Profit 
margins among the leading companies routinely have been three and 
four times higher than in other Fortune 500 industries.

A major change in pain management philosophy is now in its third 
decade. Doctors who once said pain is part of the healing process 
began reversing course in the early 1980s; most now see pain 
management as an important ingredient in overcoming illness.

Retired Staff Sgt. James Fernandez, 54, of Fredericksburg, Va., 
survived two helicopter crashes and Gulf War Syndrome over 20 years 
in the Marine Corps. He remains disabled from his service-related 
injuries and takes the equivalent of nine painkillers containing 
oxycodone every day. "It's made a difference," he said. "I still have 
bad days, but it's under control." Such stories should hearten 
longtime advocates of wider painkiller use, such as Russell Portenoy, 
head of New York's Beth Israel pain management department. But they have not.

"I'm concerned and many people are concerned, that the pendulum is 
swinging too far back," he said.

ON THE WEB: Pain Relief Network, Drug 
Enforcement Administration, American Academy of 
Pain Management,

AP writers Dave Collins and Samira Jafari contributed.
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MAP posted-by: Beth Wehrman