Pubdate: Sun, 08 May 2016
Source: Los Angeles Times (CA)
Copyright: 2016 Los Angeles Times
Contact:  http://www.latimes.com/
Details: http://www.mapinc.org/media/248

OXYCONTIN AND ADDICTION

There's never been a secret about the addictive properties of opioid 
painkillers. But a new investigation by The Times revealed something 
that wasn't so widely known: The maker of one of the most popular 
opioid painkillers pushed doctors to adhere to a regimen that, as it 
turned out, made it more likely for patients to become addicts.

And by the way, it was the regimen approved by federal regulators - 
one with unanticipated consequences that regulators and doctors have 
been too slow to address.

The drug in question is OxyContin, a version of the generic opioid 
painkiller oxycodone that Purdue Pharma introduced 20 years ago as a 
12-hour alternative to cheaper, shorter-lived oxycodone products.

The Food and Drug Administration approved OxyContin based on evidence 
that the two-pills-per-day regimen worked for half or more of the 
patients in a test group.

But sealed court records and internal company documents reviewed by 
The Times showed that the company knew that the relief wore off for 
many patients well before 12 hours.

Such results shouldn't come as a surprise.

After all, the FDA doesn't require drugs to work as promised for all patients.

What was eye-popping about The Times' findings was how Purdue 
responded when doctors told them their patients weren't getting the 
full 12 hours of relief promised.

Instead of recommending that such patients take OxyContin more than 
twice per day - which might make it less appealing than cheaper 
generic opioids with short durations - Purdue's sales reps told 
doctors to stick to the 12-hour regimen and prescribe higher-strength pills.

As several medical experts explained to The Times, the change 
accentuated the most addictive properties of oxycodone.

When the effects of OxyContin wear off well before 12 hours, a 
patient's pain returns along with symptoms of opioid withdrawal, 
increasing the craving for another pill. Switching to stronger doses 
offers more profound pain relief, but won't necessarily solve the 
problem of needing another pill in less than 12 hours.

According to experts quoted in The Times, such repeated episodes of 
craving increase the likelihood of addiction.

Purdue insists that research supports the FDA's approval of the 
12-hour regimen, and that it is dedicated to fighting the opioid 
epidemic. Yet like every other drug manufacturer, its profits depend 
on maximizing sales.

Documents show that the sale of higher-dose pills resulted in bigger 
profits for Purdue and higher paydays for its sales representatives.

Given those incentives, it's essential that the healthcare industry 
respond quickly when doctors and patients find that prescription 
drugs aren't working as expected.

The opioid epidemic resulted in part because regulators and 
prescribers didn't realize just how powerfully addictive those 
substances were. And part of the solution may be prodding the FDA to 
monitor dangerous prescription drugs more closely and update their 
usage limits and warning labels more rapidly once problems become clear.

The more immediate step is for doctors to prescribe opioids less 
frequently. To that end, the Centers for Disease Control and 
Prevention issued new guidelines for the treatment of chronic pain, 
emphasizing safer approaches than the use of powerful opioids.

This week an FDA advisory panel endorsed mandatory training for 
doctors who prescribe opioids.

And in California, a proposed law would require doctors and 
pharmacies to check a state database of existing prescriptions before 
prescribing potentially addictive drugs to new patients - a sensible 
step that would make it harder for patients to go doctor-shopping to 
feed their opioid habits.

To their credit, doctors have already reduced the number of opioids 
they prescribe.

Yet physicians' groups have pushed back against all three of these 
proposals, citing potential technical problems or the risk that 
patients who really do need the drugs won't be able to obtain them. 
It's certainly true that opioids have an important role to play in 
pain relief, and that chronic pain is a problem that defies easy solution.

But given the steady rise in overdoses and addictions from coast to 
coast, it's inarguable that the use of these drugs has gotten wildly 
out of hand. Just as regulators and drugmakers have to step up their 
efforts, so too do those who prescribe opioids.

Just as they are on the front line of the battle against chronic 
pain, so too are they the first line of defense against addiction to 
prescription drugs.
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MAP posted-by: Jay Bergstrom