by Rachel Dissell, News-Record Staff Writer
Doctors who specialize in pain management and cancer treatment are cursing recent media coverage that trumpets only the alleged evils of OxyContin, an opiate that burst onto the market in 1996 after approval by the Food and Drug Administration.
Pain practitioners praise the drug as a miraculous leap forward in the pain-management field because it delivers a continuous dose of medication with few side effects to patients. But because of highly publicized criticism of the drug and a tough stance taken by the Drug Enforcement Agency, doctors are increasingly apprehensive about prescribing it. Some patients are refusing the drug when doctors say it is in their best interest.
To Dr. Douglas Merrill, chairman of the committee on pain medicine for the American Society of Anesthesiologists, misinformation and one-sided news stories about OxyContin threaten headway made in the field of pain management. A growing number of doctors won’t prescribe OxyContin or are afraid they will lose their license because of “some stupid scare stories,” he said.
Merrill also said chronic pain patients are afraid of addiction because of fear manufactured by the media.
“There can even be a problem getting cancer patients to take a strong enough drug ,” he said.
Merrill admits that OxyContin, a version of the narcotic oxycodone, used in several pain medications, is an extremely powerful opiate. But medical experts say it is no more addictive than morphine, codeine or other opium-based medicines.
Opiates are similar to endorphins, the brain’s own “feel-good” chemicals, and do essentially the same job. But when artificially administered, the body does not absorb the drug correctly, causing a euphoric sensation.
Merrill said abuse of opiates is inevitable.
“It’s normal human nature that if a drug has a side effect of euphoria, someone will find a way to abuse it,” he said. “The drug is chosen by people who abuse other drugs, and sometimes they get more than they bargained for.”
Betsy Earle, director of the pharmacy at Rockingham Memorial Hospital, said she is “totally amazed at the number of drugs that people find a way to abuse.”
Earle said the time-released OxyContin can be crushed and ingested for an instant high, and its use has caused a recent spine in deaths due to overdose.
According to the state medical examiners office, since 1999, 68 deaths in Virginia were caused by overdoses of oxycodone, the active ingredient in OxyContin. However, according to a spokesman in the office, in some cases, other drugs were also found in the bodies.
Earle said although people use the drug improperly, the benefits outweigh the problems. “It is still a very good drug,” she said.
A Different Story
However, one pain management doctor who treats drug addiction at a California clinic says the swelling number of OxyContin addicts he sees proves the opiate is unlike others.
“It’s a good drug, and that is the problem,” said Dr. Cliff Bernstein, director of the Beverly Hills-based Waismann Institute, a drug treatment facility. And that drastically different story about OxyContin is being told by law enforcement officials, drug abuse specialists, and doctors like Bernstein who claim the number of OxyContin addicts since the drug as introduced is staggering – substantially more than with painkillers such as morphine or Vicodin. Drug-abuse treatment experts say that even people who are taking OxyContin as prescribed are quickly becoming junkies.
In a press release earlier this year, the DEA stated that no other prescription medication in the past 20 years was abused by so many people immediately after its release. The agency attributed part of the problem to overselling of the drug’s benefits without adequate warning of potential abuse.
According to a spokeswoman for the agency, “This is the first time a particular drug brand has been targeted.”
A few years ago, Bernstein said 100 percent of his patients were heroin addicts, but now he treats almost 60 percent pill addicts.
Bernstein blames the high rates of addiction and the resulting social consequences on doctors who overprescribe narcotics. He said many doctors were romanced by the drug’s manufacturer, Perdue Pharma L.P., and started prescribing the drug en masse without enough knowledge about its addictive nature.
The West Virginia attorney general’s office has even filed suit against Perdue Pharma, claiming it was unethical in the marketing of the drug.
Rich Lewis, lead attorney for the suit West Virginia filed against the company, said, “There is no doubt this is unlike any other painkiller. The question is, ‘Why?'”
He said no other reason explains why the number of addictions and deaths involving OxyContin rose exponentially higher than other opium-based medications.
Perdue Pharma Chief Operating Officer Michael Freidman called the allegations “baseless,” and in a June 13 press release said, “Solving the public health problem of prescription drug abuse will require cooperation, not confrontation.”
Tales of Tolerance
Bernstein said, like all opiates, people grow tolerant of OxyContin and begin increasing the dosage to compensate. “Like at first it takes one beer to get drunk, and then it takes three,” he said.
Except, Bernstein said, one 160-milligram OxyContin is like 70 5-milligram Vicodin or 64 Percocet. Perdue Pharma took the 160-milligram dose of the pill off the market in May because of media attention.
Bernstein asserts addiction is only a matter of time, and people then start using the drug improperly by biting off the time-release coating and chewing the drug.
“One little bite and bang! – you are off to the moon,” said Bernstein.
“We are not talking about sophisticated drug-seeking people,” said Bernstein. He said many people he treats at the Waismann Institute took the drug as prescribed by physicians.
“Most people come into this innocently,” he said. “You can’t say someone’s an addict because they have pain and they want it to feel better.”
At the institute, Dr. Bernstein treats the addiction medically by putting the addict under general anesthetic for four to six hours and administering a drug that blocks the opiate receptors in the brain. By doing that, the patient is able to go through the painful withdrawal from the drug while asleep. Bernstein said the program has more than a 60 percent success rate.
Withdrawal from OxyContin, when taken at high doses can be scary – even for people who take it as prescribed, said Bernstein. “People shake, rattle, roll, sweat and poop themselves when they are withdrawing,” he said. “And that’s real.”
But Merrill said addiction is in the mind, as well as the body – both have to be treated. “Tolerance and addiction do not go hand-in-hand,” Merrill said.
Bernstein, however, does not think that OxyContin should be yanked off the market. He agrees with OxyContin use to treat cancer pain for terminally ill patients.
“With cancer pain, there are no holds barred,” Bernstein said. “You can just give them more and more to make them comfortable. They won’t be addicted because they aren’t going to live.”
But Merrill said the distinction between cancer and non-cancer pain is somewhat of a smokescreen. “Pain is the same, whether it is cancer pain or a gunshot wound to the spinal cord,” he said. “And it deserves to be treated.”
However, Merrill admits that doctors need to be better educated about prescribing OxyContin and, more importantly, monitoring it. “If I don’t monitor a patient, I am guilty of prescribing irresponsibly, even if the drug is an antibiotic,” he said.
Poorly Treated Pain
According to Merril, studies show that pain is sorely underestimated in patients, maybe as much as 50 percent of patients are gone untreated – if treated at all. But lately, headway has been made, Merrill said, and pain assessment is required of healthcare facilities to be certified by them.
“There is a big fear this will undo what has already been done,” he said.
{Perdue Pharma, in a meeting a few months ago, with the DEA and the FDA, introduced an initiative of its own to curb illegal use of OxyContin. The 10-point plan centers on tamper-resistant prescription pads and includes educational programs and documentation kits that would aid doctors in sorting out legitimate patients from fraudulent ones.
Jim Heins, the public relations spokesman at Perdue Pharma, said the company has been proactive in quelling abuse.
“This was our own initiative that Perdue Pharma brought to the table because we do want to curb illegal use of OxyContin,” Heins said.
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