Use of Painkiller Grows Quickly, Along With Abuse

Use of Painkiller Grows Quickly, Along With Abuse
Posted by FoM on March 05, 2001 at 10:21:36 PT
By Barry Meier & Melody Petersen
Source: New York Times
Dr. Peter Leong recalls the day when he finally snapped at a drug company salesman pressing him to prescribe a powerful narcotic painkiller called OxyContin.The drug's producer, Purdue Pharma, had already failed to persuade Dr. Leong with repeated offers of free weekend trips to Florida to discuss pain management. But when the salesman suggested that OxyContin — which is as potent as morphine — was safe enough to treat short-term pain, Dr. Leong exploded.
"We threw him out of my office," said Dr. Leong, who runs a pain clinic in Bangor, Me. He thinks OxyContin is potentially too dangerous to use for anything but chronic, severe pain. "OxyContin is a good drug," he said. "But the problem was, they were pushing it for everything."If Dr. Leong was not a convert, many others were. In a little over four years, OxyContin's sales have hit $1 billion, more than even Viagra's. Although the drug has helped thousands of people in pain, its success has come at a considerable cost. An official of the Drug Enforcement Administration said no other prescription drug in the last 20 years had been illegally abused by so many people so soon after it appeared.OxyContin has been a factor in the deaths of at least 120 people, and medical examiners are still counting, according to interviews with law enforcement officials. And doctors like Dr. Leong, pharmacists and law enforcement officials say part of the problem is that Purdue Pharma often oversold OxyContin's benefits without adequately warning of its potential for abuse.The company also used an often criticized but increasingly common marketing strategy: currying the favor of doctors in private practice with free trips and paid speaking engagements. Purdue Pharma, based in Norwalk, Conn., paid the transportation and hotel costs for hundreds of doctors to attend weekend meetings in spots like Florida to discuss pain management, a company consultant said. Doctors were then recruited and paid fees to speak to other doctors at some of the 7,000 "pain management" seminars that Purdue sponsored around the country. Those meetings stressed the importance of aggressively treating pain with potent, long-acting painkillers like OxyContin.Purdue also contributed to foundations supporting research on pain, to pharmacy schools and to Internet sites aimed at educating consumers.As OxyContin's marketing message spread, the drug caught on with many doctors who medical experts said had little experience in prescribing powerful narcotics. As a result, they often could not spot those who intended to abuse the drug or who did not need it in the first place.OxyContin, introduced in December 1995, has offered patients something different: a tablet that slowly releases its powerful pain medication, permitting patients, for example, to sleep through the night. "It's a good drug in the right situation," said Dr. Art VanZee, a physician in St. Charles, Va. Purdue officials say they have promoted the drug responsibly and would have disciplined any sales representative who did not. They also said that in informing doctors about the drug, they told them how to spot potential drug abusers, and they have responded quickly to reports of spreading problems."We don't have strong medicines that don't have abuse potential," said Dr. J. David Haddox, the company's senior vice president for health policy. "What we have to do is walk the balance between helping the greater good, knowing there are always some people who will divert drugs."Abuse and addiction involving OxyContin have spread quickly in the last two years, flaring up in at least a dozen states. And while the illegal use of OxyContin took root in rural areas along the East Coast, it has begun moving into cities like Philadelphia. "Nobody is immune from this," said Brantley Bishop, a narcotics investigator in Alabama. "I'm seeing housewives; I'm seeing loggers, nurses, mechanics."OxyContin was originally thought to be less prone to abuse because its narcotic was locked in a time-release formula. That meant it would not produce the quick spike of euphoria that drug abusers crave. But abusers quickly discovered how to disarm the time-release formula; they simply crushed the tablet, then swallowed, inhaled or injected the powder to give themselves a high as powerful as heroin's. Getting OxyContin was often easy. A person simply had to find the right doctor, claim great pain and get a prescription. Others just stole prescription pads and wrote their own.Illegal use of OxyContin mushroomed even though no drug in this country is more tightly regulated. Unlike illegal drugs like cocaine or heroin, OxyContin is monitored by state and federal health officials in its production, marketing and distribution. Now, many of those regulators are trying to figure out how the outbreak occurred and what they might have done to prevent it.The Food and Drug Administration, for one, is reassessing how it reviews prescription narcotics for potential abuse. "We've learned something from this," said Dr. Cynthia McCormick, director of the F.D.A.'s division of anesthetics, critical care and addiction drug products. Dr. McCormick acknowledged that the F.D.A. had failed to research all the ways abusers might tamper with OxyContin, an oversight she said her agency did not want to repeat.Last Thursday, officials of five states met in Richmond, Va., to discuss ways to halt illegal traffic in OxyContin. In recent months, Purdue has also stepped up its efforts to halt the drug's abuse, including working with law enforcement officials. Selling a `Miracle' DrugOxyContin came to market amid a sea change in how doctors treated pain. For years, terminally ill patients suffered needlessly because doctors resisted prescribing frequent, potent doses of narcotics, fearing that patients might become addicted. But with new studies showing that doctors undertreated pain, OxyContin provided a breakthrough opportunity for Purdue Pharma. Until then, the company's biggest drug was MS Contin, which had limited appeal, partly because it contained morphine. OxyContin had broader appeal because it contained a synthetic version of morphine called oxycodone, which, among other things, carried less of a social stigma."If Grandma is placed on morphine it's like, `Oh, my God,' " said Dr. Howard A. Heit, a pain specialist in Fairfax, Va., and a Purdue consultant. "But if Grandma comes home placed on OxyContin — that was O.K."Although other pain medicine had long contained oxycodone, OxyContin differed in two key respects: it had a time-release formula, and it could be delivered in larger doses because it did not contain the type of nonprescription pain relievers that in larger quantities could cause liver damage.The F.D.A. approved OxyContin for those with moderate to severe pain lasting more than a few days.OxyContin is often prescribed for people in chronic pain, like those with back problems or severe arthritis, as well as patients with cancer and other painful diseases.For Robert E. Mitchell, OxyContin proved nothing short of a wonder drug. A victim of Guillain-Barré syndrome, a rare nerve disorder that can cause paralysis, Mr. Mitchell said his pain had become so severe he could not walk. But with OxyContin, he can now wear shoes and has learned to walk again."To me, it's like a miracle," he said.Seeing great potential in the drug, the company hatched an ambitious marketing plan. To reach consumers, Purdue financed an Internet site called Partners Against Pain, where OxyContin is promoted. It also contributed to groups like the American Pain Foundation, which championed the need for better pain treatment.Still, most of Purdue's marketing dollars were aimed at doctors. In recent years, Purdue brought in 2,000 to 3,000 doctors to three-day retreats in California, Arizona and Florida, estimated Dr. Heit, the Purdue consultant. At those meetings, doctors were lectured about treating chronic pain, while being recruited to serve as paid speakers at medical meetings sponsored by Purdue.Dr. Susan Bertrand, who treats chronic pain in Princeton, W. Va., became a Purdue speaker. She said that for her, recent studies showing the undertreatment of pain had been "almost a religious experience," making her realize how poorly she and others had been trained to deal with the problem.To help change that, she said, she gave about a dozen paid speeches sponsored by Purdue. The company also helped her start the Appalachian Pain Foundation, an educational group on pain management.Purdue's marketing campaign quickly began to pay big dividends, with OxyContin sales almost doubling every year, according to IMS Health, a firm that tracks drug sales. OxyContin now earns more in sales than any other narcotic. It also now accounts for 80 percent of Purdue Pharma's revenue, according to court documents filed by Purdue in connection with a patent dispute.Some doctors and pharmacists said they were put off by the company's sales tactics."All companies market," said Dr. Diane Meier, a pain specialist at the Mount Sinai School of Medicine in New York. "But these people were in your face all the time."Others criticized the way Purdue recruited doctors. "Essentially, they bought the doctors' prescriptions," said Steve Schondelmeyer, a professor of pharmaceutical economics at the University of Minnesota. "It says to consumers that every time you paid for this drug, you sent your doctor to a nice meeting somewhere."A Growing Concern:Purdue Pharma's critics agree that doctors must learn how to manage pain better. But Dr. Ted Parran, an associate professor at Case Western Reserve University School of Medicine in Cleveland, says doctors, in their rush to find a remedy, may have been blinded to another problem: addiction."Pain medicine docs are on a mission," said Dr. Parran, who teaches doctors how to use narcotics. "In the process, they tend to trivialize addiction."In this regard, pharmacists play an important backup role for doctors. They provide the last medical defense for preventing addictive drugs from getting into the wrong hands. For instance, they can choose not to fill suspect prescriptions.Some pharmacists said they, too, found Purdue's safety claims overblown.John Craig, a co-owner of Hancocks Drug Store in Scottsburg, Ind., remembers a Purdue salesman walking into his pharmacy several years ago with reassurances that OxyContin was safer than other narcotics."They were going around to doctors promoting that this was the answer to all abuse," said Mr. Craig, but he already knew that local people were using OxyContin to get high. Since then, the abuse has become worse.Another pharmacist, Samuel A. Okoronkwo, refused to fill an OxyContin prescription for someone he thought might be an abuser. He said a Purdue salesman suggested he could get into trouble for arbitrarily not filling prescriptions. "I told him I didn't have to fill a prescription that I didn't feel was medically necessary," he said.Another druggist, Joseph Yates in Grundy, Va., said simply, "The problem with this drug is the company."Purdue did not comment when asked about such anecdotes.Concern about Purdue's marketing practices has also reached the D.E.A. An agency official said its investigators had recently interviewed doctors and druggists about their dealings with Purdue.That official said the agency was worried that Purdue was not clearly communicating the drug's serious potential for abuse. "It may take years to repair the damage that this drug has done," said that D.E.A. official, who declined to be identified.Told of the D.E.A. comment, Purdue responded with a statement that said in part: "In 15 years of marketing narcotic analgesics, Purdue Pharma has never been questioned by the Drug Enforcement Administration regarding our marketing practices."In May, however, the F.D.A. did question a company advertisement for OxyContin, saying Purdue had improperly implied that OxyContin could be used to treat arthritis patients without first trying milder drugs. A company spokesman said that it disagreed with the F.D.A. but had voluntarily withdrawn the ad.Dr. VanZee, in St. Charles, Va., has seen the destruction the drug has caused in the valleys and small mining towns of the southwestern part of that state. He said he was treating OxyContin overdoses in youngsters he had vaccinated as infants.In the past two years, OxyContin has been a factor in the overdose deaths of 28 people in the area, said an official of the state medical examiner's office. It is difficult to tell the precise cause of an overdose, however, because more than one drug is often involved and OxyContin's active ingredient is in other drugs.One area clinic, the Life Center of Galax, expected to treat 20 patients in its new methadone program but must now find a way to treat 300, most of them addicted to OxyContin, a clinic official said.To stem this abuse, Dr. VanZee said, he met last fall with Purdue representatives in a bid to persuade them to cut back on their marketing and to issue a nationwide alert about the drug's hazards. The officials, Dr. VanZee said, appeared sympathetic, but said they viewed the problem as being limited to just a few areas of the country. "They are either very naïve about the extent of the problem," Dr. VanZee said, "or they don't understand what it means to have 300 people in your county addicted — the type of pain that causes in a community and in families."Addressing the Problem:Purdue officials said they were as surprised as anyone that OxyContin could be abused. Dr. Haddox of Purdue said he thought the time-release formula would make the pill "less desirable to addicts." That is not the case now. Last September, the company gathered 20 consultants to look for better ways for doctors to spot potential abusers, said Dr. Heit, the consultant. Four months later, Purdue asked its sales force to remind doctors that drugs like OxyContin "are common targets for both drug abusers and drug addicts."Purdue said it was now planning to reformulate OxyContin, making it less appealing to abusers. The company is also helping to educate students on the dangers of prescription drugs. Moves like this have recently earned the company praise from some law enforcement officials.Some health officials think OxyContin abuse might have been more quickly identified had more states closely tracked the prescribing patterns of narcotics; some 17 states do that now.Hospitals are addressing the problem in different ways. Mercy Hospital in Portland, Me., gives OxyContin patients urine screens to verify that they are not taking too much, or that they are obtaining the drug but not taking it and then selling it on the street.A Cincinnati-based hospital chain, the Health Alliance, decided last month to limit OxyContin to just a few types of patients, like those with cancer, after determining that another painkiller was just as effective, cheaper and less prone to abuse.Purdue Pharma — and some doctors — now worry that media reports on OxyContin abuse are scaring away patients who need the drug. "The publicity, of which you are a part, is causing patients to call us in tears because their physicians are taking them off therapy," said Robin Hogen, a company spokesman. "This is becoming a sad case of patients being abused by drug abusers."Complete Title: Use of Painkiller Grows Quickly, Along With Widespread AbuseSource: New York Times (NY) Author: Barry Meier & Melody PetersenPublished: March 5, 2001Copyright: 2001 The New York Times Company Address: 229 West 43rd Street, New York, NY 10036 Fax: (212) 556-3622 Contact: letters Website: Forum: Related Article:Va. Police Fear Rise Of New Drug
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Comment #7 posted by T.P. on March 05, 2001 at 17:46:31 PT:
I had a very severe accident when I was twelve years old,at thirty eight years of age I have been on many different pain medications over the years. Having had permanent nerve damage in my lower back I have been hospitalized on occasions with pain that most people could never imagine .My point is that I have been on pretty much everything from morphine down to over the counter meds, and currently use oxycodone on a daily basis with no problems, but what I cannot understand is why the most abused drug in the world is availible in just about every store in the state of Virginia. Alcohol !!! Could someone please help me make some sense of this?
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Comment #6 posted by FoM on March 05, 2001 at 13:12:18 PT
Cannabis is a Gateway Drug
When I think of the drugs that people can get strung out on it is mind boggling. Legal and illegal drugs are just as bad when you go through withdrawal. Cannabis is a way that has helped many people off of hard drugs and alcohol. It's a plant and can be very inexpensive and there's no way to patent a plant. That's why I think they fight so hard. Lots of money tied up. 
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Comment #5 posted by jAHn on March 05, 2001 at 12:42:55 PT
Hey, doesn't it seem... the effects that this drug (OxyContin) targets- are some of the effects that many "underground" Dr.'s cite for Medical Use of Marijuana? It's almost like they deliberately crafted this drug to combat the effectiveness of Cannabis, just so they can have NO reason what-so-ever to fall upon the use of Cannabis. I wouldn't put the option so far past Lieberman and Dodd's tricky little Politricks, you know. Has anyone heard the news about Ralph Nader suing Schering Plough(?) of N.J.? Something about Claritin's patent running out in a year and a replacement drug, "Clarinex" is "supposed" to work on the flaws that Claritin had!?! or something. They (the local news network) didn't go into Gorey details upon the Nader v Sch.-Pl.(Ashcroft) occurrence. I am eager to learn more for those that are in the know. 
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Comment #4 posted by Ethan Russo, MD on March 05, 2001 at 12:07:49 PT:
A Bloody Mess, I Say
This story illustrates something I have said repeatedly. Drugs are not necessarily bad; it depends on how they are used. In contrast, there are a lot of bad drug companies. OxyContin can be very valuable when properly employed. However, they should not have released a form that allows this abuse. Let us contrast with Concerta, the new 12 hour form of methylphenidate (Ritalin). It is in the form of a paste insided a rigid capsule. It cannot be snorted or injected. A better choice for chronic patients who are not 100% immune to abuse or diversion is methadone; Cheap, safe, lasts 12 hours per dose, and is associated with no rush.Clinical cannabis does not compare with these drugs in terms of side effects. However, it may cause habitual users to laugh derisively at politicians and overzealous law enforcement that seek to eliminate their civil rights. Authoritarian types do not like this effect of cannabis and turn in to pompous, overbearing, authoritarian automatons.I have been known to go on one of these drug company junkets every few years. I go only if it is a drug about which I would be speaking anyway. If it is a talk on Imitrex(sumatriptan, for migraine), I always present information on cannabis in migraine treatment. If I went to an OxyContin junket (and was never asked), I would also discuss the adjuntive use of cannabis in treating chronic pain. Nobody has gagged me yet.
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Comment #3 posted by Kevin Hebert on March 05, 2001 at 11:57:44 PT:
It's amazing to me that a highly addictive drug, with high potential lethality, is legal, and yet cannabis, with no lethal dose and virtually zero addictiveness, is illegal. It just boggles the mind. Who makes these decisions? And why?
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Comment #2 posted by Dan B on March 05, 2001 at 11:20:36 PT:
Paid Political Advertisements?
Purdue Pharm / Purdue Frederick gave $5000 to U.S. Sen. Christopher Dodd's most recent senatorial campaign and $10,000 to U.S. Senator Joseph Lieberman's most recent senatorial campaign. Note that these were the only two senators I have checked, as both are from Connecticut, and I have not checked out any of the other politicians from that state, nor have I checked out any of the presidential campaign contributors. It seems to me, though, that Purdue Pharm pulls at least a little weight with some very influential politicians. Could this have something to do with the recent media coverage of their most popular addictive drug? I'll leave that for you to decide.Dan B
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Comment #1 posted by observer on March 05, 2001 at 10:32:51 PT
see:'Net Yields Drugs on Demand!(OxyContin compared to cannabis) looks like really nasty stuff ... the withdrawls must be rough. 
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