OxyContin Abuse May Curb Progress in Pain Field

Riddled with pain from rheumatoid arthritis and a degenerative bone disease for years, Diana Rose rarely left the house. Then in November, a doctor prescribed the painkiller OxyContin, dramatically changing her quality of life.

“I can actually go shopping at the mall, play with my grandchildren and even swim in our pool,” said Rose, a 57-year-old Kentucky woman. “This drug has enabled me to do things without being in pain.”

OxyContin, a powerful drug that is a chemical cousin to opiates such as morphine and heroin, has enabled thousands of people, such as Rose, to resume the normal activities of life. But now some doctors fear that a backlash triggered by rampant street use of the drug dubbed “hillbilly heroin” will derail significant advances in the field of pain management. They worry that U.S. drug officials may respond to rising illicit use of OxyContin by yanking it from the market, place stricter limits on the use of all opiates, commonly used to treat cancer patients, severe back pain and other chronic pain conditions.

“This is not just about OxyContin,” said John D. Giglio, executive director of the American Pain Foundation, a nonprofit consumer group in Baltimore. “This is about the potential for rolling back progress made in pain management. It’s been an extremely hard uphill climb to get physicians to become more comfortable prescribing opiates and overcoming the stigma among patients about potential addiction and abuse.”

OxyContin is a synthetic opiate that has fewer side effects than other potent pain medications, including morphine or codeine, which can cause nausea, constipation or drowsiness. What’s more, OxyContin is formulated to keep steady levels of the drug circulating in the blood for as long as 12 hours. Patients don’t experience the intense peaks and valleys of taking other narcotics, like Vicodin or Lortab, which can take an hour to provide pain relief and whose effects wear off in four hours.

Soon after OxyContin was approved in 1995, recreational drug users discovered that chewing the pill, rather than letting it dissolve in the gastrointestinal tract, crushing it into a power that can be snorted or intravenously injected, produced an intense high. Within a few years, Appalachian communities in Virginia, West Virginia and Kentucky, and rural Maine reported a wave of users who had become addicted to the drug.

Since then, illicit use of the drug has spread throughout the country. It is estimated that more than 200,000 Americans have abused the drug, which also has been implicated in more than 100 deaths from suspected overdoses. Several doctors have been convicted of illegally dispensing the drug, while “Oxy” addicts increasingly turn to crime to feed their habits.

The growing alarm about illicit use is having a chilling effect on legitimate use of the drug. Six states--Florida, Maine, Ohio, South Carolina, Vermont and West Virginia--have set strict limits on the number of pills that can be prescribed for people on Medicaid, the state-federal health program for the poor. That means that doctors may not be able to increase dosages for patients who need stronger pain relief.

In the wake of several robberies at drugstores across the country, many pharmacies now refuse to stock it, and physicians are reluctant to prescribe it.

“Since all this hysteria began, some patients have been abandoned by their doctors,” said Dr. J.S. Hochman, executive director of the National Foundation for Treatment of Pain in Houston. “I had two patients, a mother and daughter with severe rheumatoid arthritis who had to fly from Boston to Houston to find a doctor--and were willing to do so because they were so desperate. It’s pathetic.”

Some patients are so concerned about the negative publicity, especially fears of addiction, that they’ve asked their doctors to take them off the drug.

“The day after an OxyContin story aired on one of the TV newsmagazines, I had two cancer patients come in the next day, telling me they wanted off the drug,” said Dr. Neal Slatkin, director of supportive and palliative medicine at City of Hope National Medical Center in Duarte.

“Their pain was well-controlled, and they weren’t having side effects,” he said. “So I spent a lot of time reassuring them that this drug was OK. But the whole incident was very distressing.”

Patients who continue taking the drug often face serious obstacles in getting their prescriptions. In Pulaski, Va., for example, a small town in Appalachia, police began fingerprinting patients who had OxyContin prescriptions. Under threat of a lawsuit by the American Civil Liberties Union, authorities later backed down.

“I’ve been refused treatment in the ER because they think I’m a drug seeker,” said Jeannette Murray. The 31-year-old nurse, who lives in an area of southwestern Virginia that is a hotbed of OxyContin addiction, takes the drug to relieve chronic pain from an injury to her right arm.

“It’s been difficult finding a pharmacy to get my prescription filled,” Murray said. “I’ve been cautioned not to carry my prescription on my person, which just adds more stress to an already stressful situation.”

In response to reports of OxyContin abuse, Purdue Pharma, a Stamford, Conn., pharmaceutical firm, in May stopped marketing the 160-mg version of the drug, then the strongest dosage available.

The company also recently announced plans to introduce a “smart” version of the pills, which lose their potency if they’re crushed or snorted; however, the new formulation won’t be available for a few years.

And beginning in July, the FDA required that OxyContin boxes carry the agency’s strongest warning: a black box label that calls attention to the drug’s potential for abuse and diversion.

“But all this hoopla just exacerbates patients’ underlying anxiety about taking opiates, which we know are really quite effective,” said Dr. Richard Payne, chief of pain and palliative care service at Memorial Sloan-Kettering Cancer Center in New York.

“There is still a pervasive undertreatment of pain,” he said, “and thousands of people are suffering needlessly.”