Overdose on Prescription Opioid Pain Killers
According to a January 2016 CDC report,1 over 47,000 Americans fatally overdosed on prescription opioid pain killers in 2014. This is a stunning fact. But almost as stunning is the apparent lack of concern expressed by the world's media when reporting it. TheNational Council on Alcoholism and Drug Dependence, for example, thought it worth a mere 214 words.2 NBC News was obviously more excited and pushed their coverage to a hefty 223 words.3 And even those who pushed their word totals up slightly higher ignored the real stories hidden behind the headlines.
With that in mind, let's take a look at the CDC report in detail--which virtually no news service did--and then explore the backstory that was pretty much ignored outside of a couple of surprising journalistic players. And finally, I want to take a look a stunning twist to the story that absolutely no one looked at but that to my mind is really the most important takeaway from the whole debacle.
The CDC Report on Increases in Drug and Opioid Overdose DeathsFirst of all, let's make note of the fact that the CDC report is not 200 words long, but 3200 words long. In movie-speak, that means that when the media reported on the story, they left most of it on the cutting room floor. So, what got dumped? As it turns out: the details. And as they say, the Devil is in the details. In broad terms, according to the report, the rate for drug overdose deaths has increased approximately 140% since 2000, driven largely by opioid overdose deaths.
This epidemic isn't being driven by illicit drugs, but by a surge in the use of prescription opioid painkillers.
According to government statistics, nearly 1.9 million Americans now abuse or are dependent onlegal opioids. On the slightly positive side, after increasing steadily every year since the 1990s, deaths involving the most commonly prescribed opioid pain relievers declined slightly in 2012 and remained steady in 2013, showing some signs of progress. Unfortunately, that pause was brief as drug overdose deaths jumped significantly in the last year of the study--from 2013 to 2014. In fact, in 2014, 19,000 people fatally overdosed on prescription painkillers, which represents a 16 percent increase over 2013. Increases in opioid overdose deaths were the main factor in the increase in drug overdose deaths. The death rate from the most commonly prescribed opioid pain relievers (natural and semisynthetic opioids) increased 9%. Concomitantly, the death rate from heroin increased 26%, and the death rate from synthetic opioids, a category that includes illicitly manufactured fentanyl and synthetic opioid pain relievers other than methadone, increased 80%. Nearly every aspect of the opioid overdose death epidemic worsened in 2014. And then there's heroin. In fact, heroin overdose deaths have been sharply increasing since 2010. Surprisingly, as we will discuss later, heroin overdose deaths may not mean quite what you think they mean.
Now, as bad as those broad statistics are, the details behind this epidemic of drug overdose deaths are even worse. Since 2000, the rate of deaths from drug overdoses has increased 137%, including a 200% increase in the rate of overdose deaths involving both opioid pain relievers and heroin. During 2014, a total of 47,055 drug overdose deaths occurred in the United States. From 2013 to 2014, the largest increase in the rate of drug overdose deaths involved synthetic opioids, other than methadone (i.e., fentanyl and tramadol), which nearly doubled from 1.0 per 100,000 to 1.8 per 100,000. Meanwhile, as already stated, heroin overdose death rates increased by 26% from 2013 to 2014 and have more than tripled since 2010, from 1.0 per 100,000 in 2010 to 3.4 per 100,000 in 2014.
As the CDC report explained, from 2000 to 2014, nearly half a million persons in the United States died from drug overdoses. But it gets worse. The killer statistic is that more people died from drug overdoses in the United States in 2014 than during any previous year on record. In 2014, there were approximately one and a half times more drug overdose deaths in the United States than deaths from motor vehicle crashes or gun violence.4 Let that sink in for a moment. Again, we're talking about prescription pain relievers and heroin as the main drugs associated with these overdose deaths, and, surprise, those heroin deaths are likely connected to prescription pain relievers, not to junkies on the street. In summary, the 2014 data demonstrates that the United States' opioid overdose epidemic includes two distinct but interrelated trends: a 15-year increase in overdose deaths involving prescription opioid pain relievers and a recent surge in illicit opioid overdose deaths, driven largely by heroin.
But what does that mean?
Drug overdose deaths involving heroin have continued to climb sharply, with heroin overdoses more than tripling in 4 years. This increase mirrors large increases in heroin use across the country and has been shown to be closely tied to opioid pain reliever misuse and dependence. Past misuse of prescription opioids is the strongest risk factor for heroin initiation and use, specifically among persons who report past-year dependence or abuse.5 As it turns out, the increased availability of heroin, combined with its relatively low price and high purity (compared with diverted prescription opioids) appear to be major drivers of the upward trend in heroin use and overdose.6 Finally, illicit fentanyl is often combined with heroin or sold as heroin. Illicit fentanyl might be contributing to recent increases in drug overdose deaths involving heroin. Therefore, increases in illicit fentanyl-associated deaths might represent an emerging and troubling feature of the rise in illicit opioid overdoses that has been driven by heroin.
Bottom line: we're not talking about your typical junkies now, but average people (your friends, neighbors, and co-workers) migrating from prescription pain killers prescribed by their doctors to addiction and then to heroin--and dying as a result.
The Backstory Available to Anyone Who LookedIn the old days, when reporters actually worked stories and practiced journalism, they would have run with the CDC report (heck, they would have actually looked at the CDC report itself rather than merely copying the AP summary of that report) and dug into the story behind it--perhaps even turning it into a series of reports exposing the underbelly of what has grown to become one of the leading causes of death in the United States. But that's when reporters were paid to actually ask questions.
Today, not so much.
In fact, very few media outlets made any attempt to go the extra mile. Two that did were Business Insider7 and The Week magazine, whose staff, in their February 19th issue, pushed beyond the preliminaries to report that it was medical doctors who had fueled this crisis of addiction and deadly overdoses by freely doling out prescription painkillers over the years.8
As stated in their article, "Addiction experts say doctors have fueled this crisis by recommending that patients with even minor ailments and aches take highly addictive opioids like Vicodin, Percocet, and OxyContin. Physicians wrote 259 million opioid prescriptions in 2012, triple the number two decades ago and enough to provide every adult in the country with a bottle of these pills." They then went into the history behind prescription painkillers. I've expanded upon it.
For centuries--before pharmaceutical drugs--people relied on natural pain killers like opium. In fact, laudanum, which is a tincture made from opium, was used as a painkiller as far back as the 1500s until it fell out of favor because of its addictive nature. It was replaced by morphine, an opium isolate that Merck began marketing in 1827. Unfortunately, morphine is even more addictive than laudanum, which caused it too to fall out of favor. Amazingly, morphine was replaced by heroin, which was marketed by Bayer as a non-addictive opioid alternative--despite the fact that it is synthesized from morphine and is two to four times stronger than morphine. Nevertheless, doctors believed the marketing hype and prescribed heroin extensively from the late 1800s to the early 1900s. Obviously, it soon became abundantly clear that heroin was anything but non-addictive. This provided yet another opening for the pharmaceutical companies, which they grabbed onto with a vengeance.
In 1917, three years before heroin was banned in the US, oxycodone was developed by two German scientists. Oxycodone is a semisynthetic opioid synthesized from an alkaloid found in the Persian poppy. In 1939, it was introduced to the US, but it was not until 1950 when it was combined with aspirin and sold as Percodan that it really took off as American physicians began to prescribe it by the truckload. By 1963, the state of California had determined that one-third of all drug addiction in the state was the result of Percodan abuse. Nevertheless, it still took another seven years before the DEA classified it as a Schedule II drug with a high potential for abuse.
Moving on, Percocet and its close cousin Vicodin became the next prescription opioids of choice. Theoretically, they were only to be used for managing pain during terminal illnesses such as cancer, or for acute short-term pain, like recovery from surgery--to ensure patients wouldn't get addicted. But, as The Week explained, in the 1990s, doctors came under increasing pressure to use opioids--particularly Purdue Pharma's new drug OxyContin--to treat the millions of Americans suffering from chronic nonmalignant conditions, like back pain and osteoarthritis. Sensing a marketing opportunity, the National Pharmaceutical Council released a report that actually reframed pain as the "fifth vital sign" that doctors needed to monitor…and treat. In response, numerous "pill mills" began to pop up all over the country. Pill mills are shady doctor's offices, clinics, or health care facilities that routinely conspire in the over-prescribing and dispensing of controlled substances outside the scope of the prevailing standards. In other words, they don't ask too many questions. The bottom line is that the increased availability and acceptability of opioid drugs led to an explosion in prescriptions. Dr. Russell Portenoy, an influential New York--based pain specialist, helped lead the campaign. He claimed prescription opioids were a "gift from nature," and assured his fellow doctors--based on his own 1986 study of just 38 patients--that fewer than 1 percent of long-term users became addicted.9
Purdue Pharma made similar claims for its own drug, OxyContin, and promoted it like diet cola. As The Week reported:
"In fact, when OxyContin went on sale in 1996, Purdue launched a "promotional campaign unlike [anything] we have ever really seen," says opioid abuse expert Dr. Andrew Kolodny. The company gave doctors 34,000 coupons for free OxyContin prescriptions, bombarded them with branded stuffed toys and coffee mugs, and aggressively promoted the idea that the new drug, which is stronger than morphine, was both safe and highly effective. "Drug reps were going to family-care doctors and insisting that OxyContin had no real risks -- only benefits," says Kolodny. Purdue pleaded guilty in 2007 to criminal charges that it misled regulators, doctors, and patients about OxyContin's addictive qualities. But by that point, hundreds of thousands of Americans were hooked."
By 2011, according to an IMS Health National Prescription Audit, 219 million opioid prescriptions were being handed out each year.10 At that point, the prescription painkiller crisis could no longer be ignored, and federal, state, and local law enforcement began to crack down on both drug abusers and doctors who over-prescribe and pressed for the establishment of prescription drug monitoring programs that make it more difficult for drug abusers to get prescriptions from more than one doctor. The number of states with prescription drug monitoring programs has more than doubled, from 20 states in 2006 to 48 states now. Unfortunately, no good deed goes unpunished.....
Source : LaLeva.org
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FDA Tightens Opioid Labeling
The FDA has ordered a class-wide label change for long-acting opioids such as OxyContin (oxycodone) aimed at limiting use of these drugs to patients with severe, refractory pain.The move, announced at press briefing Tuesday, is part of a handful of changes that the agency hopes will curb an ongoing prescription painkiller epidemic, including a label clarification about the risks of abuse and death with the drugs, a requirement for additional postmarketing studies, and a boxed warning about the risks of neonatal opioid withdrawal syndrome.
"Opioids are important pain relieving medications that provide significant benefits when used appropriately," Douglas Throckmorton, MD, deputy director of the FDA's Center for Drug Evaluation and Research (CDER), said during a press briefing. "But they have significant risks associated with inappropriate patient selection and improper use, whether accidental or intentional."
The announcement is the culmination of a series of agency meetings and research on opioid safety that were prompted in large part by a Citizen's Petition from the groups Physicians for Responsible Opioid Prescribing (PROP) and Public Citizen.
The petition was signed by nearly 40 doctors, researchers, and public health officials, and aimed to make it more difficult for drug companies to market opioids for chronic, noncancer pain. Among other criteria, it asked FDA to strike the word "moderate" from opioid labels in chronic pain.
Throckmorton said changing the indication to "pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate" will further discussions between clinicians and patients about their eligibility for the drugs.
"The change reflects a departure from an indication that was based on a severity scale and transitions to a more specific use," Throckmorton said. "Patients in pain will not only be assessed by a rating on a pain scale, but a more thoughtful determination of pain."
Greg Anderson, MD, a primary care physician at the Mayo Clinic in Rochester, Minnesota welcomed the FDA action.
"In the absence of malignancy related pain, examples where long acting opioids can be justified are relatively few and far between," Anderson, wrote in an email.
James A. McGowan, MD, of the center for interventional pain medicine at Mercy Medical Center in Baltimore, said chronic pain treatment is challenging but he warned that "too often these medications are prescribed without adequate thought being given to their serious side effects, their marginal effectiveness in treating long term pain, and the fact that these medications often end up doing more harm than good."
In an email, McGowan acknowledged that "small subsets of patients may benefit from chronic opiate use" but he added that the new labels would serve as a necessary reminder "to both patients and physicians that the use of these medications must be done very cautiously and only after carefully weighing the potential risks and benefits."
Randy Wexler, MD, MPH, of Ohio State University, said the changes were "appropriate" adding that he only "rarely" prescribes long-acting opioids for chronic pain.
"This will have no impact on my practice other than as support for my discussion with patients as to why such medications are often not indicated," Wexler said in an email to MedPage Today.
Kevin Hill, MD, MPH, psychiatrist-in-charge at McLean Hospital's alcohol and drug abuse program in Belmont, Massachusetts, wrote that he has experience treating opioid addiction. "I've seen patients that have been prescribed long-acting opioids inappropriately on an "as-needed" basis, and inappropriate prescribing can have the unintended effect of starting someone on a path to addiction," Hill wrote in an email to MedPage Today. "Opioid addiction is very difficult to treat, so I appreciate the FDA's effort to limit the risk associated with these medications."
The updated label will further clarify that the drugs should be used as a last resort in patients who have no other options, due to their risk of addiction, abuse, and misuse even at recommended doses, as well as greater risk of overdose and death.
The FDA is also requiring postmarketing studies to further assess those risks. Throckmorton said the agency expects companies to collaborate on the requisite trials in order to get more information as efficiently as possible.
He added that it became apparent through earlier meetingson the issue that there were not enough data available on the risks of long-term opioid use, as earlier trials had only been completed through 12 weeks.
Additionally, the agency will now require long-acting opioids to carry a boxed warning describing the risk of neonatal opioid withdrawal syndrome with chronic use during pregnancy.
"By exercising our legal and regulatory authority to take action, the FDA will ensure that the benefits of long-acting opioids will continue to outweigh the risks," FDA Commissioner Margaret Hamburg, MD, said during the briefing.
Michael Von Korff, ScD, of Group Health Research Institute in Seattle, who is also a member of PROP, said the move is a step in the right direction, but said that overall the agency's actions on the opioid epidemic leave something to be desired.
"It is not clear to me why the FDA's actions apply only to long-acting opioids when similar cautions apply to short-acting opioids, like Vicodin," Von Korff said in an email.
Von Korff added that the label now appropriately places "increased emphasis on the risks of chronic opioid therapy. But the current FDA label does not adequately reflect that data are lacking to establish the effectiveness -- and long-term safety -- of long-term or high-dose opioid therapy for chronic pain."
"Prescribing opioids for longer than 90 days for chronic pain should remain an option for physicians and patients, but it should be an off-label use, because there is almost no research establishing that this use is either safe or effective," Von Korff said.
Source : MedPageToday
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Anatomy of an Epidemic: The Opioid Movie
Driving home from a hunting trip in 2008, Johnny Sullivan called his wife to say he was having trouble staying awake.
It was early afternoon, but Mary Lou Sullivan wasn't surprised. Her husband was a long-time user of the narcotic painkiller OxyContin (oxycodone) and frequently dozed off as a side effect,sometimes in the middle of chewing his food.
About 10 years earlier, Sullivan and six other chronic pain sufferers had been featured in a Purdue Pharma promotional video for the drug, which Purdue makes. In the video, Sullivan stood at a construction site and talked about how the powerful narcotic eased his back pain and enabled him to run his company again.
But a few years after being prescribed OxyContin, Sullivan became addicted to it and other prescription opioids, his family said. That afternoon in 2008, Sullivan, 52, fell asleep while driving and flipped his truck on a country road in North Carolina.
"I told my sons one day 'that medicine is going to kill him,'" his widow said.
Expanding the market
Purdue Pharma's marketing of OxyContin in the late 1990s marked the beginning of the industry's push to promote narcotic painkillers for treatment of chronic pain -- an indication for which both safety and efficacy remain unproven.
The first decade of the 21st century has been a good one for makers of prescription painkillers as sales quadrupled from 1999 through 2010, but even in a growth industry OxyContin stands out -- ringing up sales of nearly $3 billion a year.
Meanwhile, health officials and regulators have declared a national epidemic as addictions to prescription painkillers have skyrocketed and fatal overdoses have more than tripled in the past decade.
A U.S. Senate investigation -- prompted in part by Journal Sentinel/MedPage Today reports -- is probing financial relationships of drug companies and the doctors and organizations that have advocated for use of the drugs.
Against that background, the Purdue promotional video emerges as a case study of marketing running ahead of science in the pursuit of the bottom line.
The video, made 14 years ago, showcased ordinary people who spoke glowingly of their experiences with OxyContin.
· Two of the seven patients died as active opioid abusers.
· A third became addicted, suffered greatly, and quit after realizing she was headed for an overdose.
· Three patients still say the drug helped them cope with their pain and improved their quality of life.
· A seventh patient declined to answer questions.
The doctor who not only played a starring role but also recruited his patients for the video now concedes some of his statements caught by the camera went too far.
In the video, the doctor, Alan Spanos, MD, a paid specialist in North Carolina, urged doctors to consider prescribing opioids more often.
Spanos, who was once a paid promotional speaker for Purdue, now says the video was meant to be one teaching aid used in lectures by experienced doctors.
But it was unclear then, and remains unclear now, what percentage of patients benefit from the drugs.
"We don't know whether success stories like this are one in five, one in 15, one in 100, one in a thousand", Spanos said in an interview. "They may be quite rare."
Nonetheless, the video was distributed to 15,000 doctors as part of a marketing campaign in which Purdue claimed, among other things, that the drug was less addictive and less subject to abuse than other drugs.
That wasn't true, and in 2007 The Purdue Frederick Co., an affiliate of Purdue Pharma, agreed to pay $634.5 million in penalties for misbranding the drug as part of a U.S. Justice Department investigation.
The sanctions didn't stop the pharmaceutical industry from promoting OxyContin and other narcotics for people with chronic, long-term pain -- a much larger group of potential customers than just those being treated with opioids for intense short-term pain caused by cancer and end of life pain or acute pain caused by severe injuries or surgery.
Building the market
At the time the video was produced, clinicians were often reluctant to prescribe narcotic drugs for chronic pain, fearing the risk of addiction and having little evidence of the drugs' long-term safety and effectiveness.
That changed as Purdue Pharma and other drug makers rolled out broad campaigns aimed at convincing prescribers of the efficacy and safety of their products. At the same time, professional organizations and associations that write treatment guidelines began endorsing opioids for chronic pain. Many of the people writing those guidelines had financial ties to the drug companies.
Over time, doctors began writing more and more prescriptions for opioids -- including Oxycontin, Vicodin (hydrocodone bitartrate and acetaminophen) and Percocet (acetaminophen and oxycodone) -- for more and more chronic conditions, such as back pain, fibromyalgia and arthritis.
Part of OxyContin's unique appeal was that it was a time-released version of the generic painkiller, oxycodone. Patients only had to take two pills a day, which allowed them to sleep through the night without having to get up to take more medicine.
In the 1998 video, Spanos says opioids "don't wear out," meaning patients won't need stronger doses over time.
However experts say it's common for opioid medications to lose their painkilling effect as patients develop tolerance, leading doctors to increase doses.
"Humans develop tolerance to opioids and -- pharmacologically and physiologically -- this is a well-known fact that was also well-known in the 1990s," said Beth Darnall, PhD, president of the Pain Society of Oregon and an associate professor at Oregon Health & Science University.
It worked well at first
Consider Lauren Cambra, one of the seven patients in the video. She was in her mid-40s and suffering from severe low-back pain until she went to see Spanos, who prescribed OxyContin.
"I was pain free," she said in an interview with the Journal Sentinel/MedPage Today. "I was able to get up. I could walk up a flight of stairs. I was very happy with the therapy."
Then her dose had to be doubled. Eventually it was doubled again.
She lost her job in the Dot-Com collapse and could no longer afford the $600 a month she needed for OxyContin. When she tried to do without, she spent days on the couch curled up with withdrawal symptoms.
"The next month, I knew I was going to figure out how to get the money," she said.
Instead of paying her bills or her mortgage, Cambra bought OxyContin. She lost her car and her home. She filed for bankruptcy.
Eventually, over a period of months, she weaned herself off the drug.
"I thought that if I didn't stop doing this, if I didn't get off this medicine, I'd probably end up dead," she said.
Today she is managing her back pain the way she did before she went on OxyContin. If she has a flare up, she gets a prescription for a few days of a different opioid, such as hydrocodone (Vicodin). Then she stays off the drugs completely for weeks or months.
"You could not get me to take another OxyContin," she said.
Estimating the tolerance risk
Looking back on his claim that opioids didn't wear out, Spanos said he wanted to address a 1990s stereotype that all patients would develop tolerance and need higher doses.
"I would hope that what was conveyed in the video is that there are patients in whom tolerance doesn't happen," Spanos said.
In an email, Purdue spokesman James Heins said that OxyContin labels have always included warnings about side effects and tolerance, and they're updated when new medical evidence emerges.
He noted the video was made 14 years ago and has not been shown in a decade. He also said he could not comment on what happened to the patients in the video without obtaining their permission.
Heins said statements made in the video reflected the medical consensus regarding opioids at the time.
In fact, Spanos claimed in the video that the rate of addiction among pain patients was much less than 1%.
Spanos acknowledged in a July interview that the 1% addiction figure did not come from long-term studies of chronic pain patients and that he went too far by suggesting it did. He said he regretted it if doctors got the wrong message. It has since has become clear that the percentage of patients who are addicts or will become addicted is "all over the place," Spanos said.
"Those of us who were impressed by the clear benefits for patients did not have a big enough eye on the possible unintended consequences of our enthusiasm rubbing off onto some of our colleagues,," Spanos said of opioid painkillers. "They should be reserved for people for whom the benefits justify the risks and baggage that come with the drug and the most tricky problem is that we do not know the size of the risks."
Today, the National Institute on Drug Abuse says studies among chronic pain patients have found addiction rates from 3% to 40%.
Purdue Pharma spokesman Heins said the rate of addictive disorders among chronic pain patients has not been established by prospective studies. He said the current literature suggests it ranges from less than 1% to 24%.
At least part of the discrepancy in addiction estimates has occurred because many studies exclude patients with prior substance abuse problems. However, real-world pain treatment does not.
When OxyContin was approved in 1996 there was less concern about addiction because opioids were being used mainly to treat cancer and short-term pain, said Mark Sullivan, MD, professor of psychiatry and behavioral sciences at the University of Washington in Seattle.
"They just didn't have the relevant addiction data," Sullivan said.
Addiction and pain
At least three of the seven patients in the video, including Johnny Sullivan, struggled with addiction.
Ira Pitchal, who had fibromyalgia, said in the video that OxyContin allowed him to exercise and do physical therapy, which reduced his cholesterol and returned his blood pressure to a healthy level.
A few years later, Pitchal was found dead in his Florida apartment at age 62.
The cause of death was listed as high blood pressure and cardiovascular disease, though lab tests showed the presence of two opioids in his system, nalbuphine and oxycodone.
Numerous medications were found in his kitchen cabinet and he had pills in his pocket, according to a sheriff's department report.
Pitchal had a history of alcohol and narcotic painkiller abuse, the report said. He had been released from a detox center a month before his death.
A cousin, Marilyn Frey, said Pitchal had suffered from mental health problems for years and may have doctor-shopped for pills.
"He was on gobs of medicines, probably a whole bunch at the same time that he should not have been on," she said. "So many folks who use lots of drugs perhaps would be better off with ibuprofen and some really good (psychological) therapy. I think he was one of them."
Limited research suggests that about 30% of pain clinic patients may benefit from using opioids for long-term pain, according to Ed Covington, MD, director of the Neurological Center for Pain at the Cleveland Clinic. For those best-case patients, the average pain level is reduced by an estimated 30%, he said.
Rigorous clinical trials still have not been done to measure the long-term safety and effectiveness of opioids for various kinds of chronic pain. Without such research, it is difficult to know who is likely to benefit and who is likely to be harmed.
"My biggest complaint is that they (opioids) were pushed by all the zealots in a misleading way," Covington said. "So we were given a false choice - agony without opioids, comfort with."
But when it works...
Three patients in the video say they have greatly benefited from taking OxyContin to manage their long-term pain. Two of the women had severe, debilitating conditions while the third has taken the powerful painkiller for nearly 15 years to deal with back pain.
Mary Dell, who asked that her last name not be used, said in the video that she felt normal for the first time in a decade after taking OxyContin. She had undergone spinal surgery and suffered from back pain for years.
Mary Dell, now 73 and a biotechnology researcher in North Carolina, said not much has changed for her since the video was filmed. She still takes OxyContin every day.
"I would not be able to do the work I love here if I did not take the medicine," she said. "I would be lying on the bed with a heating pad."
OxyContin also made life livable for Dorothy, a patient who asked that she be identified only by her first name.
Dorothy appeared in the video wearing a neck brace. She had been in a car accident five years earlier and had spent the time since trying to control her neck and back pain. At times, she was in so much pain she felt like a "badly injured animal" with no appetite. She remembered staring at a salad one day, unable to move to put the food in her mouth. Riding in a car was unbearable, she said.
Dorothy said Spanos monitored her medication closely and made it clear she shouldn't get narcotics from other doctors in addition to him. The drugs helped her recover from her injury. She was able to move around more and strengthen her muscles. She could keep appointments with friends and not just live hour-to-hour in her house, she said.
"As the pain got better, I got out more," she said. "Life became more predictable."
The drugs were strong, Dorothy said, and the thought of withdrawal frightened her. Her mouth was often very dry, a common side effect of opioids.
But she never felt out of control and the side effects were worth it, she said.
Dorothy said she stopped taking OxyContin in 2004 or 2005 because she got to a point where she was able to function without it.
OxyContin was "a lifesaver" for Susan, another patient in the video who asked that her last name not be used because she is still taking the medication.
Diagnosed with rheumatoid arthritis at age 25, Susan had undergone more than a dozen surgeries, including several on her hip as well as knee replacements, wrist surgery, ankle surgery, fusing of her neck and a hysterectomy.
Susan had tried for years to manage her pain. Some doctors thought she was an addict seeking pain pills, she said. The pain was so bad that she discussed suicide with her husband. Before finding Spanos and OxyContin, she was required to pick up one day's worth of medicine at a pharmacy each morning.
In the video, Susan said finding the right medicine made her life "wonderful again."
"I have found life again and it is worth living now. And I'm so grateful," she said.
Fourteen years later, Susan is still taking OxyContin. She had been taking a massive dose when the video was filmed. Now her dose is about one-tenth of that and she still deals with major pain. She can barely turn her head because her neck is fused, and her wrists are permanently crooked. Her husband Kevin has to help her stand up and she walks slowly, often grimacing in pain.
"If Susan didn't have the painkillers, she couldn't function at all," Kevin said.
For a few years after the video, Susan worked as a paid speaker for Purdue, giving talks at medical schools and to doctors.
The three patients in the video who say OxyContin has helped them are worried that additional restrictions on prescribing narcotics might prevent people like them from getting the pain relief they need.
In July, a group of nearly 40 doctors, researchers and public health officials petitioned the FDA to change the labeling on opioids in ways that would make it more difficult for drug companies to market the medications for chronic, non-cancer pain lasting longer than 90 days.
The recommended changes, if approved, might prompt Medicaid, Medicare and many private insurers to impose restrictions on paying for opioids -- hurdles that would hurt patients who benefit from the potent painkillers, according to doctors who advocate use of the drugs for long-term care.
A better approach would be to improve doctor education, especially in the area of monitoring patients for early signs of addiction, said Lynn Webster, MD, president-elect of the American Academy of Pain Medicine, in a statement.
What about side-effects?
In the video, Spanos downplayed the risk of sedation and doctors' concerns that patients on narcotics seem "sleepy and vague" and "look stoned all the time."
"Nothing could be further from the truth," he said, noting that sedation usually settles to "little or nothing within two weeks."
Numerous papers in medical journals -- published both before and after the video -- warn of the sedative effect of opioids like OxyContin.
Doctors say drowsiness can lessen in two weeks in some patients, but remain an ongoing problem for others, especially when on high doses.
Such sedation can lead to respiratory depression and even fatal overdoses.
"Enough opioids can make you sleepy to the point of dead," said Deborah Grady, MD, a professor of medicine at the University of California, San Francisco and a physician at the San Francisco VA Medical Center.
Spanos said in an interview he agrees high doses can cause sedation but those who are sedated long-term are being "over-treated."
Spanos said it remains unknown how many patients will have a "stellar response" from taking opioids.
"Back then, we all just assumed that someone, somewhere was doing rigorous studies ... and so we'd know the numbers pretty soon," he said.
"And we still don't."
The last ride
Opioids didn't just make Johnny Sullivan sleepy. They overpowered him, said his widow Mary Lou.
"He would fall asleep while we were eating," she said. "I'd hear him gasping for breath."
Early on, the drug seemed to help Sullivan, his wife said.
But then his doses had to be increased.
Sullivan had been prescribed both OxyContin and morphine. He alternated between the drugs and made sure they were never out of reach.
He kept a pouch filled with pills hidden under the seat of his pickup truck. Mary Lou said she did not know which drug he was taking at the time of the accident and a blood test was never done.
At least twice he was taken to the hospital because of an accidental overdose, Mary Lou said.
One trip to the hospital began with a strange incident at a restaurant.
"He had a hamburger, but instead of biting the hamburger he would actually be biting his hand," she said.
Mary Lou took him the emergency room and he was put in intensive care for 24 hours, but he never remembered the incident.
As time went on, the drug had more profound affects, Mary Lou said.
She had to put on his socks and shoes, shave him and wash his hair.
Sullivan's family said they were hesitant to confront him about his addiction because they knew he was in pain.
He didn't acknowledge having problems either, and still painted a positive picture in a second video that Purdue distributed in 1999.
"Never a drowsy moment around here," Johnny Sullivan said, his voice slurred and his eyes heavy.
This story was reported as a joint project of the Journal Sentinel and MedPage Today.
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OxyContin Remake Sends Abusers to Other Opioids
Reformulating OxyContin to make it less abusable has led drug users to switch to other opioids, particularly heroin, a survey showed.
OxyContin abuse fell significantly after the abuse-resistant version was introduced 2 years ago, but use of other opioids -- including fentanyl (Duragesic), hydromorphone (Dilaudid), oxymorphone (Opana), and heroin -- jumped from about 20% to 32% (P=0.005), according to Theodore Cicero, PhD, of Washington University in St. Louis, and colleagues.
"Abuse-deterrent formulations may not be the 'magic bullets' that many hoped they would be in solving the growing problem of opioid abuse," they wrote in a letter in the July 12 issue of the New England Journal of Medicine.
The new version of OxyContin -- harder to crush, chew, or dissolve -- entered the market in August 2010.
Between July 2009 and March 2012 the researchers surveyed 2,566 patients who were opioid-dependent but were entering a treatment program.
About 100 of these patients also gave personal interviews for further information about abuse patterns.
The researchers found the percentage of patients using OxyContin as their drug of choice fell from 35.6% before the new formulation was introduced to 12.8% almost 2 years later (P<0.001).
But primary abuse of other powerful opioids such as fentanyl, hydromorphone, oxymorphone, and heroin rose markedly during that time, from 20.1% to 32.3% (P=0.005), they found.
Indeed, clinicians and law enforcement officials now consider oxymorphone abuse a bigger problem than OxyContin abuse.
Cicero and colleagues found that abuse of hydrocodone (Vicodin) and other oxycodone products also rose slightly, but not anywhere near as steeply as the other, more powerful opioids.
OxyContin use also fell when patients were asked what opioids were used to get high in the past 30 days at least once -- from 47.4% before the introduction of the new formulation to 30% afterwards (P<0.001).
Again, users simply appeared to switch opioids, with heroin use nearly doubling during that time, they reported.
Almost a quarter of drug users (24%) said they found a way around the tamper-resistant mechanism in OxyContin, but the vast majority (66%) said they just switched to another opioid instead.
While the abuse-deterrent OxyContin "successfully reduced the abuse of a specific drug," the researchers wrote, it also "generated an unanticipated outcome:" that users simply switch to other opioids.
That's a concern not only because it doesn't do anything to stop the current opioid addiction epidemic, they said, but also because more powerful drugs such as heroin, which can put patients at greater risk of complications such as respiratory depression, can pose an even greater public health risk.
Primary source: New England Journal of Medicine
Cicero TJ, et al "Effect of abuse-deterrent formulation of OxyContin" N Engl J Med 2012; 367(2): 187-189.
Source : MedPage Today
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Purdue: Block Disclosure Of OxyContin Documents
A long-simmering court battle over a trove of OxyContin documents has finally won the attention of Purdue Pharma. The drugmaker is belatedly seeking to intervene in a 2008 lawsuit in a Massachusetts state court, where an attempt is being made to force the state attorney general to release documents that were used to prosecute Purdue and three current and former execs several years ago. At issue are countless documents that were compiled by the US Department of Justice, which charged Purdue and the execs with misbranding - they facilitated improper use of the drug and misled patients, regulators and doctors about addictive risks. All totaled, $634 million in fines were paid, and the execs were barred from doing business with federal healthcare programs, such as Medicare and Medicaid (see here).
More background: The guilty plea took place in 2007. And at the same time, 26 states also brought consumer fraud charges against Purdue for encouraging doctors to overprescribe OxyContin and, collectively, received a $19.5 million, of which nearly $1 million went to Massachusetts. But in a motion filed late last month, Purdue argues the documents contain confidential and proprietary info, and maintains the state attorney general acknowledged these would be exempt from public disclosure and treated confidentially (read the motion here).
The lawsuit seeking disclosure was brought by David Egilman, a clinical associate professor in the Brown University Department of Family Medicine and a frequent expert witness for attorneys who file product-liability litigation against drugmakers. He played a key role in leaking sealed court documents concerning serious side effects of the Zyprexa antipsychotic to the media, which he undertook because the public was not aware of the extent of the problems, including diabetes and obesity. [Eli Lilly, which sells the pill, paid a $1.4 billion fine to settle civil and criminal charges, while Egilman reached a $100,000 settlement in lieu of civil and criminal penalties.]
As noted previously, Egilman believes the Purdue documents may indicate evidence of FDA and state regulatory incompetence, as well as malfeasance committed by the drugmaker. In a letter to the AG, one of his attorneys wrote that releasing the info “could only inform the general public and create an incentive for other pharmaceutical companies to obey consumer protection laws.”
However, the AG has refused to release the documents, arguing that an exemption permits the office to exercise its discretion, and cites state law that say releasing the documents would not be in the public interest because there is a possibility of prejudicing effective law enforcement (here is the lawsuit, a series of letters and other motions filed in the court and here is a list of documents sought).
Source : Pharmalot (Jan 4 2010)
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Drug Company Profiteering, Pill Mills and Thousands of Addicts: How Oxycontin Has Spread Through America
Corruption down the line, from Big Pharma to doctors and the war on drugs, builds a growing epidemic and an addiction-fueled empire.
June 30, 2011
I left a very white, very affluent Philadelphia suburb for NYU in 2007. When I go home, Oxys always come up in conversation with friends: Who got really "bad" (and can you believe it was him?!), who started selling, or what new pill-based friendship is the strangest. On one visit, I found pens gutted to be used as straws (to snort pills) and tin foil in my old best friend’s bedroom, to smoke Oxys.
In Glen Mills, Pennsylvania, suburban moms and dads enjoy a short commute to the city and send their kids off to a “Blue Ribbon School of Excellence” to prepare them for the educational institutions to which they aspire. Aside from school and work and partying in big houses, there is not much to do.
Boredom tends to inspire some creative takes on “fun.” Out of my town, for example, came the
Jackass crew. Their worm snorting and reckless self-injury (shocking their testicles, paper-cutting their eyelids) might not have occurred if they had the resources of a city. When Jackass star Ryan Dunn died in a
drunk-driving accident June 20, he crashed his car on Route 322, a road members of my community use regularly.
Drugs are another common way to escape boredom. Pop one pill and working at the local pizza parlor after school might not be such a drag.
Of all the prescription pills people used – Xanax, Klonopin, Percocet, Vicodin, Adderrall, Rittalin, Codeine –
OxyContin, the brand name for slow-release oxycodone, is king. The most potent painkiller of its class
(opioids like codeine, Percocet and Vicodin), Oxys are what you graduate to. Being hooked on percs wouldn’t make sense. Eventually, as tolerance increases and more pills are needed (not just to get high but to avoid withdrawal) Oxys seem like the way to go.
My generation Y, also called the Echo-Boomers, grew up on pills: anti-depressants, ADHD medication like Ritalin, sleeping pills, anti-anxiety meds. Nearly as commonplace as being on prescriptions was sharing
them, whether they were your own, your little brother’s, or something you found in your parents’ medicine cabinet.
At parties, no one said anything but “let me get some” as kids crushed and snorted pills off coffee tables, then blacked out and cruised through the night. Being so out in the open about it was a way
to be cool, to establish yourself as a bad-ass, or make friends by sharing.
Pills were not only visible at parties. School was sometimes a comical display of who got too fucked up that morning. Kids would walk aimlessly in the hallway, fall off chairs, fall asleep, and often, be escorted to the nurse’s office and punished or arrested.
Finding the pills for a party or school day was not particularly difficult because there are enough Oxys in circulation for dealers to maintain stock. Some sources (not all) claim opioids have become the most commonly prescribed drug category in the United States. Furthermore, 15 percent to 20 percent of doctor office visits in the United States included the prescription of an opioid, and 4 million Americans per year are prescribed a long-acting opioid. The network to find these pills is strong and loyal because, as OxyContin users know, the withdrawal is so bad addicts will do almost anything to find it. The jocks, the
cheerleaders, the shy kids, and the rebels – they were all exchanging connects, drugs and tips to get high. Eventually, many of them started to sell drugs to finance their own addictions, creating another network of unlikely drug dealers.
Most of my peers made it through high school alive but shortly after, that began to change. First, the former
principal’s son – a well-liked athlete -- died from an overdose of a cocktail of pills, including OxyContin. "The kids that Tim hung out with in high school were kids we as parents wanted him to hang out with … but they were good kids making bad decisions," said his father, who urged that parents communicate,
at a school assembly.
After he died that I learned that he was not the first. Another girl had overdosed on methadone the year before. Unfortunately, they were not the last. Since then, at least two people have died from opioids, and “who's next” is not an uncommon question for debate. It's like a virus or the grim reaper, sneaking around the suburbs at night and picking kids.
A 2008 study by DAWN (Drug Abuse Warning Network) for Philadelphia, Bucks, Montgomery, and Delaware counties shows that, combined, there were 681 deaths due to drug use (the vast majority of which involved
opioids) and 45 drug-related suicides. One Bucks Country reporter noted that, for his county, drugs are killing more people a week than the Vietnam War did. While the rates of overdose are startling, death is not the only deterrent to OxyContin use. Addiction itself can take the fun out of experimentation. While some people so enjoy the drug they do not want to quit, others desperately want to be clean – to return to the life they
had before, when they did not have to mess with fate just to make it through the day. But another voice – the voice of addiction – overpowers this will, so that they are caught in an overwhelming battle. The problem is so bad, and so common, that I regularly see the ups and downs on Facebook statuses-- posts like “sometimes I think I can’t make it,” “hardest thing I’ve ever had to do,” “being strong,” “getting clean,” and “finally getting back to my normal self."
What makes quitting so hard is how good Oxys, and other opioids, feel. “These drugs are just amazing. For some, it’s a sense of intoxication. For some, it’s a sense of peace. For some, it washes away the pain of existence,” said Scott Kellogg of the New York State Psychological Association. “For some, it’s a sexual experience. The metaphor is always that it’s better than sex – it has some orgasmic quality.”
OxyContin’s euphoric effects vary depending how the drug is taken. When swallowed, active ingredients are time-released, and the high is less intense. When crushed, however, all time-release properties are obsolete so that when snorted, smoked, or shot up, Oxys (at much higher doses than immediate-release oxycodone) flood the body with a rush of warmth and confidence. Called a “miracle drug” by manufacturer Purdue Pharma, OxyContin is a physical and psychological pain eraser. It works by activating the mu-opioid receptor, “hijacking” the body’s natural painkilling system to release much higher levels of endorphins and block out the pain.
At first, Kellogg explained, people use the drugs to feel good. The body so enjoys this intoxication that it craves it. Then it needs it at increasingly higher doses, until users are so sick with days of fatigue, irritability, nausea, pain, diarrhea and vomiting they cannot imagine how to stop. At this point, people are not using to feel good, but to avoid terrible sickness. Withdrawal from opiates has often been called “a
living hell.” Kellogg described the withdrawal as “a dramatically painful experience that can last up to five days.”
Both pain patients and abusers of OxyContin fear withdrawal. Many people who use, or have used, note that anyone suffering from that kind of “dope sickness” would do whatever it takes to escape. Even the head of the DEA would be on his hands and knees, begging for heroin.
Heroin, not OxyContin, because often serious Oxy addicts will turn to heroin to keep up their high. “For practical purposes, it’s the same thing,” said Kellogg. Unlike other painkillers like Vicodin and Percocet, OxyContin and heroin are both derivative of poppy.
OxyContin and heroin have withdrawal symptoms with intense physical effects. Bill Twillman of the American Academy of Pain Management described opioid withdrawal as “the worst flu you ever had times two,” and that might be an understatement.
The horrific withdrawal, combined with Oxys’ high cost, can also drive users to heroin. OxyContin, synthetic heroin, has a street value of $40 for an 80 mg. pill. Heroin, on the other hand, costs about $10 a hit. When people are sick and broke, switching to heroin becomes somewhat of a no-brainer. But while heroin causes fewer deaths in the U.S. than OxyContin (maybe because more people use Oxys), its shifting purity makes users sensitive to overdoses, and the tendency for addicts to use it intravenously presents a wealth of new issues, like hepatitis C and HIV.
A National Epidemic?
Glen Mills is not the only town affected by what has been called “the OxyContin epidemic.” Reports of widespread OxyContin (and subsequent heroin) use have surfaced in many suburbs, including those in Chicago and New York.
Its high profitability helps to spread OxyContin use. Addicts’ overwhelming need for more Oxys makes the black market worth millions of dollars. What’s more, these pills are as costly as they are deadly. Widespread use and availability, matched with difficulty quitting, allows the numbers of users and deaths to skyrocket. A study by Drug Abuse Warning Network shows that visits to the emergency department caused by non-medical use of opioids from 2004 to 2008 increased by 111 percent. Prescription drug overdoses are now the second leading cause of accidental death behind traffic crashes, and painkillers are the top narcotic leading to death.
While death and use is on the rise nationwide, Appalachia has been so hard hit by OxyContin that it has given the pill a new name: Hillbilly Heroin. According to the 2010 National Drug Intelligence Center (NDIC) National Drug Threat Survey (NDTS), 25 of the 43 law enforcement respondents in the Appalachia High Intensity Drug Trafficking Areas identify controlled prescription drugs, of which oxycodone is most popular, as the greatest threat to their regions.
“Readily available and abused at high levels,” controlled prescription drugs also result in a wealth of crime, from hustling to burglaries. Law enforcement officers estimate that 90 percent of all property crimes committed in several West Virginia counties stem from OxyContin abuse alone.
Appalachian Oxy use exposes not only the street level crime associated with OxyContin, it also reveals a bigger trend in OxyContin trafficking – pill mills. In Current TV’s documentary series "Vanguard," reporters exposed “The OxyContin Express,” a flight from West Virginia to Florida, where pain management clinics, commonly referred to as “pill mills,” handed out hundreds of pills per patient, many of whom took their pills back home to sell. Prisons were stocked full of people locked away for selling drugs to support their own habits. As the show noted, all the pain is in Appalachia, while all the profit is in Florida.
A Trail of Corruption
As prescriptions to OxyContin and abuse of the drug rise, it becomes clear that there is far too much of the drug available on the black market. Obviously, something has gone awfully wrong in the pharmaceutical supply system.
In a study on OxyContin patients, researchers at the Albert Einstein College of Medicine and the Montefiore Medical Center revealed that part of the problem with OxyContin is lack of regulation by prescribers. Researchers determined that 8 percent of patients were urine tested (to see if they were drug addicts looking for a fix or non-users looking for cash), and less than half of the patients had regular meetings with their doctors to check on signs and symptoms of addiction. Shockingly, more than one quarter of patients were receiving multiple early refills, suggesting that tolerance (and addiction) had them using at a higher rate, or selling them quicker than they could re-stock.
Pill mills, some of which call themselves "pain management centers," are doctors’ offices that hand out powerful narcotics at a much higher rate than for strictly medical reasons. Like drug dealers, they require “patients” to pay in cash and usually do not perform physical exams or require evidence of injury. They treat pain with pills only, and they often give patients the option to choose their own medicines before directing them to “their” (conspiring) pharmacy. In some cases, doctors operating pill mills have been imprisoned for trafficking narcotics.
“If you live or work close to an OxyContin mill…99 percent of everybody that you see going in there is either an addict or a criminal,” said Assistant Scioto County, Ohio Prosecutor Joe Hale in a suit against OxyContin’s manufacturers. “If they are not an addict — if they don’t need that prescription just to get by every day — then they are going in there out of greed, because they know that they can pay some doctor $400 to write a prescription. They can take it up to Columbus, walk out with a bottle of pills, and in a matter of days they can turn it into $3,000, $4,000, $5000 — and who couldn’t use that?”
While doctors, dealers and addicts are locked-up for OxyContin, Purdue Pharma, the manufacturer, evades responsibility for the collateral damage caused by its product.
Devastation in Appalachia is so costly that several Appalachian and Southern states, including Kentucky, Mississippi, Louisiana, Virginia, and West Virginia have sued Purdue Pharma. Purdue has knocked down nearly every one of the more than 1,000 suits that have been filed against it.
With Rudy Giuliani on its side ( Giuliani Partners was an external adviser to the company since 2002), clearly Purdue has enough money and legal clout to avoid legal responsibility for its money-making, addiction-fueling product.
Alongside legal tools, Purdue Pharma, the only manufacturers of slow-release Oxycodone (which includes higher doses than fast-acting), used marketing to maintain its stronghold on Oxys and Oxy addicts. By advertising OxyContin in mainstream media, Purdue increased demand for its product, leading to large amounts of OxyContin in circulation.
“There’s just so much of it available,” said Twillman, “because they did a really good job of marketing it.”
In fact, they did too good a job.
In May 2007, Purdue Pharma and company chief executive officer Michael Friedman, general counsel Howard Udell and former chief medical officer Paul Goldenheim each pleaded guilty to a misdemeanor count of misbranding the drug, thereby misleading doctors and patients by claiming OxyContin is less likely to be abused (and addicting) than traditional narcotics. Effectively, Purdue Pharma synthesized legal heroin and advertised it to the masses as safer than other painkillers.
These “misbranding” misdemeanor offenses occurred between 1995, when the FDA approved OxyContin for sale, and 2001, when Purdue faced regular, public criticism and cut the “reduced-risk” marketing. During those years, OxyContin made Purdue Pharma $2.8 billion in profits. As Purdue championed the safety of its drug and watched the money pile up, the DEA said the number of deaths related to OxyContin rose 400 percent, and the annual number of OxyContin prescriptions increased nearly 20-fold.
In the end, Purdue Pharma paid more than $600 million to 26 states and the District of Columbia. No one at the company faced jail time.
“The damage to the public from these white-collared drug pushers surely exceeds the collective damage done by traditional street drug pushers,” said Dr. Sidney Wolfe, the director of the health research group at Public Citizen, at the time of the trial.
But the trial did not mark the end of Purdue’s attempts at bogus safety claims. In 2001, when the FDA urged Purdue Pharma to add a more accurate label to OxyContin, Purdue announced it was working on a patent application for a new formula of OxyContin designed to be less likely to lead to abuse and addiction. The result, OxyContin OP, entered the market this year with a special coating so it cannot be crushed and snorted. Addicts, however, have learned to work around this.
On my last visit home, I learned it is possible to cook up Oxys so they can be crushed. Some people even like the new pill better, calling it a “more doped out high” as opposed to the “energetic” Oxy rush. Google “the new OxyContin” and the first results are forums that include more than 100 comments on how to melt away the coating, using a microwave or lighter, and snort or shoot the medication. One comment even recommended a website with videos demonstrating how to successfully crush and snort or shoot the new Oxy.
At the same time, pain patients complain that the new Oxy causes nausea or does not work as well.
Treating Purdue Pharma’s Sick
Stirring up mass hysteria is not a good response to the high rates of Oxy addiction -- but neither should the addiction be downplayed.
Bill Twillman of the American Academy of Pain Management notes that OxyContin addiction is a “problem of our society,” where pills are considered the be-all, end-all of physical and psychological pain. Using, sharing and abusing prescription pills has become so embedded in our culture that addiction to OxyContin, and pills in general, is all too common. Most often, it is not OxyContin alone that causes death, but the pill mixed with alcohol and/or other prescription drugs, particularly Xanax and Klonopin. The bottom line is that prescription pills are quite pervasive. Big Pharma, physicians, street dealers, government, and users themselves all contribute to the wave of OxyContin use and the rising death toll.
Even if the new OxyContin did prevent users from crushing it, the epidemic would not be over. Twillman notes that users put off by the regulation are now turning to Roxicodone and other fast-acting opioids like Oxy IR. So how can we stop, and prevent, what Scott Kellogg called the potential “loss of half a generation”?
Taking OxyContin, or any opioid, deregulates the body’s natural opioid system so that, for some long-term users, the effects can be permanent. According to Kellogg, when addicts stop using these drugs, brain images show the brain starting to look better over time, but the earlier the intervention, the better the chances of a return to baseline.
Many people consider medical treatment like suboxone and methadone, though highly effective, “switching one thing out for another,” and families and friends of addicts often pressure them to go off these medications before they are ready. The result is often relapse. For this reason, combined with potential permanent brain alteration, the “diabetes” model of addiction as a life-long disease that requires a lifetime of treatment can be highly effective, according to Kellogg.
The neurochemistry of some addicts (and of those who most abuse the drug), might never have been “normal” in the first place, Kellogg notes. Thus, faulty brain chemistry sends potential addicts off on a quest for self-medication, and for that reason, prescription pills are attractive – and addicting.
In regard to suppliers, Twillman says pharmaceutical companies must go to the DEA and report how many pills they will manufacture the upcoming year. The DEA, however, is mandated by law to ensure there is enough medication available for the people who need it. OxyContin is obviously overprescribed, and to cut the numbers of pills manufactured as rates of use rise seems like an obvious solution.
However, because opioids work well for many pain patients, Twillman was leery of suggesting legal regulations that require doctors to use alternate pain treatments. Instead, he supports a crackdown on pill mills and guidelines that recommend treatments like acupuncture, chiropractic, local anesthetic patches, and a wealth of other action.
Taking OxyContin off the market would not only endanger pain patients, but addicts as well. Sick from withdrawal, they would increasingly turn to heroin, which could be impure, and therefore dangerous.
To minimize the surplus of Oxy in circulation, several states, including Florida and Ohio, are passing laws to regulate and stop pill mills. Though laws to regulate pill mills may be a step in the right direction, the government’s reaction to prescription pill abuse is fundamentally flawed. Purdue Pharma intentionally misled the public in advertisements designed to boost demand, profit-hungry doctors overprescribed highly addicting drugs, and parents left excess prescriptions in medicine cabinets. Rather than focus on why addicts use (like naturally flawed opioid receptors in the brain), the government focuses on jailing street dealers and addicts who are in dire need of life-long treatment.
At this point, Pandora’s box is open. Oxy addiction is widespread, and regulating the drug will result in higher numbers of heroin use. As was evidenced in Russia’s attempts to crack down on heroin, addicts will do nearly anything, including injecting flesh-rotting house-held chemicals, to avoid withdrawal. The time has come to pursue legal action against the real dealers – the manufacturers and the doctors in their pill mills – and apply money from lawsuits against them to treat the sick before the death toll rises and thousands more people face addiction that could change their brain chemistry indefinitely.
Source : Alternet.org
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