Feb 07, 2002
A panel convened by the American Enterprise Institute (AEI) here Thursday mostly agreed that Purdue Pharma should not be viewed as the culprit in the problem of the abuse of its long-acting painkiller OxyContin.
Only one panelist, a journalist from a West Virginia newspaper, said the company should do more to keep its drug out of the hands of abusers.
Greg Stone wrote a series about OxyContin abuse in his community last year for the Charleston Gazette. Stone said the problem continues unabated, citing an arrest in Charleston just days ago of two men who had arrived from Baltimore with 10,000 OxyContin pills in their vehicle, and a recent interview with a woman who said she was injecting 400 mg of OxyContin -- with a street value of $400 -- each day.
"It raises the question of manufacturer responsibility when you're holding something that explosive," he said.
Stone suggested that unless OxyContin could be reformulated to discourage abuse, it should perhaps be taken off the market.
Purdue Pharma senior medical director for health policy J. David Haddox told the meeting that the company is studying a pairing of OxyContin, known generically as oxycodone, with naloxone or some other agent to make it more difficult for abusers to achieve a "high" by crushing and then snorting or injecting the tablets. But it is proving technically difficult, he said, noting that the company has to determine how much naloxone it can safely add without neutralizing the legitimate pain-killing effect when the tablets are swallowed.
OxyContin reportedly is being abused more than other opioids. But that assumption -- and the assumption that the drug is causing more deaths -- has been debated because overdose victims usually have other substances in their systems as well. And, since oxycodone is in other prescription medications, such as Percocet, OxyContin can't be definitively fingered as the culprit.
Haddox said no data suggest that OxyContin is any more addictive than other opioids.
The company has been criticized for what some see as aggressive marketing, which may have raised OxyContin's profile in the eyes of potential abusers. But Haddox said, "I don't accept the premise that aggressive marketing is bad," adding that the company was seeking to address the problem of under-use of medications for pain.
Sally Satel, an AEI fellow and psychiatrist who works at a methadone clinic in Washington DC, said that Purdue Pharma was not creating addicts through marketing or insufficient monitoring. Satel is known for her controversial position that people choose to be addicts.
"Compulsive use often has tragic consequences, but that's not the fault of the drug," she said.
Satel and several other panelists said they believed that OxyContin abuse was mostly limited to several regions of the country, and that there was a bit of an overreaction in the media. But an audience member cited data he claimed showed that diversion was spreading throughout the nation.
Another audience member, a substance abuse specialist, suggested the company could have foreseen the potential for OxyContin abuse, given the rising trend in prescription drug abuse when OxyContin was introduced in 1995. He said the company, distributors and pharmacies should do more to monitor sales and dispensing.
Panelists said it was likely that OxyContin abuse would remain mostly a law enforcement issue, rather than a company or medical issue. The US Food and Drug Administration (FDA) has no legal authority to pull the drug from the market or enforce restrictions on access in response to the diversion problem, said Erika King, a food and drug law attorney with Covington & Burling in Washington DC.
The FDA could pressure the company
to further restrict access, she noted. But she added that she was among
those who did not think Purdue Pharma should be held responsible for the
diversion and abuse of its drug.
© 2002 Reuters Ltd