Clampdowns on the painkiller because of abuse makes it harder to get prescriptions, some patients say.
Published May 27,
By WES ALLISON
© St. Petersburg Times
In one short year, OxyContin has become the dastardly villain in the war on drugs, engendering the ire of prosecutors and federal regulators while being blamed for dozens of deaths from New England to Florida.
Nervous physicians are on the lookout for addicts faking injuries to con prescriptions. The government is considering restricting distribution.
But OxyContin is also the drug that lets Ed Madonia, 74, who suffers from a diseased spinal column, teach a Tuesday night self-improvement class at Palm Harbor Unity Church. It lets Liz Constable, who suffers from fibromyalgia, resume some semblance of a normal life after nearly a decade of debilitating pain.
As law enforcement tries to battle the illegal use of OxyContin, a powerful prescription pain reliever that has become a hot new street drug, some patients and pain management groups worry they'll be the ones to suffer.
Already some doctors are blanching at prescribing it, they say, and advocacy groups fear new government restrictions that will make it more difficult for people who need it to get it.
"I had to literally go beg doctors to give me a prescription because everybody is so paranoid," said Constable, who read about the benefits of OxyContin in a fibromyalgia newsletter, then visited three doctors before one agreed to let her try it.
"I'm a 51-year-old retired schoolteacher," she said, exasperated. "The last thing I'm going to do is sell a drug on the street."
Dr. Russell K. Portenoy, a member of the board of the American Pain Foundation and chairman of pain management and palliative care at Beth Israel Medical Center in New York, blames media hype and government overreaction for having a "chilling effect" on some doctors.
Portenoy, a national leader in the field of pain management, has been asked to serve as a consultant to a U.S. Food and Drug Administration panel that will meet in the fall to consider whether oxycodone, the generic name for OxyContin, and other opioids need more restrictions.
He says patients have reason to worry.
"Because of the pervasive fear of these drugs in this country, what I would call the stigmatism of these drugs, stories about (misuse) may drive regulators and those in law enforcement to take actions that are not warranted and would have the unintended effect of reducing access to patients who need them," Portenoy said.
Maggie Tucker, 39, who has lesions on her spine from multiple sclerosis, had been on several drugs that left her groggy and in pain before she mentioned OxyContin to her physician.
He agreed it could help but didn't want to be the one to prescribe it, she said. She got it from a pain specialist four months ago.
"He was afraid just because the DEA would come down on him, because he's a family practitioner," said Tucker of Palm Harbor, an insurance agent who has been unable to work. "He said I need somebody to back me on this. Your best bet is to go see (a specialist)."
Since being approved in 1995, OxyContin has become one of America's most-prescribed medicines for chronic pain, reportedly with sales of $1-billion last year. Its popularity rose as family doctors, who long resisted giving opioids to people with non-fatal diseases, have become more comfortable with stronger drugs.
Several Tampa Bay-area residents suffering from chronic pain say they tried other medications, but they made them feel sleepy or didn't work as well.
"For the first time in 15 years, I've had days where I've been able to function. And that's been a blessing," said Madonia, who took Percodan for a decade before switching to OxyContin early this year.
OxyContin is a synthetic morphine, an opioid like Percocet or Vicodin. Dr. Ron Schonwetter, medical director of Lifepath Hospice in Tampa and chief of the geriatrics program at the University of South Florida, said OxyContin provides sustained relief and has few side effects.
The key to OxyContin is its timed-release formula, in which small amounts of painkiller are released into the bloodstream gradually, usually over 12 hours. Most opioids ease persistent pain for a couple hours, then wear off.
But when used illegally, the pill is often crushed and snorted, or mixed with water and injected, or chewed. This delivers all the drug at once, producing an intense high that also can kill.
Oxycodone and hydrocodone, another morphine-like drug, were blamed for 152 overdose deaths in Florida in the last six months of 2000, state medical examiners report.
Addicts and dealers typically steal it from pharmacies or patients, or buy prescriptions from unscrupulous doctors. Or they concoct elaborate ruses in hopes of persuading a physician to prescribe it.
Dr. Lynne Carr Columbus, a pain management specialist now treating Madonia and Tucker, said she was duped into writing a prescription for OxyContin for a man claiming to have bladder cancer.
He sported bogus medical records and a wheelchair, and she had no reason to doubt him. A pharmacist got suspicious, and police were alerted.
Two weeks ago, Tarpon Springs police arrested a 36-year-old Michigan man for fraud after he allegedly used false "claims of injuries and illnesses" to obtain prescriptions for OxyContin and other pain relievers from 18 area physicians, clinics and emergency rooms, the police report said.
In Florida, the DEA is working with police to stop the spread. Investigators may audit any pharmacy or doctor at any time, and OxyContin has taken priority, said Special Agent Joe Kilmer.
"There are many, many investigations that are in progress right now," he said.
OxyContin's manufacturer, Purdue Pharma, has met with officials in several states, including Florida, to discuss ways to control distribution, and it recently sent brochures to 400,000 doctors.
Purdue says it has marketed OxyContin responsibly, although some doctors complain it was pitched as benign. Portenoy, from the American Pain Foundation, said it was marketed to general practitioners just as opioids have been marketed to cancer specialists in the past -- but general practitioners often aren't as well-trained in managing narcotics or addiction.
"It was almost preordained that, with that increased use and the vast amounts of it on the market, this would happen," Portenoy said.
Columbus said physicians can take steps to reduce the chances drugs they prescribe will be misused. Her clinic, Gulf Coast Pain Management in Palm Harbor, requires patients to present photo identification to pick up a prescription for OxyContin, and patients must keep a "pain dairy" that charts their pain and keeps track of every pill.
Many patients also are given urine tests to ensure they're taking the drug, not selling it, she said.
Columbus said she has several new patients whose doctors refused to prescribe OxyContin.
"I think that there's definitely been fear put in the doctors about the medication, and I've had a lot of patients come to me and say they're being told by their primary care physicians that they can't prescribe it, that they don't have the expertise," she said.
"There's a risk we could lose our license over issues with this. It is scary. I worry about it every day."
Generic: controlled release oxycodone. It has no generic equivalent.
Availablity: 10-, 20-, 40- and 80-milligram pills. Prescription only.
Cost: $278 for 60 40-mg pills.
Street value: About
$40 per pill.
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American Pain Foundation, www.painfoundation.org
Purdue Pharma, www.oxycontin.com or www.purduepharma.com .