October 5, 2005
Blessing or Curse? Weighing the Pros, Cons of OxyContin
By Sue Scheible; SUE SCHEIBLE
The stories have come from people of all ages and circumstances: parents who turned in their children to police, grandparents whose cancer medications were stolen, orthopedic patients unwittingly hooked on painkillers, teenagers snared in a lark that led to addiction.
The problem is OxyContin, a powerful, long-acting narcotic analgesic. A special state commission will soon make recommendations on increased controls. The focus is expected to be tighter prescribing practices, rather than a ban.
"Some of the stories break your heart," said Hingham state Rep. Garrett Bradley, who serves on the commission. "It just is destroying lives."
OxyContin, introduced in 1996, was initially described as a wonder drug for relieving pain in patients with cancer, severe back injuries and other chronic conditions.
"This medicine has been very helpful," said Dr. James Everett of Weymouth, a cancer specialist affiliated with South Shore Hospital. "There are other shorter-acting pain drugs, but they have more side effects, including the potential for liver damage if given in excess dose." OxyContin also is used in emergency care, primarily for patients who are already taking it. "It is a great drug for chronic pain, but there does need to be more control over it," said Dr. Donald Hansen, chief of emergency services at Jordan Hospital in Plymouth.
Jordan's emergency physicians have gotten occasional inappropriate requests for OxyContin by patients in the emergency department, but Hansen said abuse is not widespread.
Not long after the drug's introduction, reports began accumulating of how the pills could be crushed and snorted or dissolved and injected for a fast, potent high - instead of the slow, time-released relief the medicine was designed to give. Illegal use led to addiction and heroin; the street price soared along with a wave of pharmacy holdups.
Many pharmacies now refuse to stock the drug, requiring at least 24-hour notice to order small quantities for specific customers. Cancer patients are fearful they will be followed home when they pick up their medications. They are told to keep it in a locked box. And federal and state lawmakers have proposed the drug be banned.
The state commission has conducted four hearings on OxyContin and other opium-based painkillers. The final hearing is at 10 a.m. Oct. 5 [Correction: 10 a.m. Oct. 4 in Gardner Auditorium] at the State House. By the end of October, the panel plans to make its recommendations on legislation.
"This drug does a lot of good, but we have to make sure it is getting to the people who really need it," said Bradley, the Hingham representative. "There are other medications for acute pain."
Last week, a truck with pharmaceutical drugs including OxyContin and other narcotics was stolen in Pembroke after the driver had made a delivery to a CVS Pharmacy.
Paul Nolan, deputy police chief in Milton, said he believes many of the bank robberies that have occurred on the South Shore in recent months have been related to OxyContin addiction.
"They should tighten up who they prescribe it for," he said.
State Sen. Steven Tolman, who filed a bill to ban OxyContin, said he is "open to compromise," but the rate of addiction is so high he believes the federal government should outlaw the drug.
"It is out there everywhere, and it should not be prescribed for knees, teeth, elbows," he said.
A 48-year-old man who was prescribed OxyContin after knee replacement surgery said he developed a physical dependency without realizing it. He said he became severely depressed, a known side effect, when he tried to stop taking it and his doctor did not withdraw him correctly by lowering the dose gradually.
"The drug definitely did the job in relieving my pain, but no one warned me about how that stuff could affect me," he said. "There was zero information and I ended up taking it too long, and in larger dosage, than I needed to, all because of a lack of direction."
Duval's Pharmacy in Whitman was held up in February by a masked man demanding OxyContin. It was owner John Duval's first armed robbery in 40 years of practice. He has stopped stocking the medication. Patients can order it a day ahead and he will get small quantities for them.
"If people don't pay attention to the fact they are running out, or if their doctor hasn't given them another drug until this one comes in, they can run into a problem,'' Duval said. The Massachusetts Pharmacists Association has no figures on how many pharmacists no longer stock OxyContin, but spokesman Carmelo Cinqueonce said, "They are trying to balance the needs of the patient with the threat of armed robbery."
During the hearings, the state panel heard from oncologists, pain specialists, the American Cancer Society, and Roger Brown, pharmacist and clinical coordinator at Brockton Hospital. All urged that a balance be kept.
The Massachusetts Medical Society opposes any ban and supports the drug's use under controlled medical conditions, with physician supervision, said spokesman Richard Gulla.
Rep. Bradley criticized OxyContin maker Purdue Pharma "for not informing the health care community of how powerful the drug was." Attorney Tim Bannon, spokesman for the company, said the problem is broader than the abuse of one drug.
"There has never been any reliable data to suggest that OxyContin itself is the most abused prescription drug," he said. Purdue Pharma supports education programs for doctors, patients and the public about prescription drug abuse in general, Bannon said. Bradley said the company waited too long to begin those programs.
Sue Scheible may be reached at [email protected]