Pinsky admits to holding a minority view when he says no one should be
treated with opiates more than two weeks, particularly if there's a family
history of addiction. "If you have a history of addiction and have an
extraordinary need to go beyond two weeks, it needs to be monitored very
carefully by someone in the addiction field." He says there are many
non-narcotic pain medications, such as Toradol, and alternative therapies, such
as acupuncture, massage, and chiropractic treatment.
Pinsky, who is medical director for the department of chemical dependency
services at Las Encinas Hospital in Pasadena, Calif., tells WebMD he admits at
least two patients a day for overusing painkillers. "They've been addicts
all along. They didn't suddenly develop an addiction. They come to me with
overwhelming pain -- back pain, neck pain, headaches. They can't
He says chronic physical pain in addicts is often an expression of past
trauma. Drugs relieve the pain but feed the addiction. His approach is to take
them off the pain medicine. "I say it will be the worst pain of your entire
life for two weeks, but that will be the end of it. Meanwhile, we do 12-step
and group therapy programs with them and intensive treatment of their
The Backlash of OxyContin Abuse
In certain parts of the country, the crackdown on illegal use of OxyContin
has made it hard for pain patients to get legitimate prescriptions.
"OxyContin was the first prescription medication listed as a drug of
concern by the federal Drug Enforcement Agency, which made it a target,"
says Ronald T. Libby, PhD.
The drug, Libby says, is "monitored by pharmacies and [Perdue] Pharma,
the maker of OxyContin. Some physicians, knowing the DEA or sheriff is looking
at these scripts, refuse to write prescriptions for fear of prosecution.
Doctors can be scammed, and if a patient takes some pills and sells some, the
doctor can be guilty of diversion." Libby is the author of a Cato Institute
policy report titled "Treating Doctors As Drug Dealers: The DEA's War on
Prescription Painkillers" andprofessor of political science and public
administration at the University of North Florida in Jacksonville.
"The war on drugs has become a war on legal drugs, on patients who take
them, and on doctors who prescribe them," Serkes tells WebMD.
The Association of American Physicians & Surgeons has issued a warning
to doctors: "If you're thinking about getting into pain management using
opioids as appropriate, don't. Forget what you learned in medical school --
drug agents now set medical standards. Or if you do, first discuss the risks
with your family."
Libby, who is writing a book entitled The Criminalization of Medicine:
America's War on Doctors, says OxyContin can be safer to take than
nonsteroidal anti-inflammtory drugs (NSAIDs) such as ibuprofen and aspirin.
"OxyContin does no damage to internal organs, but NSAIDs irritate the
stomach lining, liver, and other organs."
Pinsky says, "If you had cancer you would thank God OxyContin exists.
Unfortunately there's a huge social movement vilifying it as an evil product of
drug companies. It's total nonsense. The drug itself is not bad. It's a great
medication, but it has to be used by skillful clinicians."
It's a challenge to balance the needs of chronic pain patients, health care
providers, the chemical dependency treatment community, and law enforcement.
But efforts are under way. The Pain & Policies Study Group at the
University of Wisconsin Paul P. Carbone Comprehensive Cancer Center issues
annual progress report cards evaluating states' policies regarding the use of
opioid analgesics in pain management. The concern is that cancer pain is often
undertreated, and opioids like OxyContin are essential.
Evaluation scores reflect a balaned approach in which law enforcement
practices to prevent diversion and abuse do not interfere with the medical use
of opioid analgesics in treating pain. In the group's 2006 report, it was noted
that policies adopted in the last decade by 39 state legislatures and medical
boards addressed doctors' concerns about being investigated for prescribing
opioid pain medications.
The report concludes: "Despite a growing effort by policymakers and
regulators, the fear of regulatory scrutiny remains a significant impediment to
pain relief and will take years of further policy development, communication,
and education to overcome."
By Leanna Skarnulis
Reviewed by Louise Chang
B)2005-2006 WebMD, Inc. All rights reserved