OxyContin: Pain Relief vs. Abuse

(WebMD)  From time to time, OxyContin abuse flares up as a hot topic around the water cooler. If it isn't celebrities in the news for abusing the prescription painkiller, it's reports of drug-dealing doctors and overdose deaths. Add to that a law enforcement crackdown on OxyContin, and the result is a backlash affecting legitimate use of the drug: Many chronic pain sufferers won't take OxyContin for fear of becoming addicted, and some health care providers refuse to write OxyContin prescriptions for fear of being prosecuted.

WebMD talked to experts about OxyContin as a legitimate medication for moderate to severe pain, the dangers of abuse, the issue of addiction, and the climate of suspicion that restricts patients' access to the drug.

OxyContin Use and Abuse
OxyContin is the brand name for a timed-release formula of oxycodone, a narcotic analgesic (medication that reduces pain). It's used to relieve pain from injuries, arthritis, cancer, and other conditions. Oxycodone, a morphine-like drug, is found along with non-narcotic analgesics in a number of prescription drugs, such as Percodan (oxycodone and aspirin) and Percocet (oxycodone and acetaminophen).

OxyContin contains between 10 and 80 milligrams of oxycodone in a timed-release formula that allows up to 12 hours of relief from chronic pain. What distinguished OxyContin from other analgesics was its long-acting formula, a blessing for patients who typically need round-the-clock relief.

"If you have pain that's there all the time, four hours goes by very quickly," says cancer specialist Mary A. Simmonds, MD. "If you're not watching the clock, the pain comes back. People tend not to take their pills on time. The pain builds back up, so you're starting over. It's not very good management of pain."

Simmonds gave testimony on the value of OxyContin for alleviating cancer pain at a 2002 Congressional hearing. "For moderate to severe pain, aspirin and Tylenol aren't effective. We do need opioids."

It's the high content of oxycodone that makes OxyContin popular on the street. People who abuse the drug crush the tablet and swallow or snort it, or dilute it in water and inject it. This destroys the time-release mechanism so that the user gets the full effects of the narcotic. Users compare the high to the euphoria of heroin.

"What makes OxyContin dangerous is not only that it's addictive, it can also be lethal," says Drew Pinsky, MD, best known for his Loveline radio show. "It makes you feel you can tolerate more, but it can precipitate respiratory failure, especially when used with other drugs like alcohol or benzodiazepenes."

Street names for OxyContin include OC, Kicker, OxyCotton, and Hillbilly Heroin. According to the U.S. Drug Enforcement Administration, oxycodone has been abused for more than 30 years. But with the introduction of OxyContin in 1996, there has been a marked escalation of abuse.

According to the U.S. Department of Health and Human Services 2006 revised Substance Abuse Treatment Advisory on OxyContin, the regions most affected are eastern Kentucky, New Orleans, southern Maine, Philadelphia, southwestern Pennsylvania, southwestern Virginia, Cincinnati, and Phoenix. However, the DEA says the problem has spread across the country.

While there is special concern about teens' use of OxyContin, the percentage of 12th graders who said they had abused the drug in the past year declined in the 2006 Monitoring the Future survey of the National Institute on Drug Abuse (NIDA). The information is summarized in "NIDA Infofacts: High School and Youth Trends." Abuse of OxyContin decreased for the first time since its inclusion in the survey in 2002, from 5.5 percent in 2005 to 4.3 percent in 2006.

Drug Tolerance vs. Addiction
Chronic pain patients often confuse tolerance with addiction. They become fearful when the dosage of a narcotic has to be increased, but it's normal for the body to build up tolerance over time, says Simmonds, spokeswoman for the American Cancer Society. "Patients don't get a high, and they don't get addicted."

Simmonds, who is in private practice in Harrisburg, Pa., tells WebMD, "The tragedy is that any day of the week a patient will be in my office in real pain, and a family member will say, 'Don't take morphine.' Patients will suffer needlessly because they think they'll get addicted. We have to take time to educate them."

Kathryn Serkes, director of policy and public affairs for the Association of American Physicians & Surgeons in Tucson, Ariz., agrees. She says the standard of pain management care is more aggressive today than what it was just five years ago. She disagrees with some critics who would use OxyContin only as a last resort. "The phrase 'addicted to painkillers' is used fast and loose."

Treatment of Pain in Addicts
Is it inhumane, as some in pain management believe, to withhold opiates from someone in pain who has a history of addiction? No, say two experts in chemical dependency who talked with WebMD.

"Medical professionals need to be educated about addictions," says Peter Provet, PhD, president of Odyssey House Inc., in New York City. "A problem with addicts is they don't like pain of any kind. They've been medicating their emotional pain, physical pain, or familial pain. The addict is quick to ask for a pill, but sometimes we have to deal with our pain.

"All other kinds of treatment should be first considered before the physician jumps to what is the easiest solution, a synthetic opiate," he tells WebMD. "An addict or recovering addict suffering pain from cancer or after a car accident should talk with a physician well-versed in addiction. On occasion, someone who is in recovery may need a drug like OxyContin. It would need to be done thoughtfully with full knowledge of addiction, and then the treatment should be very carefully monitored."

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[trillion1]

My doctor never had a problem prescribing codiene for an inoperable back problem. I was never prescribed enough to get addicted just to relieve the pain when needed. Then the goverment had to started meddling. Since they don't feel my pain they say I don't have any pain. Goverment "thinking". Now I have had to find outside sources to live a normal life.

[seer999]

The entire issue of pain management is very complicated. It is made more difficult by the governments ongoing attempts to practice "back seat" medicine. The prime example here, is that JCOAH (joint commission on accredidation of hospitals) now lists pain as a "fifth" vital sign. A hospital can actually be penalised for not adequately treating a patients pain. There is also a legal risk to a physican who does not adequately treat a patients pain. BUT, if that same hospital or physician treats pain in good faith and in accordance with the rules, they may be prosecuted as "pill pushers" or "pill mills". Simple isn't it!?

[skater314159]

To BeBe28, I am sorry for your losses, but I disagree with you.

I have a condition that causes me to have chronic pain - I have had it since I was 15, and I will have it until it kills me. My life basically ended when I first began to suffer from my disease. I was not even able to do anything but lie in bed, in pain, unable to even get up to go to the bathroom by myself. I couldn't go to school or do anything that normal teenagers get to do. My disease is a death sentence.

Thanks to drugs like Oxycontin and Morphine (which are used in my case to treat the severe, chronic pain) in addition to other drugs which make my disease managable, I now have my life back. I still have severe health problems, and can't do a lot of things... but I instead focus on what I can do. I am married, finishing up college, and looking at going into a career where I can help others who are facing health issues like my own. If it was not for Opiates, Immuno-suppressives, and RA drugs, I would still be lying in bed, or dead.

As I said, I am very, very sorry for you loss BeBe... but I am very, very thankful for my life. Please don't take my life away by banning a drug that makes it possible for me to be free of pain. Please let me and all the other people who suffer have relief.

Thanks.
skater314159

[glb1969]

Just goes to show why we should prohibit the government from interfering with an individual's right to medical treatment and privacy.

[jjp735i]

It's a shame how people scream to remove a drug that does help so many people who need it.

Yes there is abuse of drugs and alcohol, but that does not mean people who need treatment should have trouble finding it, nor should a Doctor be afraid to prescribe a medication they feel is needed.

Alcohol abuse causes the same hardships listed in some complaints posted here, but people screamed to be allowed to drink even though there is no real reason for it. Why are people in large number not calling for alcohol to be banned?

Let people receive the treatment they need. if you find abuse, report it. Don't make all people suffer because you don't like something.

[bebe28-2009]

I could write a book on what Oxycontin can do to a person's life. My son became addicted through a doctor's care. The entire staff at this facility was later arrested and are in jail. It became a nighmare for all those whose family members were being treated by these so called professionals. My son lost everything, I lost my marriage, all of us are in financial ruin and that is just the beginning. I despise the drug and I can tell you that it is one of the hardest addictions to get over. They can take it off the market for all I care. I think that the pharmaceutical company should be made to compensate every family torn apart and destroyed, because of this drug!!!!!!

[mikekleber]

Several years ago I became addicted to Vicoden after an auto accident left me with multiple injuries. Addiction is a horrible condition. No one can truly understand the problem unless they have gone through the ordeal. People change completely when addicted. I only sought help after losing a job, lost respect from co-workers, and realizing what my problem had done to my family. That was twelve years ago. Two years ago, while walking through my shop, I slipped and fell. I broke two bones in my pelvis. Pelvic fractures are painful. Walking is painful, but sitting is worse. I did not want to become addicted again. My wife would give me one pill at a time. The pills really didn't help, so I just took Tylenol. I learned that a person can endure quite a bit of pain. For nine months, I had pain every day and night. I realized how powerful the mind can be. My prayers to all in chronic pain, and to all of those addicted.

[sparks224]

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