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Nothing to Fear but Pain Itself

Are You Opio-Phobic?
By
WebMD Feature

Aug. 13, 2001 -- Oncology nurse specialist Carol Blecher, RN, MS, AOCN, knows the face of pain and the face of fear.

Cancer, says Blecher, is not a gentle, silent enemy but rather a painful, raging foe, which must be fought with powerful weapons that often cause their own unremitting pain. So easing or eliminating a patient's pain is often Blecher's primary concern.

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"But every day patients and families come to me filled with fear about taking opioids," she says -- narcotic drugs like methadone, morphine, and OxyContin. That fear, called "opio-phobia," can stand in the way of relief for many patients.

At her office at Valley Hospital System in Ridgewood, N.J., Blecher says the media frenzy surrounding abuse of the long-acting painkiller called OxyContin has fueled patients' fears. "Now patients and families are asking: Does this drug make you an addict? I have to just tell them over and over that they are taking the drug for pain, not for addictive reasons," says Blecher, a spokesperson for the Oncology Nursing Society.

Drug a 'Lifeline' for Cancer Patients

The furor surrounding use of opioid painkillers is very frustrating for pain management specialists like Syed Nasir, MD. "I take care of people who have cancer, and for these people [OxyContin] is a lifeline," says Nasir, a neuro-oncologist at the Culichia Neurological Clinic in New Orleans.

Both patients and physicians have traditionally been wary about the use of narcotics for pain relief, he says, because of fears it could trigger addiction. It makes for a great movie-of-the-week plot -- traumatic injury leads to unrelenting pain that can only be eased with morphine, turning an unsuspecting housewife or grandmother into a raving junkie -- but such tales have little basis in medical reality, says Nasir. In fact, he says, only about 1% of people who take drugs such as OxyContin for treatment of chronic pain will become addicted.

How It's Abused

Johns Hopkins University cancer expert Michael Carducci, MD, tells WebMD that some cases of OxyContin abuse may be related to confusion about how the drug should be given. Doses of older long-acting opioids, such as MS-Contin, could be increased from two times a day to three, four, or more times a day. OxyContin, on the other hand, is "a twice-a-day drug, not three times, not four times a day," he says.

The drug's special formulation allows for an immediate release into the bloodstream followed by "12 hours of slow release, so each pill lasts for 12 hours," says Carducci.

Abusers of the drug discovered that if extended-release OxyContin pills were ground up and snorted or injected, the user could, in effect, get the entire 12 hours' worth of drug at one time, resulting in a much more intense high. Such use has been blamed for around 100 deaths nationwide and prompted the FDA last month to strengthen warnings on the drug's label, likening it to morphine. The agency also mailed letters to doctors, pharmacists, and other healthcare providers alerting them of its potential for abuse.

And just last week, manufacturer Purdue Pharma announced its plans to reformulate the drug in an effort to discourage such abuse. The new form of OxyContin -- available in three to five years -- will come mixed with tiny beads of naltrexone, a drug that counteracts the effects of narcotics and is used to treat heroin addiction. The naltrexone is designed to be inactive as long as the pill is intact -- crush it, however, and the high-busting naltrexone is released.

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