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.
Hannah Kalil is 83 years old, and lives by herself in upstate New York. She
has aides who help with her caregiving throughout the day. But the
responsibility of managing her finances, health care -- both mental and
physical -- and long-term living situation falls to one person: her daughter --
and my mother -- Eleanor.
It's almost a full-time job. Making sure my grandmother is happy and not
feeling lonely means daily visits. Her never-ending stream of medical issues
means weekly -- if not...
"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
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.