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.
When Nancy Levitt's mother was first diagnosed with dementia 14 years ago at age 78, the doctor told her she could safely drive to familiar places. But Levitt, 61, who volunteers at UCLA's Center on Aging in Los Angeles, was still nervous. Unexplained nicks and dents started appearing on her mother's car. She forgot where she parked. Levitt tried to discuss driving safety with her mother, but she angrily denied there was a problem. Then, she would forget their talks about driving altogether.
"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.