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.
In Nora Ephron's best-selling book, I Feel Bad About My Neck, she laments the sorry state of her 60-something neck: "Our faces are lies and our necks are the truth. You have to cut open a redwood tree to see how old it is, but you wouldn't have to if it had a neck," she writes.
"Every so often I read a book about age, and whoever's writing it says it's great to be old. It's great to be wise and sage and mellow; it's great to be at the point where you understand just what matters in life. I can't...
"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.