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OxyContin: Pain Relief vs. Abuse

Are worries over abuse having an impact on the drug's legitimate use as a painkiller?

Treatment of Pain in Addicts continued...

Pinsky, author of When Painkillers Become Dangerous: What Everyone Needs to Know About OxyContin and Other Prescription Drugs, says the risk of addiction is so great, not only for addicts but for anyone genetically prone to addiction, that any patient who comes forward with pain should first be asked if there is a family history of alcoholism or addiction.

"How does the health care provider know who is genetically predisposed to addiction? It may be hidden back three generations. The risk is triggering opioid and opiate addiction, the addiction with the poorest prognosis." Opioids and opiates act similarly on the brain and the terms are often used interchangeably, but unlike opiates, opioids -- such as methadone -- are not morphine based.

Pinsky admits to holding a minority view when he says no one should be treated with opiates more than two weeks, particularly if there's a family history of addiction. "If you have a history of addiction and have an extraordinary need to go beyond two weeks, it needs to be monitored very carefully by someone in the addiction field." He says there are many non-narcotic pain medications, such as Toradol, and alternative therapies, such as acupuncture, massage, and chiropractic treatment.

Pinsky, who is medical director for the department of chemical dependency services at Las Encinas Hospital in Pasadena, Calif., tells WebMD he admits at least two patients a day for overusing painkillers. "They've been addicts all along. They didn't suddenly develop an addiction. They come to me with overwhelming pain -- back pain, neck pain, headaches. They can't sleep."

He says chronic physical pain in addicts is often an expression of past trauma. Drugs relieve the pain but feed the addiction. His approach is to take them off the pain medicine. "I say it will be the worst pain of your entire life for two weeks, but that will be the end of it. Meanwhile, we do 12-step and group therapy programs with them and intensive treatment of their withdrawal."

The Backlash of OxyContin Abuse

In certain parts of the country, the crackdown on illegal use of OxyContin has made it hard for pain patients to get legitimate prescriptions.

"OxyContin was the first prescription medication listed as a drug of concern by the federal Drug Enforcement Agency, which made it a target," says Ronald T. Libby, PhD.

The drug, Libby says, is "monitored by pharmacies and [Perdue] Pharma, the maker of OxyContin. Some physicians, knowing the DEA or sheriff is looking at these scripts, refuse to write prescriptions for fear of prosecution. Doctors can be scammed, and if a patient takes some pills and sells some, the doctor can be guilty of diversion." Libby is the author of a Cato Institute policy report titled "Treating Doctors As Drug Dealers: The DEA's War on Prescription Painkillers" andprofessor of political science and public administration at the University of North Florida in Jacksonville.

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