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
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
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
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.