Pubdate: Wed, 16 May 2001 Source: Cleveland Free Times (OH) Issue: May 16-22, 2001 Section: Public Square Copyright: 2001 Cleveland Free Times Media Contact: http://www.freetimes.com Details: http://www.mapinc.org/media/1385 Author: Sandeep Kaushik OXYMORONS : GOVERNMENT NOW PRESSURING DOCTORS AND PURDUE PHARMA ABOUT OXYCONTIN PANIC On the morning of Tuesday, May 1, just hours before the Free Times went to press with "OxyCon Job: The Media-Made OxyContin Drug Scare," The New York Times reported that the Drug Enforcement Administration (DEA) was attempting to limit sales of OxyContin. The leading agency of the "war on drugs" is asking the manufacturer, Purdue Pharma, to sharply limit its marketing of the huge-selling morphine-like painkiller. The action - a first for the agency, which never before had fixed its sights on a single prescription drug - was justified by the alleged tidal wave of illegal abuse associated with OxyContin. A slew of sensational media reports had labeled Oxy the new "street drug of choice" across the country, the agency claimed. The N.Y. Times had good reason to crow about the DEA action, the first in a series of recent state and federal government attempts to turn up the heat on the manufacturer. Back on March 5, it had published its own major examination of the OxyContin "epidemic," reprinted in scores of papers nationally, which redirected government attention squarely onto the company and the doctors who prescribe the opiod analgesic, and away from illicit users and sellers. Other media accounts had limited themselves to repeating the self-interested pronouncements of narcotics cops and publicity-seeking politicians about an explosion of abusers. For instance, many media outlets reported that, in eastern Kentucky, the heart of the "epidemic," there had been around 60 deaths as a result of Oxy. But in fact, a Free Times investigation reveals that only two deaths in the entire state can be attributed solely to an overdose of Oxy - and suicide can't be ruled out in either case. Sales reps from a competing pharmaceutical company are telling doctors that the DEA's going to get them for prescribing Oxy. But the NYT story instead attempted to ferret out the origins and root causes of the burgeoning trend. The explanation was two-pronged. First, Purdue Pharma sales reps had aggressively oversold the powerful, morphine-related analgesic to general practitioners as a first-choice drug, and second, the company's marketing efforts geared to those docs - including free trips to Purdue-sponsored pain management seminars in resort locales - were uniquely unethical, nearly crossing an invisible line into bribery. Many GPs were essentially duped into "over-prescribing" the drug, the article implied, and with legitimate sales ballooning past the $1 billion-per-year point in only five years, surging illicit usage followed close behind. The NYT account has become the single most widely disseminated article on OxyContin. And now it seems to have caught the attention of the frontline drug warriors at the DEA, as well as other government bureaucrats, leading to public pressure on Purdue to crack down on overprescribing doctors. Meanwhile, the wave of negative OxyContin media coverage has continued to crest, with dozens of fresh accounts published in metropolitan dailies or beamed over the airwaves, even though actual hard evidence of significant abuse outside of Appalachia remains thin to nonexistent (for example, in Cleveland, there have been only eight criminal incidents involving Oxy in the last two years). Since the publication of "OxyCon Job," the Free Times has received dozens of calls, notes and letters, many from leading experts in the pain management community, who have not only derided media reporting as hopelessly biased and misinformed, but also have questioned - if not outright contradicted - the findings of the NYT writers and the government actions based on them. The NYT focus on Purdue salesmen as drug pushers, some doctors contend, is the result of competitors in the pharmaceutical market, who are seemingly intent on building support for their own products by making many doctors too afraid to utilize an important weapon in the battle against debilitating, long-term pain. Sales representatives from a competing pharmaceutical company have been "telling every doctor around here [in turn] that [each doctor is] the number-one prescriber of OxyContin, and sooner or later the DEA's going to get him," says Dr. Dana Richard, a pain specialist in Palm Beach, Florida. "It's beyond ridiculous, it's insulting." Another tells of hearing similar reports from across the country: "I've heard reps from [the competitor] have been approaching key prescribers with the Times [article], telling them OxyContin is too dangerous and prone to abuse and they need to switch to their product," a tactic he describes as a "dirty tricks" marketing strategy. The extent of such efforts is unclear, but there is no question that any such activity represents an ethically dubious attempt to undercut the medical community's reliance on a critically important lifeline for tens of thousands of previously undertreated chronic pain sufferers. What's more, specialists in the field reveal that Purdue has distinguished itself as a leader in the field of physician training regarding pain management, and that there is nothing shady about the educational seminars and lectures they sponsor, which fill a void left by inadequate medical schooling. "Seventy-six percent of medical school graduates get no pain management training in medical school," says Dr. Howard Heit, a chronic pain sufferer since a car wreck in 1986 left him wheelchair-bound for four years. He also just happens to be a pain specialist in Fairfax, Virginia. "I saw firsthand how little pain training my fellow physicians had after my accident," he explains. "It's one of the reasons I became a lecturer for Purdue." The programs Purdue puts on, he adds, focus on legitimate education about general pain management techniques: "They're not about selling a particular product." As for giving doctors free trips to weekend seminars, a centerpiece of the NYT allegations, that may well be a no-no, says Mike Lynch, a spokesman for the American Medical Association. But he admits "it happens all the time." "It's industry-wide," concurs Micke Brown, a registered nurse who is a pain management advisor for the American Pain Foundation, "though the Purdue events are real educational meetings, unlike some others." Despite the educational benefit, the company has recently discontinued the practice of offering free trips to the sessions, a Purdue spokesman states. The sustained, simultaneous assault from the press, and now the government via the DEA, is having an effect. Last Friday, Purdue announced it would "temporarily suspend shipment" of the largest OxyContin pill size, provoking yet another round of negative media coverage, some of which has misleadingly portrayed the move as a harbinger of the drug's imminent removal from the market altogether. Take last Friday's noon report on WEWS Channel 5 in Cleveland, a three-sentence story stating in part that "if you rely on OxyContin for pain relief, you may have to find another drug," since Purdue has "suspended shipments of the high-dosage pill" due to "a growing problem with abuse." No mention was made that the 160mg pill accounts for only 1 percent of the drug's sales, leaving the other four sizes completely untouched. One doctor was charged with manslaughter when the patient gave pills to his son, who then died from mixing Oxy with alcohol. The move does show how desperate Purdue has become to stave off further government interventions - the FDA is now pushing them to alter product labeling, a group of state attorneys general has begun the formation of a national OxyContin task force, and the DEA has warned that it will "target aggressively" medical professionals who "over-prescribe" the drug - as politicians and officials scramble to respond to and capitalize upon the heightened media interest. That the company has been forced into even this seemingly minor concession angers some pain control experts. "It's incredibly irritating," says Dr. Richard of Palm Beach. "We finally get a good medication that can help people with serious pain, and it suddenly gets all this bad press and government pressure." While he understands the company's motives, he believes its decision is a serious mistake. "It looks like they're taking their scared asses and running, leaving us people who believe in the product alone on the front lines," he argues, adding that "the bottom line is that OxyContin is a useful tool for the treatment of chronic, intractable pain." Meanwhile, the DEA and local police around the country have already begun their "aggressive" monitoring of physicians. Brown tells of tagging along with a Purdue sales representative calling on doctors in rural Virginia. One told the rep that less than 30 minutes after her last visit, local DEA agents showed up at the office to question him about both what the rep had told him and whether he was going to start prescribing OxyContin to his patients. "We began to wonder if we were being followed and whether we were going to get arrested that day, even though we weren't doing anything wrong," she explains. Later that same day, she was asked by a gas station attendant to sign an anti-Oxy petition. Mary Baluss is an attorney with the Bazelon Center for Mental Health Law in Washington, D.C., working to break down legal barriers to better pain management; many of her cases involve aiding good, caring doctors charged with crimes by authorities ignorant of pain management techniques. She tells of a doctor in rural California charged with multiple counts of murder for prescribing opiods to legitimately suffering patients. One of the murder counts - thrown out by a judge - centered on a patient who died while a passenger in a car wreck. Authorities said because she was on morphine she was unable to assist the driver when he lost control of the vehicle, and therefore, her death was the doctor's fault. In another count - reduced to manslaughter - the doctor prescribed opiods to a legitimate patient, who gave some of the pills to his son, who then died after mixing them with alcohol. Again, the doctor's fault. The clincher, Baluss says, is the one where the doc was charged because a patient, upon learning that the physician was under investigation, committed suicide because she became afraid her pain would no longer be adequately treated. The combination of negative press coverage, like the NYT article, and overzealous law enforcement is making many already leery general practitioners completely unwilling to prescribe much needed medication, according to dozens of letters sent to the Free Times by chronic pain victims. One patient, who asks to remain anonymous, asserts "I was told by my doc that because of the sensational media attention ... the DEA is planning on regulating OxyContin to control its abuse and, most likely, he will soon not be able to write scrips for me or his other chronic pain patients who need this drug." And while such fears are shared by almost all chronic pain patients, others report being harmed even more directly by the hyperbolic media coverage and government crackdown. No story is worse than that of Jeannie Wills-Ray, from a small town in Pennsylvania just across the Ohio border, the victim of an aborted house robbery directed at her supply of the medication. Though she staved off her attacker (who, she concluded, was a strung-out heroin addict), her problems only really began with the arrival of the police. "They immediately seized my prescription bottle and began to count the pills inside," she relates. "They treated me like some crack dealer who had been taken on the street corner and dared to report it as a robbery." The situation grew even more horrifying when the local newspaper got involved. The cops "released my most private information to the local newspaper, who printed my name, age and complete address in a highlighted area of this popular news rag," she recounts angrily. "I was in more danger than I ever was from the robber himself."