Pubdate: Wed, 15 Aug 2001 Source: USA Today (US) Copyright: 2001 USA TODAY, a division of Gannett Co. Inc Contact: http://www.usatoday.com/news/nfront.htm Details: http://www.mapinc.org/media/466 Author: David M. Sibell, M.D., Oregon Health and Science University, Portland, Ore AVOID MISINFORMATION I thank USA TODAY for the well-balanced article on the benefits and risks of the use of opioid medication to treat chronic pain. As a pain management specialist, I am familiar with these issues. I have seen a preponderance of bad journalism on opioid drug abuse recently. Some stories report the misconception that there is a substantial risk of addiction when opioid medication is used appropriately. In fact, fewer than 1% of patients taking opioids by prescription become addicted. This leads to the question of which drugs cause more risk. Currently, the hot topic is OxyContin. In the past, there were similar problems with Duragesic, Dilaudid and morphine. Before this, opium and laudanum were abused. These are all controlled substances because of the potential for abuse. Currently, abuse is largely restricted to those who obtain the drug illicitly. When a patient abuses his or her medication, there are safe and effective means to deal with these issues. A vigilant physician can practice medicine safely and effectively using current practice and regulatory guidelines. So what medications are most frequently abused? The most common prescription drug abused in the United States is hydrocodone/acetaminophen -- that is, such drugs as Vicodin, Lortab and Lorcet. This medication combines a short-acting opioid with acetaminophen. It is considered Schedule III by the U.S. Drug Enforcement Administration, which means that physicians can phone in prescriptions and give refills. With Schedule II drugs -- OxyContin, Duragesic, Dilaudid, morphine -- this is not possible. The increased availability of hydrocodone/acetaminophen has led to widespread indiscretion in its use. For some physicians, this is the only medication they seem to know. Lastly, I have communicated with the pharmacists in charge of drug recovery in Oregon and California on this issue. They have verified that much, if not most, of the current OxyContin abuse results from illegal trafficking of this drug across our borders with Mexico and Canada. Some diversion from patients has occurred, but this is thought to represent the minority of street abuse of this drug. Therefore, while physicians and patients alike must exert caution with opioid medications, the current atmosphere of panic over these medications largely overestimates the public health impact nationally. As USA TODAY's article states, the widespread tolerance of chronic pain by society leads to far more disability and mental health disorders than this abuse issue. Therefore, as regulatory agencies investigate this problem, it is essential that they bear in mind the good that comes from the appropriate use of these medications. They must not prevent physicians from prescribing opioids, but should rather improve the education and safety of medical practice regarding these medications. David M. Sibell, M.D. Oregon Health and Science University Portland, Ore - --- MAP posted-by: Jay Bergstrom