Pubdate: Sun, 23 Sep 2001
Source: State, The (SC)
Copyright: 2001 The State
Contact:  http://www.thestate.com/
Details: http://www.mapinc.org/media/426
Author: Valerie Bauerlein
Bookmark: http://www.mapinc.org/find?186 (Oxycontin)

POPULAR PAINKILLER MIRED IN CONTROVERSY

S.C. Severely Limits Use Of Oxycontin By Medicaid Patients, Fearing Drug Abuse

South Carolina has enacted the most rigorous restrictions in the country 
for Medicaid patients seeking prescriptions for Oxycontin. Since June, the 
state has required doctors to ask a state pharmacist's permission before 
prescribing the drug, a powerful narcotic called the "hillbilly heroin" for 
its popularity in Appalachia and the high it gives when crushed and snorted.

Medicaid patients who have cancer, sickle cell or terminal illness still 
qualify for the drug. But hundreds of patients who were taking Oxycontin 
for back pain or other problems do not.

Also, many doctors are moving patients to other painkillers rather than 
spend 10 minutes or more on the phone, answering the state pharmacist's 
questionnaire on prior approval.

The state said it restricted access to the drug to reduce the risk of abuse 
and possible side effects, such as addiction and physical dependence. An 
added bonus has been a monthly savings of about $400,000. Drug manufacturer 
Purdue Pharma is striking back, saying the state is giving preferential 
treatment to people with one kind of pain, such as cancer, over another.

Ruptured discs, osteoarthritis and fibromyalgia also can be treated by 
Oxycontin. "Pain is pain," spokesman Jim Heins said.

Lobbyists Hired

The fight over Oxycontin is about health. But, critics say, it also is 
about money, control and politics.

Purdue Pharma, based in Stamford, Conn., has hired two of South Carolina's 
most influential political figures as advocates: attorney Dwight Drake and 
political consultant Richard Quinn Sr.

Drake is a close friend of Democratic Gov. Jim Hodges and a former 
colleague in then-Gov. Dick Riley's office with Bill Prince, now executive 
director of the state Health and Human Services Department, the agency that 
administers Medicaid.

Quinn is a Republican political strategist who is managing the 
gubernatorial campaign of Attorney General Charlie Condon. He also is the 
father of State Rep. Rick Quinn, R-Richland, House majority leader and head 
of the House's health subcommittee.

Purdue Pharma also will step up a public-relations campaign in South 
Carolina, beginning in early October. The program will include a new drug 
prevention campaign for teens.

Powerful Form

Oxycontin is a powerful form of oxycodone, a painkiller in legal use in the 
United States for decades and the key ingredient in drugs such as Percodan. 
Oxycodone is a Schedule II controlled substance, considered by the federal 
government to be second only to drugs such as heroin and cocaine in its 
habit-forming potential.

What makes Oxycontin different from other oxycodone drugs is its 
time-release formula.

The drug is released steadily over 12 hours, a boon to very sick people who 
do not want to take pills every few hours. Also, patients say they feel 
more alert on Oxycontin than other narcotics.

The time-release function that is the drug's boon also has been its bane, 
however.

Drug abusers have found that by crushing and snorting a pill, they get a 
euphoric high  -  the result of ingesting 12 hours of narcotics in seconds.

South Carolina has not had as high a rate of reports of Oxycontin-related 
thefts, overdoses and deaths as other East Coast states, such as West Virginia.

But Oxycontin has risen quickly in popularity. Three years ago, it was not 
on the list of the 40 most-prescribed drugs for Medicaid patients. Now, 
that list includes three strengths of Oxycontin.

As for incidents of fraud, Health and Human Services had noticed unusually 
high numbers of prescriptions coming from some locations, including a 
Myrtle Beach pain clinic, closed in June as a result of Drug Enforcement 
Agency sanctions.

The S.C. Department of Health and Environmental Control reported 32 of its 
420 cases of prescription drug fraud were related to Oxycontin last fiscal 
year.

Since July 1, 13 of 103 of all cases have been related to Oxycontin.

Much of the evidence about addiction is anecdotal.

Dr. Stephen Merlin, the director of chemical dependency at Palmetto 
Richland Memorial Hospital, said he has seen more than 100 patients on 
Oxycontin in the last six months.

"I've seen a 75-year-old woman addicted to Oxycontin, and I've seen an 
18-year-old boy."

Doctors are over-prescribing Oxycontin because it is well-marketed and it 
cures pain. But many patients don't need a drug as strong or as 
habit-forming as Oxycontin, Merlin said.

Tighter Rules

Early this spring, the state looked at prior approval as a way to control 
prescription drug costs, particularly for expensive name-brand drugs.

The state picked several classes of drugs, including heartburn and antacid 
drugs.

The stated added Oxycontin after detecting fraud and hearing anecdotal 
evidence about addiction and abuse.

Doctors questioned the changes at first, especially for the popular antacid 
drugs.

But the most pressure by far has been expended by Purdue Pharma, said 
Prince, director of Health and Human Services.

"I think by the people they've employed in the state, they're trying to 
affect the change," Prince said, adding that there has been "significant 
political pressure."

Purdue Pharma said it would not release specific statistics about S.C. 
usage. But the Medicaid numbers show that more than half the patients who 
had been taking Oxycontin before prior approval since have been prescribed 
an alternative.

In June, the agency approved prescription requests 197 times and denied 
them 9 times. Physicians changed the patient to another drug 380 times. In 
July, the agency approved the drug 155 times and denied it 7 times. Doctors 
changed to another drug 149 times.

Patients Or Profits?

Purdue Pharma posted more than $1 billion in revenues last year.

Said Prince: "If this was not affecting them in the pocketbook, they would 
not have any concern about what we do with the Medicaid program."

But spokesman Heins said Purdue Pharma is concerned about patients, not 
profits.

"When you get calls from patients every day who are often condemned to pain 
the rest of their life and they can't get treatment because of drug abuse, 
it's real sad."

Dr. Matt Midcap is the medical director at the Center for Pain Management, 
affiliated with Palmetto Baptist Hospital.

Midcap maintains that Oxycontin is no more addictive than other narcotics. 
When taken properly, the risks of becoming addicted are minimal: one in 
10,000, according to a 1996 study.

Midcap often speaks to physicians about pain, sometimes at conferences 
underwritten by drug companies, including Purdue Pharma. "My question to 
the physicians I talk to is: Do you not treat the 9,999 patients for risk 
of the one?"

He is outraged by requiring prior approval. "I think it's kind of 
discriminatory, really."

Drake, the Columbia attorney, said the state is setting policy on the basis 
of what saves money, not what makes people better. He sent the agency a 
letter late last month, arguing that the agency changed its policy to 
require prior approval of Oxycontin, but not other oxycodone drugs, without 
notifying Purdue Pharma.

To avoid a lawsuit, Drake said the agency should change its policy to allow 
patients to have up to six tablets a day, or 180 tablets a month, without 
prior approval.

Drake said he is optimistic the state and the drug company can negotiate an 
agreement. That, if anything, is all his relationships with Hodges, Prince 
and others would help foster, he says.

"I trust them, I have confidence in them, I hope they would feel likewise."

Health and Human Services might consider some change, Prince said, but only 
as a temporary "test-case" to compare usage with and without prior approval.

Prince, also a lawyer, said the department is on sound legal ground in 
requiring prior approval.

The state was not obligated to notify drug manufacturers of any change, 
just the physicians and pharmacists, Prince said, adding that it is 
following established guidelines for prior approval.

House Majority Leader Rick Quinn said he supports prior approval for 
Oxycontin and other drugs. Quinn said he has felt no pressure from his 
father to change his position.

Drug costs have been a major factor in Health and Human Services' running a 
deficit for the past four years, Quinn said.

"We have just got to control those costs," Quinn said. "I think prior 
approval and some of the other things the agency asked for are right on 
target."

Prince said the goal is to control Medicaid costs but also to ensure access 
to appropriate drugs. "We're not denying anybody," Prince said. "We're just 
regulating the use."
- ---
MAP posted-by: Beth