Pubdate: Sun, 07 Jul 2002
Source: Charlotte Observer (NC)
Copyright: 2002 The Charlotte Observer
Contact:  http://www.charlotte.com/mld/observer/
Details: http://www.mapinc.org/media/78
Author: Cristina C. Breen And Debbie Cenziper

FOR MANY, DRUG IS A WAY OUT OF UNREMITTING AGONY

POWELL'S POINT - When the pain overwhelms her, Mary Pittman props pillows 
around herself and covers the bedroom window with a comforter to keep out 
the light.

For weeks, she's been confined to bed in her home on the Outer Banks near 
Kitty Hawk because of crippling pain in her knees, back and abdomen.

"Look at them," she says as she and her three daughters lie in bed watching 
the movie "Anastasia." "It's a bright, sunny day and where are they? In the 
house."

Pittman cuddles with her 6-year-old, Mercedes.

"She's going to be 7," says Pittman, 34, "and I've been down half her life."

In the late 1990s, health problems, including degenerative disc disease and 
a shattered knee, left her bedridden. In November 2000, she started taking 
OxyContin, and until recently was able to withstand the pain.

But five months ago, Pittman lost her access to OxyContin when the Drug 
Enforcement Administration seized her doctor's registration to prescribe 
narcotics, saying, among other things, that he inappropriately prescribed 
narcotics to abusers.

Pain patients like Pittman say the DEA, police, the medical community and 
the media have too heavily focused on OxyContin abuse when the drug has 
brought relief to thousands.

The fury over OxyContin, patients say, has prompted some doctors to label 
pain patients as addicts, and at times cut patients off from the drug.

Officials from Connecticut-based Purdue Pharma, a privately held company 
which manufactures the drug, also fear patients may go without treatment.

The company did not anticipate the extent of abuse of OxyContin, officials 
say. Purdue has taken steps to discourage abuse, including developing an 
abuse-resistant pill, but it will likely take months or years before it's 
available.

Publicity about OxyContin, meanwhile, has frightened doctors, says Purdue 
spokesman Jim Heins.

"What happens," Heins says, "is that patients suffer."

DEA officials and local law enforcement counter that abuse of few other 
prescription drugs has presented as massive a challenge. Part of the blame, 
say some doctors, addiction experts and law enforcement, lies with Purdue.

The head of the DEA testified in Congress last December that Purdue has 
contributed to the disproportionate abuse of OxyContin by representing the 
drug as having a lower abuse potential than other narcotic pain relievers, 
and encouraging physicians to use OxyContin over less addictive painkillers.

At a February congressional hearing, a doctor representing professionals 
and community members in one of the hardest hit Virginia regions said 
Purdue "heavily lobbied" primary care physicians to prescribe OxyContin 
even though those doctors traditionally have little training in pain 
management and addiction.

Purdue faces lawsuits from patients who say they became addicted after 
taking OxyContin.

The Food and Drug Administration, which regulates the promotion of drugs 
approved by the agency, in May 2000 told Purdue it was inappropriately 
representing OxyContin in a medical journal advertisement. Purdue disagreed 
with the FDA, but pulled the ad. FDA officials have said the company's 
marketing efforts have complied with regulations, but the FDA does not 
regulate the extent to which a company chooses to promote a product.

Purdue officials defend their appeal to primary care physicians.

"These people are out there on the front lines treating pain," says Dr. 
David Haddox, senior medical director at Purdue.

The company only promoted OxyContin to health-care professionals who were 
already prescribing opiod painkillers, officials say. They add Purdue has 
not promoted OxyContin as less abusable than other painkillers, and did not 
encourage doctors to switch medications unless those drugs were not working.

To curb abuse, the company has launched an education and prevention 
campaign, including working with law enforcement and educating medical 
professionals about how to spot abusers.

Company officials, meanwhile, argue OxyContin fills a crucial need.

For decades, experts say, chronic pain was often inadequately treated 
because doctors feared narcotics like morphine were too addictive to 
prescribe long-term. New research has shown narcotics can be used 
successfully to treat pain.

About 50 million people in the United States suffer from chronic pain, but 
a majority go untreated.

Pittman was a patient of Dr. Joseph Talley, a general practitioner who ran 
a medical clinic in Grover, N.C. But when the DEA suspended Talley's 
registration to prescribe narcotics in February, Pittman's world collapsed.

Unable to find a doctor, she went to a Virginia pain clinic, where she says 
doctors treated her "like a drug addict" and wouldn't prescribe narcotics. 
The pain returned.

Doctors in pain clinics and emergency rooms defend their hesitation to 
immediately prescribe narcotics.

"I think the patient is not necessarily the best judge of what the best 
medication is," says Dr. Gerald Aronoff, chair of the Department of Pain 
Medicine at Presbyterian Hospital and past president of the American 
Academy of Pain Medicine

In early May, Pittman found a pain doctor in Raleigh willing to prescribe 
narcotics.

"Now I totally understand when someone says they hurt," Pittman says. "My 
heart breaks for them."
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