Pubdate: Thu, 04 Apr 2002
Source: Salon (US Web)
Copyright: 2002 Salon
Contact:  http://www.salon.com/
Details: http://www.mapinc.org/media/381
Author: Damien Cave
Note: Damien Cave is a senior writer for Salon
Bookmark: http://www.mapinc.org/find?186 (Oxycontin)

NO RELIEF

The War On Drugs Is Preventing Many Americans From Getting Desperately 
Needed Pain Medicine

After three decades of chronic, searing pain, Marie Dabrowski was finally 
able to sleep. She was able to think. And sometimes, thanks to her new 
pills, she could almost forget about her fibromyalgia, a mysterious nerve 
disorder characterized by fatigue, migraine headaches and full-body aches.

But Dabrowski's respite did not last. The medication responsible for her 
two-year break from daily misery was OxyContin. And about a month ago, 
Dabrowski's doctor cut her off. The move had nothing to do with callousness 
or lack of concern, says Dabrowski, who asked that her doctor remain 
anonymous. Instead, the doctor was spooked by a proposed Virginia law 
designed to intensify scrutiny of physicians who prescribe the drug. In the 
end, says Dabrowski, it was the prospect of police interrogation that 
pushed her doctor over the edge.

"When I went in [to her office], her receptionist explained to me that it 
was the DEA that was the problem and that my doctor was scared of getting 
in trouble," she says. "I told them that this was dangerous. People on 
[OxyContin] finally have something that keeps the pain away, and if the 
pain comes back they're going to commit suicide."

Widespread abuse of OxyContin, a painkiller made by Purdue Pharma LP, was 
first reported in the media about a year ago. Called "hillbilly heroin" 
because early cases of addiction surfaced in Appalachia, the pills were 
being crushed and then snorted or injected by users, who found the drug 
cheap and easy to obtain. Once touted by its manufacturer as a safe and 
effective alternative to highly addictive morphine, "Oxy" quickly became 
the scourge of law enforcement, spreading across the country with lightning 
speed, leaving hundreds of addicts in its wake.

Even as Purdue hastily promised to produce OxyContin in a form less 
vulnerable to abuse, legislators in at least 17 states pushed to create 
strict prescription tracking programs, while others took steps to limit the 
number of OxyContin pills that people on Medicaid can receive. The 
Department of Justice has proposed a national crackdown on painkiller 
abuse, and some states are considering laws that would ban OxyContin, as 
well as its main ingredient, oxycodone, a synthetic opiate prescribed to 
millions of patients since 1916.

It is difficult to argue with laws intended to make it harder for addicts 
to get drugs; and the DEA has said it does not want to limit the supply to 
those with a legitimate need for relief. But there are dangerous side 
effects to the new restrictive policies on prescription painkillers -- 
chief among them, widespread, unnecessary suffering. Patients with chronic 
pain, routinely undertreated in the past, had in recent years begun to get 
adequate relief, thanks, in part, to OxyContin, one of the few drugs that 
reduces or eliminates pain without nausea or damage to vital organs. The 
onslaught of regulations designed to curtail OxyContin abuse now threatens 
to reverse these advances.

Increasing numbers of the estimated 30 to 50 million people in the country 
who suffer from some form of chronic pain say the OxyContin crackdown means 
they can no longer get adequate or sustained relief. For some, the new 
rules and medical practices create frustrating delays in receiving 
medication. But for others, there is no help at all.

Cancer patients and sufferers of debilitating diseases report that they are 
getting ineffective dosages of OxyContin, running out of places to fill 
legal prescriptions for it, or finding themselves without doctors, many of 
whom choose to avoid OxyContin headaches by sending patients to overwhelmed 
pain specialists struggling with the same regulations.

Our simmering fear of painkiller abuse, brought to a boil by the OxyContin 
scare, has created a world of hurt for legitimate victims of illness: The 
war on drugs has increasingly become a war on patients.

"I wake up crying every morning because I don't have anything for the 
pain," Dabrowski says. "The law isn't even in place, but it's already 
affecting me. I feel like I'm burning from the inside out."

- - - - - - - - - - - - -

Americans have something of a tortured relationship with opioids -- pain 
relievers derived from real or synthetic opium that work on the central 
nervous system. Doctors were the earliest targets of prescription drug 
panic: As early as 1914, with the passage of the Harrison Narcotic Act, the 
government identified doctors as agents of But experts question the 
sincerity of law enforcement's dedication to those who truly need strong 
pain medication. There have been no mitigating laws passed in the interest 
of patients. Joranson, the pain policy expert, argues that in many states 
new prescription laws amount to simple politics: "Politicians need to be 
seen as doing something about drugs," he says. And others fear that 
Hutchison's stated attempt to protect legitimate prescribing will go 
unheeded. With press attention focused on doctor busts and new laws that 
extend police powers, authorities may not curtail their efforts, but expand 
them.

"While the DEA has strived to be sensitive in their central office to pain 
medications, I question whether that commitment has trickled down to the 
field," says John Giglio, one of several pain-management advocates who met 
with Hutchison last fall to plead the pain patients' case. "I also question 
whether the people in the office of diversion control have really gotten 
that message, much less gotten the additional training that they need to 
treat doctors and patients fairly."

Some patients are fighting back. Mike Schrader, for example, had his 
prescription switched from OxyContin to methadone a month ago. At first, 
the former X-ray technologist didn't mind. The methadone alleviated some of 
the pain he suffers in his hips and back -- the result of 14 separate 
surgeries -- and he was willing to give it a try. But eventually he 
discovered that the new pills were weaker than expected.

"My pain level before OxyContin was an 8 out of 10," he says. "With 
OxyContin it was on a 4-5 level. Now I'm back up around a 6."

Schrader figures that there's no reason to sit back and take the pain. He 
says that for as long as the methadone fails him, he'll keep asking his 
doctor for the same level of relief he received with OxyContin. "I'm not 
going to let him force me to suffer just because he's scared to write the 
prescription," he says.

Few victims of chronic pain have Schrader's energy or clarity of mind to 
protest undertreatment, so pain advocates are trying to back them up -- to 
little avail. "We are an opiophobic nation," says Barbara Coombs Lee, 
president of the Compassion in Dying Federation, a nonprofit that is suing 
U.S. Attorney General John Ashcroft for trying to overturn Oregon's 
physician-assisted suicide law. "We have a craziness about this issue and 
the effect is that it harms patients in pain and those at the end of their 
life."

Adds Murray, "If [OxyContin] was taken off the market right now, it would 
not hurt the drug addicts," she adds. "It would only hurt the people who 
need it. The addicts will get another drug. It's gonna be us that pays."
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