Pubdate: Thu, 26 Feb 2004
Source: Sun Herald (MS)
Copyright: 2004, The Sun Herald
Contact:  http://www.sunherald.com
Details: http://www.mapinc.org/media/432
Author: Jean Prescott
Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone)
Bookmark: http://www.mapinc.org/find?232 (Chronic Pain)

OXYCONTIN ABUSERS GIVE DOCTORS PRESCRIPTION DILEMMA

The U.S. Drug Enforcement Agency has come down hard on doctors who
would seem to be careless in the prescription of certain pain-killing
medications, powerful opiods including OxyContin, a drug intended to
treat chronic pain.

National Public Radio reported a particularly scary story Feb. 12
about a Tucson, Ariz., pain doctor whose office was raided and her
files confiscated by DEA agents. The agency determined that this
doctor prescribed the offending drug far too often.

Will doctors discontinue to prescribe any such drugs for fear of being
targeted by the DEA?

"More likely they would be afraid of being sued (by their patients),"
says Dr. Bhavin Suthar, a pain specialist who practices in Jackson
County and with the Singing River Hospitals system.

People who have taken OxyContin are being invited, via television
commercials, to participate in class-action lawsuits regardless of the
outcome of their treatment, "And they aren't even aware that they are
suing their own doctors," Suthar says.

The drug is "in the cross-hairs," he says, "because so much punch can
be packed into one pill. It's time-release, so one pill might contain
80, sometimes 160 milligrams of the drug. But drug abusers can take a
pill and crush it. They can chew it or even snort (the powder) and get
a huge high immediately. Kids don't realize how many milligrams are in
one pill, so they take these high doses, and they stop breathing
(overdose)."

He believes the vast majority of people with legitimate chronic pain
complaints and their primary care physicians, the doctors who refer
patients to the pain specialist, are on solid ground.

"Here's the biggest problem," he says. "People don't completely
understand the definition of addiction. Addiction means that you
continue to take a medication despite of doing harm to yourself."

Physical dependence, tolerance and withdrawal are not the same things
as addiction.

"All are very different, but people have the mistaken notion that they
are just different ways of saying the same thing.

"Anyone who takes an opiod for at least several months - it could be
you, the pope, even the president. If you take the medication and then
stop suddenly, you will have withdrawal. That doesn't mean you were
addicted.

"Physical dependence is not the same as addiction, either. It means
that your body requires the medication to prevent the pain. It
shouldn't have a negative connotation."

Tolerance is yet another misunderstood term: "If you take a medication
for some time, your body does become tolerant, and you will need a
larger dose or a different drug" to achieve the same end. Again, a
condition quite different from addiction.

"Of course you have to be cognizant of the medications you prescribe,"
Suthar says, but if a pair of doctors working together to assess a
case agree that a patient needs opiod therapy, everyone "should be
just fine, the doctors and the patient.

"Here's what we do," he says and then runs down a list of
always-and-never practices beginning with the fact that his patients
are always referrals, and, "We don't prescribe opiods until we develop
a relationship with the patient. We do try to get the patient on
appropriate medication, and there are some diagnoses in which opiods
aren't going to help.

"In any case, patients have to be periodically drug tested, for legal
and illegal drugs. We're not the Gestapo, but we must do the testing
because I cannot subjectively determine who's taking what. Addicts
look just like you and me, and I never try to size someone up just by
looking at them.

"We don't make it easy for someone to walk in off the street and
obtain medications without the proper medical workup. But understand
that pain management is not just about prescribing opiods. It's a lot
of other things, too. We give injections, suggest physical therapy,
pain psychology, maybe even surgery. We try to relieve pain so (the
patient) can get off medication."
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MAP posted-by: Larry Seguin