Pubdate: Mon, 21 Feb 2005
Source: U.S. News & World Report (US)
Copyright: 2005 U.S. News & World Report
Contact:  http://www.usnews.com/
Details: http://www.mapinc.org/media/464
Author: Elizabeth Quera
Bookmark: http://www.mapinc.org/find?232 (Chronic Pain)
Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone)
Bookmark: http://www.mapinc.org/walters.htm (Walters, John)

THE NEWEST WAR ON DRUGS

When Anne's grandmother was hospitalized two years ago with chest pains, 
she couldn't remember what medications she was on. So doctors sent Anne to 
the woman's home in eastern Washington State to look in her cabinets. What 
they found shocked both the family and the doctors. In the basement, the 
woman had several copies of the Physician's Desk Reference, scales for 
weighing pills, and a cupboard chock-full of both prescription and 
over-the-counter medications. All in all, doctors told the family later, 
she had 11 types of prescription medications, including at least 400 Valium 
pills. Her medications, doctors said, would probably fetch about $15,000 on 
the street. "When I went down there," says Anne, "I thought, 'Oh my God, it 
looks like a pharmacy in here.' "

To get pills, Anne's grandmother would go from doctor to doctor complaining 
of anxiety, asking each for a prescription so that, unbeknownst to the 
doctors, she racked up a huge stockpile of drugs. The practice is known as 
"doctor shopping," and it's one of the most common ways that prescription 
pills are obtained illegally. Figuring out how to stop the practice, along 
with other strategies people use to obtain prescription drugs illegally, is 
a major challenge facing law enforcement, the medical profession, and 
government agencies.

Though use of illicit drugs has held relatively stable, prescription-drug 
abuse has risen dramatically in the past few years. Indeed, only the 
illegal use of marijuana is more prevalent today. Although abuse is rising 
among all age groups, officials are especially concerned about abuse among 
teenagers: One in 10 high school seniors has tried the painkiller Vicodin 
without a prescription, and 1 in 20 has taken the potent pill OxyContin.

Local, state, and some federal agencies have been combating this problem 
for decades. But the issue started getting widespread attention just last 
year, when the Bush administration released its first-ever plan targeting 
prescription-drug abuse. The White House set up new federal 
programs--including increased physician education and support for state 
prescription monitoring efforts that can catch people with multiple 
prescriptions for the same drug. In addition, two members of Congress 
introduced the Prescription Drug Abuse Elimination Act, some provisions of 
which passed as part of another bill. And outside the government, the 
Partnership for a Drug-Free America recently completed a study of 
adolescent attitudes on prescription drugs and will most likely release an 
ad campaign later this year warning of the dangers of popping pills. As 
these efforts gear up, experts at all levels are realizing that fighting 
the war on prescription drugs may be unlike anything they've done before.

"Kiddie Dope."

"We are faced here with a different kind of threat," says John Walters, the 
U.S. drug czar. "With most illegal drugs, such as cocaine, production and 
distribution are illegal activities. In this case, this is a diversion from 
a legitimate source."

In contrast to other types of illicit drugs, fighting this threat takes 
more finesse than force. Education is one of the main components--people 
are still unaware that prescription drugs can be just as dangerous as 
illegal drugs. There's an idea that because doctors recommend prescription 
drugs for some uses, they must be safe. The perception even extends to law 
enforcement, says John Burke, vice president of the National Association of 
Drug Diversion Investigators. Federal agents and others refer to 
prescription pills as "kiddie dope" and don't regard rounding up those who 
sell it illegally as a top priority, he says.

This drug war also has different players: medical professionals, patients, 
and pharmaceutical companies, all of whom have legitimate uses for the 
drug--and lobbyists in Washington to make sure their interests have a 
voice. The word balance is often used to describe the complex task of 
keeping these groups happy while preventing the drugs from falling into the 
hands of illicit users and criminals. The most delicate relationship right 
now is between law enforcement and doctors, who want to be able to 
prescribe medication as they see fit without evoking suspicion of drug 
trafficking--a fact not lost on the Drug Enforcement Administration. Says 
William Walker, head of the agency's Office of Diversion Control: "The DEA 
in no way attempts to hinder any medical practitioners who are legitimately 
prescribing and administering controlled substances to their patients."

Anxiety and Pain.

Haley Bruns knows firsthand how dangerous prescription drugs can be. She 
became addicted to the anxiety medications Xanax and Ativan but has been 
sober for about five years now. When she had knee surgery last month, 
however, and was prescribed the painkillers Percocet and OxyContin, she was 
wary. Even though she's never been addicted to those drugs, she says: "I 
didn't want to tempt myself." She solved the problem by getting only a few 
pills at a time from the pharmacist, even though it meant going into the 
store every day. "The first time I did it, the pharmacist was like 'you're 
nuts,' " she says. "I think it's a great way of doing it."

Painkillers like Vicodin, Percocet, and OxyContin, derived from opiates, 
technically known as narcotic analgesics, are the biggest concern among 
policymakers and experts because they can be very addictive. Even patients 
who use them properly for pain can become addicted, though it happens 
rarely. Abuse of these drugs is increasing "quite dramatically," says Nora 
Volkow, director of the National Institute on Drug Abuse. More than 31 
million Americans say that they have illicitly used narcotic analgesics, 
and emergency room visits related to this type of drug have more than 
doubled in the past decade, to 108,000 in 2002. People take the drugs 
because they produce a sense of euphoria, similar to the high from heroin. 
When taken improperly, these drugs can be fatal.

But the heavy focus on abuse of painkillers, along with several 
high-profile court cases involving doctors, has had a chilling effect on 
pain medicine, doctors contend. Millions of patients, they say, are 
suffering because doctors are either underprescribing to avoid suspicion or 
are leaving the field altogether. One woman in New York started a patient 
advocacy organization, the Pain Relief Network, because of her husband's 
chronic joint pain. "These people deteriorate because it hurts to move," 
says Siobhan Reynolds. "I can't even begin to explain the severity of the 
repercussions on their lives."

Rift.

The Office of Diversion Control says it's not in the business of 
prosecuting doctors who operate legitimate medical practices. The problem 
is that there isn't an agreed-upon definition of what prescription 
practices are legitimate. Diversion Control tried to address this problem 
several years ago when a couple of its agents teamed up with four pain 
specialists and spent two years writing a "Frequently Asked Questions" 
document that addressed issues like how narcotic analgesics should be used 
to manage pain and what federal regulations were involved with prescription 
painkillers. The 32-page document was released in August 2004 and lauded in 
the Journal of the American Medical Association. Shortly after, the DEA 
pulled the FAQ off its website with no explanation, according to David 
Joranson, the director of the Pain and Policy Studies Group at the 
University of Wisconsin and a member of the drafting committee. "It was 
just amazing to have that collaboration unilaterally ended," he says, 
"without explanation."

If that rift is not mended, it could impede the war on prescription drugs, 
which depends on cooperation between the medical community and law 
enforcement. Ensuring such cooperation will require strategies new to drug 
enforcement. But at least one person is optimistic. "Unlike street drugs, 
people don't want to do the wrong thing here," says Walters. "The vast 
majority of the people we're dealing with are committed to people's health 
and welfare."
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MAP posted-by: Richard Lake