Monday, February 26, 2001

OxyContin users wary of backlash

Widespread abuse prompted Health Alliance to institute limits

By Tim Bonfield
The Cincinnati Enquirer

Gil shows off his OxyContin.
| ZOOM |
        As a Catholic, Gil believes that people who commit suicide are condemned to hell. But four months ago, this 56-year-old Northern Kentucky man was ready to drive off a bridge be cause years of escalating pain from fibromyalgia had become unbearable. Then, his doctor prescribed OxyContin.

        “For the first time in 12 years, I have hope,” Gil said last week. “The change in my life has been incredible.”

        Now Gil stands with a growing number of patients and doctors outraged by the Health Alliance of Greater Cincinnati's recent decision to limit OxyContin use primarily to cancer patients.

        “I guarantee you that not one person on that board that voted to cut OxyContin ever suffered from chronic pain,” said Gil, who asked that his full name not be published so he does not become a target for drug thieves.

  A multistate “pipeline” that runs through Greater Cincinnati is funneling the painkiller OxyContin to mountain communities in Eastern Kentucky.
        OxyContin is a powerful narcotic pain reliever introduced in 1995 by Purdue Pharma L.P. The time-released medication made headlines six years ago in medical journals because it could last 12 hours and caused fewer side effects than many other pain relievers.

        But in the past month, OxyContin has grabbed headlines because of its growing popularity among drug abusers — especially in Kentucky. (Feb. 7 story). A federal raid Feb. 6 arrested 207 people, accused of abusing or trafficking in it.

        Two weeks ago, U.S. Drug Enforcement Administration agents teamed with Covington police to arrest nine people on OxyContin trafficking charges. It came after a five-month investigation.

        Tristate police say OxyContin is the drug of choice among pharmaceutical abusers. In the past year, Tristate police have confiscated more than 13,000 doses of OxyContin.

Wary of trend

        Gil gets his OxyContin prescription filled by a retail pharmacy that has no connection to the Health Alliance.

        Even so, he fears the Tristate's largest hospital group will have influence beyond its facilities.

        “It's the trend I'm worried about,” he said.

        “OxyContin is an expensive drug. If they do (restrict it) and get away with it, then my HMO could take a look and say, "You know what? We could save millions of dollars if we follow their lead.'”

        Earlier this month, the Health Alliance drug policy committee voted to drop OxyContin from its list of recommended drugs in favor of another drug, Oromorph, a long-acting type of morphine. (Feb. 20 story)

        Committee doctors contended that Oromorph is roughly equivalent to OxyContin in terms of pain control and side effects, yet less expensive and apparently not as popular among drug abusers.

        However, after complaints from Dr. Rebecca Bechhold and other oncologists, the committee changed its policy so cancer patients could continue receiving OxyContin. The committee also emphasized that exceptions can be made for other patients whose doctors think they need OxyContin.

        Dr. Tim Freeman, a family practice physician and member of the drug policy committee, said the committee agreed that OxyContin is a better drug than Oromorph, at least for the higher doses often needed to control cancer pain.

        “At low to moderate doses, however, there was no significant difference between using Oromorph and OxyContin in terms of pain relief,” Dr. Freeman said.

New rules questioned

        The idea that noncancer patients should require special permission to receive OxyContin also drew criticism from Dr. J. David Haddox, senior medical director for health policy at Purdue Pharma.

        He said this is the first time he has heard of a hospital or insurer restricting OxyContin use. The policy conflicts with uses approved by the Food and Drug Administration for any type of moderate to severe pain that is expected to last more than a few days.

        He said the policy also flies in the face of the national effort to improve pain control.

        “The medical community has been struggling for years now to make pain control a higher priority,” Dr. Haddox said. “I worry about any time there's a new barrier put up to patient care, particularly when it comes to pain control.

        “Pain is pain. And severe pain is severe pain. You can have severe pain for lots of reasons, not all of them have to be malignant.”

        The Health Alliance committee's attempt to draw a line between cancer pain and other types of pain also was criticized by patients and doctors.

        Dr. Carl Shapiro, a member of the Mayfield Clinic & Spine Institute, prescribes the drug for extreme pain from neck and back injuries, severe arthritis and other noncancer pain. He said OxyContin beats Oromorph on several fronts:

        • It is easier to adjust dosages.

        • It produces fewer side effects than morphine and nonnarcotic pain relievers.

        • Patients really seem to respond.

        “OxyContin is the best medicine out there of its kind,” Dr. Shapiro said.

        “I've had patients with disrupted sleep for years who are sleeping through the night for the first time, thanks to this drug. I have people who would be shut-ins who are out in the community because of this drug.”

OxyContin's benefits

        Delhi resident John Walls, 39, said he has been taking OxyContin for 1 1/2 years after suffering a back injury delivering milk to stores. He says the medication allows him to continue working at the dairy in a less physical job.

        “I tried a lot of other drugs, and they don't work like OxyContin does,” Mr. Walls said.

        Before he injured his neck 12 years ago, Gil was a computer systems analyst and college professor. He developed fibromyalgia, which is characterized by chronic pain, fatigue and swollen joints. He can no longer work.

        Before starting on OxyContin, Gil said he was taking eight doses a day of hydrocodone (a short-acting narcotic pain reliever), 25 aspirin a day, an antidepressant, plus “so many back rubs with Ben Gay you could smell my house two blocks away.”

        With OxyContin, he still suffers pain but he is down to about 10 aspirin and one back rub a day. His activity level is much higher.

        His pharmacist told Gil that a one-month supply of his doses would fetch about $4,200 on the street.

        Gil had this response:

        “But let me tell you, if you put $4,200 on one side of a table and a bottle of OxyContin on the other, I'd take the OxyContin every time.”


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