STOP OXYCONTIN ABUSE, NOT ITS USE

Recent media reports about abuse of the prescription painkiller Oxycontin
are no doubt alarming.

Newspapers describe pharmacies being robbed, abusers shoplifting to pay for
their habit and physicians afraid to prescribe it. Authorities are looking
into restricting the drug and asking the manufacturer to alter the
preparation to prevent abuse.

In regulating the drug, we must be diligent not to penalize our most
vulnerable patients -- those who suffer chronic pain.

As physicians, we recognize that making Oxycontin and other opioid drugs
available to patients who need them risks increasing access to abusers. Yet
painkiller abuse occurs rarely. While estimates vary, we believe true
addiction occurs in only 3 percent to 6 percent of the general population.
There is no reason to suspect the prevalence is higher in the pain clinic
population or general medical community, where opioids are administered in
a controlled setting and carefully monitored.

Opioids occupy a vital position in the management of acute and chronic
painful disorders. In fact, they provide the most effective treatment and
could not be abandoned without grave ramifications. Instead of denying
legitimate access to opioids, we must seek strategies to eliminate abuse.

Over the past decade, we have improved our understanding that opioids
occupy a legitimate role in pain management. In the early 1990s, many state
medical examination board members believed it was inappropriate to
prescribe opioids for nonmalignant pain. They went so far as to investigate
physicians who took such action. This policy instilled an undercurrent of
fear in many physicians, making them less willing to prescribe opioids and
leading to poor-quality treatment for pain nationwide.

Fortunately, these inaccurate and restrictive attitudes changed as a wealth
of information accrued on the efficacy of opioids, including their low
incidence of addiction and manageable side effects. To date, hundreds of
thousands of patients have been monitored while receiving opioids. We now
know we can improve the quality of pain care only if opioids remain part of
the clinical regimen.

As we move forward, we must maintain a sense of balance. We must reassure
physicians that it is legally safe to prescribe opioids, even as we
investigate those who engage in criminal activity.

We need to assure our patients they will have access to the only
medications that can manage their intractable pain, even as we prevent
criminals from diverting them for illicit use. Finally, we need to instruct
our patients that selling their medications is a criminal act with penalties.