AVOID MISINFORMATION

I thank USA TODAY for the well-balanced article on the benefits and risks
of the use of opioid medication to treat chronic pain. As a pain management
specialist, I am familiar with these issues.

I have seen a preponderance of bad journalism on opioid drug abuse
recently. Some stories report the misconception that there is a substantial
risk of addiction when opioid medication is used appropriately. In fact,
fewer than 1% of patients taking opioids by prescription become addicted.

This leads to the question of which drugs cause more risk. Currently, the
hot topic is OxyContin. In the past, there were similar problems with
Duragesic, Dilaudid and morphine. Before this, opium and laudanum were
abused. These are all controlled substances because of the potential for abuse.

Currently, abuse is largely restricted to those who obtain the drug
illicitly. When a patient abuses his or her medication, there are safe and
effective means to deal with these issues. A vigilant physician can
practice medicine safely and effectively using current practice and
regulatory guidelines.

So what medications are most frequently abused?

The most common prescription drug abused in the United States is
hydrocodone/acetaminophen -- that is, such drugs as Vicodin, Lortab and

Lorcet. This medication combines a short-acting opioid with acetaminophen.
It is considered Schedule III by the U.S. Drug Enforcement Administration,
which means that physicians can phone in prescriptions and give refills.
With Schedule II drugs -- OxyContin, Duragesic, Dilaudid, morphine -- this
is not possible. The increased availability of hydrocodone/acetaminophen
has led to widespread indiscretion in its use. For some physicians, this is
the only medication they seem to know.

Lastly, I have communicated with the pharmacists in charge of drug recovery
in Oregon and California on this issue. They have verified that much, if
not most, of the current OxyContin abuse results from illegal trafficking
of this drug across our borders with Mexico and Canada. Some diversion from
patients has occurred, but this is thought to represent the minority of
street abuse of this drug.

Therefore, while physicians and patients alike must exert caution with
opioid medications, the current atmosphere of panic over these medications
largely overestimates the public health impact nationally.

As USA TODAY's article states, the widespread tolerance of chronic pain by
society leads to far more disability and mental health disorders than this
abuse issue.

Therefore, as regulatory agencies investigate this problem, it is essential
that they bear in mind the good that comes from the appropriate use of
these medications. They must not prevent physicians from prescribing
opioids, but should rather improve the education and safety of medical
practice regarding these medications.

David M. Sibell, M.D.

Oregon Health and Science University

Portland, Ore