DOCTORS TIGHTEN CONTROLS ON PAIN DRUG OXYCONTIN

As more restrictions are placed on the prescription painkiller OxyContin,
and law enforcement agencies assail its potential for abuse, the drug's
maker and some doctors are scrambling to shore up controls to ensure it
stays on the market.

The slow-release opioid that came on the market in December 1995 is
considered a miracle drug among pain doctors and patients because it has
few side effects. But when chewed, snorted or injected, OxyContin produces
a quick and potentially lethal high. It has been linked to more than 100
deaths.

In some cases, doctors are summoning patients into their offices between
regular visits for a random pill count to make sure none is missing.

Dr. Jack Kabazie, director of the Institute for Pain Medicine at the
Western Pennsylvania Hospital, said he had to discharge a patient from his
care last month when the pills didn't add up.

While he said such incidents don't occur very often, he needs to be
vigilant to safeguard its proper use. Other doctors have become more
selective in prescribing the medication, which is intended for moderate or
severe pain.

"We need every weapon we can get," Kabazie said about pain control. "You
don't go to a gunfight with a knife. If OxyContin is the medication you
should use, it would be terrible to lose that."

Just two weeks ago, the drug maker Purdue Pharma of Stamford, Conn., under
an agreement with the Food and Drug Administration, placed the strongest
warning possible on the medication - a black box describing OxyContin as
potentially as addictive as morphine and explaining that chewing, snorting
or injecting it can kill. Purdue wrote 800,000 doctors about the warnings.

Last year, U.S. doctors wrote 6.5 million prescriptions for OxyContin. In
June, Purdue began distributing tamper-resistant prescription pads that
contain six ways to prevent fraud. For example, if a person tried to
photocopy the form, the word VOID shows up on the copy.

Company representatives also are holding forums for doctors and the public
to educate them about proper use and handling of OxyContin and other
prescription drugs.

"We want them in the hands of the patients who need them and to keep them
out of the hands of those who abuse them," said Pamela Bennett, a
registered nurse who is leading Purdue's educational efforts.

Kabazie prescribes OxyContin, as well as other opioids, for chronic pain
that may stem from cancer, orthopedic problems or even shingles. First,
patients are evaluated for the cause of their pain. If surgical techniques,
nerve blocks, physical therapy or medications such as Motrin don't ease the
pain, he may turn to opioids.

OxyContin is part of an arsenal that includes the slow-release morphine
pill called MS Contin, methadone and the fentanyl patch.

The advantage of OxyContin, Kabazie said, is that most people, including
older people, can take it without suffering serious side effects. It is
more potent per milligram than morphine and comes in several strengths. In
addition, one pill lasts 12 hours, so patients don't risk stomach upset by
popping several pills a day.

To reduce the potential for abuse, Kabazie's office works with only one
pharmacy and uses that pharmacy's tamper-resistant prescription sheets. In
addition, each patient signs an "opioid contract" agreeing to seek the
medication only from that doctor. The office also won't fill prescriptions
after hours, on weekends and requires a five-day notice from patients.

Colleen Dunwoody, a clinical nurse specialist for pain management at UPMC
Presbyterian who is past president of the American Society of Pain
Management Nurses, said she continually has to address misconceptions
patients have about the OxyContin.

"This whole OxyContin furor has made it necessary to explain to patients
that if they have to take the drug, they won't become addicted (if they
follow the prescribed dosage)," she said. "They were very relieved to know
it was safe."