A CURSE AND A CURE

Is The Crackdown On An Abused Drug Causing Needless Suffering?

Jeanette Murray had spent more than a decade caring for others, both as a
neonatal nurse and a mother of two. Suddenly she couldn't even care for
herself. A workplace fall in 1999 caused irreparable nerve damage in her
right arm, and near-constant, burning pain that radiated all the way up to
her neck. Barely able to get out of bed–much less return to work or do
simple tasks like cooking dinner–Murray tried treatment after treatment,
from physical therapy and surgery to more than a dozen powerful
prescription medications, including Darvoset and Lortab. But only one
remedy worked.

OxyContin is a highly regulated, opium-based painkiller that was approved
for treating moderate to severe pain in 1995. It quickly became regarded as
a major breakthrough, thanks to a unique time-release delivery system that
produces a steady amount of oxycodone, its active ingredient, in the
bloodstream for up to 12 hours. "All I know is it worked better than
anything else," says Murray, now 31, who started taking 40-mg pills twice a
day and found she could finally bathe and dress herself again. "I felt hope
for the first time."

Some 18 months later, her miracle cure has become as much a cause of
anxiety as a source of relief. The same chemical formulation that makes
OxyContin such an effective pain treatment also makes it a prime candidate
for abuse. In recent months, reports of people grinding, snorting,
injecting–and becoming addicted to–the drug have mushroomed, beginning in
rural areas such as Appalachia and Maine but slowly spreading across the
country.

Backlash.

Reaction has been swift, in the form of lurid media reports as well as
federal and local crackdowns on doctors and pharmacies with questionable
practices. Three class action lawsuits have charged the drug's
manufacturer, Purdue Pharma, with inappropriate, aggressive marketing and
failure to warn of possible addiction. Further, last week the FDA announced
that OxyContin packaging will now bear the agency's strongest warning,
which cautions that the drug is potentially addictive and can kill when
used incorrectly. Purdue had already stopped shipping the most potent
160-mg Oxy pill; now, in an attempt to save its billion-dollar market, the
company is alerting 800,000 healthcare workers to the more stringent
recommendations.

While it's clear that abuse of OxyContin is a serious and growing problem,
many doctors are now just as concerned that such measures will have
unintended consequences for patients like Murray, who are in legitimate
need of pain relief. Pain care in this country is already characterized by
widespread undertreatment and stigma, and the worry is that doctors,
pharmacies, and insurance companies will overreact–to avoid addicting
patients or to avoid prosecution, or both. "The big question here is what
should drive medical care policy–police concerns or clinical concerns,"
says Richard Weiner, executive director of the American Academy of Pain
Management. He contends that when taken as directed, OxyContin is a safe,
effective pain medication with few side effects, and that reports of
related deaths almost always involve other substances. The roughly one
million legitimate patients using the drug aren't the ones getting hooked,
agrees J. S. Hochman, a Houston-based pain specialist. He cites myriad
studies showing that patients properly treated with opiates have about a 1
percent chance of becoming addicted. "They don't get goofy, high, or giddy,
and there's no euphoria–the pain is simply gone."

Still, patients around the country testify to a noticeable chilling effect
in recent months. Murray was recently refused treatment at a local hospital
in southwest Virginia, where physicians accused her of seeking drugs for
recreational use. Though she has a documented medical history, she has also
had problems with her workers' comp carrier regarding continued coverage.
"When people see the name OxyContin, they automatically think you're a
junkie," laments Murray.

Wary Doctors.

John Murman Jr., who was injured in a car accident several years ago and
now suffers from multiple herniated disks, bone spurs, and other back
problems, knows this all too well. Earlier this year, the 33-year-old
Pittston, Pa., resident began taking his medical diagnosis with him to the
drugstore, after one local pharmacist refused to fill his prescription–even
after checking with his doctor. He visited 10 other stores before locating
one that stocked his full dose. Still, these were just inconveniences
compared with what happened in June, when Murman's family physician said he
had to "get him off these Oxys." When Murman complained that he needed some
sort of pain relief, his doctor told him to go elsewhere. Specialists like
Hochman in Houston report an influx of patients in similarly desperate
situations, some of whom now travel cross country for care.

Such stories signal an unfortunate shift in attitude toward the treatment
of chronic pain, which affects some 50 million Americans. Though only 1 in
4 of these people receives adequate care even now, the past decade has seen
vast improvements in pain management. The long-standing myths regarding
opiates have been largely overcome, as doctors–including family
practitioners–have grown more comfortable treating chronic but not
life-threatening pain. In January, the Joint Commission on Accreditation of
Health Care Organizations, which certifies some 19,000 hospitals and
clinics, implemented new standards for pain treatment; the commission
suggests that pain be treated as a fifth "vital sign," along with blood
pressure, pulse, respiration, and temperature.

None of this provides much comfort to John Murman, whose new pain
specialist will not prescribe OxyContin because of all the negative
attention; his new medication has not proved as effective. "I just want my
pain treated the best as it can be while leaving my mind clear, so I can
have some semblance of a career and a life. Is that too much to ask?"