OXYMORONS : GOVERNMENT NOW PRESSURING DOCTORS AND PURDUE PHARMA ABOUT
OXYCONTIN PANIC

On the morning of Tuesday, May 1, just hours before the Free Times went to
press with "OxyCon Job: The Media-Made OxyContin Drug Scare," The New York
Times reported that the Drug Enforcement Administration (DEA) was
attempting to limit sales of OxyContin. The leading agency of the "war on
drugs" is asking the manufacturer, Purdue Pharma, to sharply limit its
marketing of the huge-selling morphine-like painkiller. The action - a
first for the agency, which never before had fixed its sights on a single
prescription drug - was justified by the alleged tidal wave of illegal
abuse associated with OxyContin. A slew of sensational media reports had
labeled Oxy the new "street drug of choice" across the country, the agency
claimed.

The N.Y. Times had good reason to crow about the DEA action, the first in a
series of recent state and federal government attempts to turn up the heat
on the manufacturer. Back on March 5, it had published its own major
examination of the OxyContin "epidemic," reprinted in scores of papers
nationally, which redirected government attention squarely onto the company
and the doctors who prescribe the opiod analgesic, and away from illicit
users and sellers.

Other media accounts had limited themselves to repeating the
self-interested pronouncements of narcotics cops and publicity-seeking
politicians about an explosion of abusers. For instance, many media outlets
reported that, in eastern Kentucky, the heart of the "epidemic," there had
been around 60 deaths as a result of Oxy. But in fact, a Free Times
investigation reveals that only two deaths in the entire state can be
attributed solely to an overdose of Oxy - and suicide can't be ruled out in
either case.

Sales reps from a competing pharmaceutical company are telling doctors that
the DEA's going to get them for prescribing Oxy.

But the NYT story instead attempted to ferret out the origins and root
causes of the burgeoning trend. The explanation was two-pronged. First,
Purdue Pharma sales reps had aggressively oversold the powerful,
morphine-related analgesic to general practitioners as a first-choice drug,
and second, the company's marketing efforts geared to those docs -
including free trips to Purdue-sponsored pain management seminars in resort
locales - were uniquely unethical, nearly crossing an invisible line into
bribery. Many GPs were essentially duped into "over-prescribing" the drug,
the article implied, and with legitimate sales ballooning past the $1
billion-per-year point in only five years, surging illicit usage followed
close behind.

The NYT account has become the single most widely disseminated article on
OxyContin. And now it seems to have caught the attention of the frontline
drug warriors at the DEA, as well as other government bureaucrats, leading
to public pressure on Purdue to crack down on overprescribing doctors.
Meanwhile, the wave of negative OxyContin media coverage has continued to
crest, with dozens of fresh accounts published in metropolitan dailies or
beamed over the airwaves, even though actual hard evidence of significant
abuse outside of Appalachia remains thin to nonexistent (for example, in
Cleveland, there have been only eight criminal incidents involving Oxy in
the last two years).

Since the publication of "OxyCon Job," the Free Times has received dozens
of calls, notes and letters, many from leading experts in the pain
management community, who have not only derided media reporting as
hopelessly biased and misinformed, but also have questioned - if not
outright contradicted - the findings of the NYT writers and the government
actions based on them.

The NYT focus on Purdue salesmen as drug pushers, some doctors contend, is
the result of competitors in the pharmaceutical market, who are seemingly
intent on building support for their own products by making many doctors
too afraid to utilize an important weapon in the battle against
debilitating, long-term pain. Sales representatives from a competing
pharmaceutical company have been "telling every doctor around here [in
turn] that [each doctor is] the number-one prescriber of OxyContin, and
sooner or later the DEA's going to get him," says Dr. Dana Richard, a pain
specialist in Palm Beach, Florida. "It's beyond ridiculous, it's insulting."

Another tells of hearing similar reports from across the country: "I've
heard reps from [the competitor] have been approaching key prescribers with
the Times [article], telling them OxyContin is too dangerous and prone to
abuse and they need to switch to their product," a tactic he describes as a
"dirty tricks" marketing strategy. The extent of such efforts is unclear,
but there is no question that any such activity represents an ethically
dubious attempt to undercut the medical community's reliance on a
critically important lifeline for tens of thousands of previously
undertreated chronic pain sufferers.

What's more, specialists in the field reveal that Purdue has distinguished
itself as a leader in the field of physician training regarding pain
management, and that there is nothing shady about the educational seminars
and lectures they sponsor, which fill a void left by inadequate medical
schooling. "Seventy-six percent of medical school graduates get no pain
management training in medical school," says Dr. Howard Heit, a chronic
pain sufferer since a car wreck in 1986 left him wheelchair-bound for four
years. He also just happens to be a pain specialist in Fairfax, Virginia.

"I saw firsthand how little pain training my fellow physicians had after my
accident," he explains. "It's one of the reasons I became a lecturer for
Purdue." The programs Purdue puts on, he adds, focus on legitimate
education about general pain management techniques: "They're not about
selling a particular product."

As for giving doctors free trips to weekend seminars, a centerpiece of the
NYT allegations, that may well be a no-no, says Mike Lynch, a spokesman for
the American Medical Association. But he admits "it happens all the time."

"It's industry-wide," concurs Micke Brown, a registered nurse who is a pain
management advisor for the American Pain Foundation, "though the Purdue
events are real educational meetings, unlike some others." Despite the
educational benefit, the company has recently discontinued the practice of
offering free trips to the sessions, a Purdue spokesman states.

The sustained, simultaneous assault from the press, and now the government
via the DEA, is having an effect. Last Friday, Purdue announced it would
"temporarily suspend shipment" of the largest OxyContin pill size,
provoking yet another round of negative media coverage, some of which has
misleadingly portrayed the move as a harbinger of the drug's imminent
removal from the market altogether. Take last Friday's noon report on WEWS
Channel 5 in Cleveland, a three-sentence story stating in part that "if you
rely on OxyContin for pain relief, you may have to find another drug,"
since Purdue has "suspended shipments of the high-dosage pill" due to "a
growing problem with abuse." No mention was made that the 160mg pill
accounts for only 1 percent of the drug's sales, leaving the other four
sizes completely untouched.

One doctor was charged with manslaughter when the patient gave pills to his
son, who then died from mixing Oxy with alcohol.

The move does show how desperate Purdue has become to stave off further
government interventions - the FDA is now pushing them to alter product
labeling, a group of state attorneys general has begun the formation of a
national OxyContin task force, and the DEA has warned that it will "target
aggressively" medical professionals who "over-prescribe" the drug - as
politicians and officials scramble to respond to and capitalize upon the
heightened media interest.

That the company has been forced into even this seemingly minor concession
angers some pain control experts. "It's incredibly irritating," says Dr.
Richard of Palm Beach. "We finally get a good medication that can help
people with serious pain, and it suddenly gets all this bad press and
government pressure." While he understands the company's motives, he
believes its decision is a serious mistake. "It looks like they're taking
their scared asses and running, leaving us people who believe in the
product alone on the front lines," he argues, adding that "the bottom line
is that OxyContin is a useful tool for the treatment of chronic,
intractable pain."

Meanwhile, the DEA and local police around the country have already begun
their "aggressive" monitoring of physicians. Brown tells of tagging along
with a Purdue sales representative calling on doctors in rural Virginia.
One told the rep that less than 30 minutes after her last visit, local DEA
agents showed up at the office to question him about both what the rep had
told him and whether he was going to start prescribing OxyContin to his
patients. "We began to wonder if we were being followed and whether we were
going to get arrested that day, even though we weren't doing anything
wrong," she explains. Later that same day, she was asked by a gas station
attendant to sign an anti-Oxy petition.

Mary Baluss is an attorney with the Bazelon Center for Mental Health Law in
Washington, D.C., working to break down legal barriers to better pain
management; many of her cases involve aiding good, caring doctors charged
with crimes by authorities ignorant of pain management techniques. She
tells of a doctor in rural California charged with multiple counts of
murder for prescribing opiods to legitimately suffering patients. One of
the murder counts - thrown out by a judge - centered on a patient who died
while a passenger in a car wreck. Authorities said because she was on
morphine she was unable to assist the driver when he lost control of the
vehicle, and therefore, her death was the doctor's fault.

In another count - reduced to manslaughter - the doctor prescribed opiods
to a legitimate patient, who gave some of the pills to his son, who then
died after mixing them with alcohol. Again, the doctor's fault. The
clincher, Baluss says, is the one where the doc was charged because a
patient, upon learning that the physician was under investigation,
committed suicide because she became afraid her pain would no longer be
adequately treated.

The combination of negative press coverage, like the NYT article, and
overzealous law enforcement is making many already leery general
practitioners completely unwilling to prescribe much needed medication,
according to dozens of letters sent to the Free Times by chronic pain
victims. One patient, who asks to remain anonymous, asserts "I was told by
my doc that because of the sensational media attention ... the DEA is
planning on regulating OxyContin to control its abuse and, most likely, he
will soon not be able to write scrips for me or his other chronic pain
patients who need this drug."

And while such fears are shared by almost all chronic pain patients, others
report being harmed even more directly by the hyperbolic media coverage and
government crackdown. No story is worse than that of Jeannie Wills-Ray,
from a small town in Pennsylvania just across the Ohio border, the victim
of an aborted house robbery directed at her supply of the medication.
Though she staved off her attacker (who, she concluded, was a strung-out
heroin addict), her problems only really began with the arrival of the police.

"They immediately seized my prescription bottle and began to count the
pills inside," she relates. "They treated me like some crack dealer who had
been taken on the street corner and dared to report it as a robbery."

The situation grew even more horrifying when the local newspaper got
involved. The cops "released my most private information to the local
newspaper, who printed my name, age and complete address in a highlighted
area of this popular news rag," she recounts angrily. "I was in more danger
than I ever was from the robber himself."