PAINKILLER BACKLASH FEARED

Doctors Worry That Abuse Of Oxycontin Will Cause Setbacks In Pain Treatment

Rebecca Work doesn't like to take medicine, even aspirin. But when she had
surgery last fall, after doctors cut through her ribs, the muscles in her
back and her lungs, the pain was beyond anything she had felt in her 52
years. "It was pain so bad you just couldn't think about anything else,"
she said.

She left the hospital with a prescription for Percocet, a strong
painkiller. It helped at first, but she could only take it every four
hours. By the third hour, the pain would start searing through her again.

So when she had to go back to the hospital a few weeks later, her doctor
almost immediately gave her OxyContin, a narcotic. Within minutes, she felt
no pain at all. Zero. And that relief lasted for 12 hours.

"It was really like a miracle thing for me," she said. "It's a wonder drug."

Work's OxyContin story is not the kind most people read in the newspaper.
Instead, there have been stories about addiction and abuse: People selling
OxyContin like crack or heroin, people breaking into drugstores to steal
OxyContin, people overdosing on OxyContin.

All those stories have doctors worried about an OxyContin backlash that
could set them back years in their war against pain.

"Now some patients don't want to take it, some physicians are hesitant to
write it," said Dr. Alex Gupta, medical director of Carolina Pain
Consultants of Rex Healthcare. "That's unfortunate ... for some patients
[OxyContin has] done miracles."

Abuse, Death And Fear

OxyContin pills have a special coating designed to slowly, over 12 hours,
release the drug into the body and block pain receptors in the brain. But
if the pill is crushed, it can be snorted or injected like heroin to get an
intense, immediate rush.

About a million people in the United States were prescribed OxyContin last
year, according to James Heins, a spokesman for Purdue Pharma L.P., which
has been making the drug since 1996. The company hopes to introduce a new
form of the drug within a few years that would block the euphoric effects.

But in the meantime, in some rural areas of Maine and Appalachia, and in
cities like Boston and Philadelphia, people are calling misuse of the drug
an epidemic. And police say illegal use of the drug is becoming more and
more common here.

Last year 21 people died in North Carolina from overdoses of oxycodone, the
active agent in OxyContin. And although toxicology reports aren't in yet,
police believe that an overdose of OxyContin killed a 26-year-old China
Grove man earlier this month and that the drug may have contributed to the
death of a 20-year-old University of North Carolina at Chapel Hill student
two weeks ago.

L.C. Ingold of the State Bureau of Investigation said he thinks it's the
most popular prescription narcotic on the streets now.

To Lt. Doug Scott of the Cary Police Department, the incentive for selling
OxyContin is clear; someone who walked into a drugstore with a prescription
for 30 pills could easily net $2,000 selling them on the street.

There were two break-ins of pharmacies in North Raleigh earlier this year
by people looking for OxyContin, said Lt. Kent Sholar of the Raleigh Police
Department.

This summer the Food and Drug Administration strengthened warnings on the
drug because of concerns about abuse and diversion of the drug.

The Vital Sign

After decades of fighting misconceptions about the addictive properties of
narcotics, and the stigma attached to drugs like morphine and methadone,
the medical community has begun aggressively treating pain. New national
standards made pain a priority for medical professionals this year, calling
it the fifth vital sign that should be constantly monitored in any patient.

But with all the bad news about OxyContin abuse, many doctors and
pharmacists worry that the pendulum will swing in the other direction.

"We have known for many years leading up to this that, many times, very
high levels of pain were left untreated or undertreated," said Barry
Jackson, regional advocacy manager for the American Cancer Society. "Our
biggest fear is that, because of backlash from illegal and inappropriate
use of OxyContin, there will be a stigma among medical professionals and
patients, and patients won't get the medication that they need."

Some local doctors say they have already felt a bit of that backlash.

Sometimes patients say, "Oh, gosh, didn't I read about that in the paper?"
when OxyContin is mentioned, said Dr. William Blau, director of pain
medicine at UNC Hospitals. Just like with methadone or morphine, he has to
explain that the drug is effective and safe and that addiction is extremely
rare for patients being treated for pain.

Last week a woman at Duke University Medical Center had a morphine pump
surgically implanted because she didn't want a prescription for OxyContin.

Blau said some doctors are more reluctant to prescribe it now, too. "One of
the other doctors I work with here has attempted to switch some of his
patients off OxyContin, not so much because he feels it's a bad drug but
- --" he paused, and pulled down a newspaper ad someone had posted in the
clinic, from a lawyer drumming up OxyContin-related grievances. "... I
don't think a physician prescribing appropriately and managing responsibly
is likely to be liable for someone who goes out and misuses medication, or
it's stolen and someone else overdoses." But it could be a nightmare for a
doctor to go through a case like that, he said.

Some worry about whether having OxyContin puts their patients in any danger.

"We are being very careful with OxyContin, not merely from the point of
view of the drug and what it does, but those patients may be more at risk,"
said Dr. Sunil Dogra, director of the pain fellowship program at UNC
Hospitals. "Occasionally you hear, 'I was at home, my medication was stolen
from my bathroom cupboard,' 'I think my son stole my pills,' -- that's
quite worrying, too."

David Work, Rebecca's husband and the executive director of the N.C. Board
of Pharmacy, has heard lots of concern from pharmacists about the drug --
especially about the possibility of armed robberies. But OxyContin is just
the latest craze on the street, he said. A few years ago it was Dilaudid
and in a few years it will probably be something else. It just means people
have to be even more careful with it, he said. CVS and Eckerd stores are
continuing to stock the drug, spokesmen there said.

Dogra and other doctors said they are extremely cautious about all opioids,
watching for warning signs of misuse. "Now we are learning how to treat
pain better. We are not very good at it yet -- we still have a long ways to
go."

Rebecca Work was surprised by how concerned the staff at Duke University
Medical Center was about her pain. "The immediate response was, 'We can
take care of that.' " And they did.

She only took OxyContin for a few days; she has been healing for the past
several months, building her strength back up. She hates to think of
doctors not prescribing the drug or patients avoiding it because they've
read about problems in the news. "That would be awful. It would be terrible
if patients in pain could not have it just because other people are abusing
it."