THE PROBLEM IS THE ADDICTION, NOT THE PRESCRIPTION

Much has been made by the media of the recent cases of abuse of the drug
Oxycontin. Now we have individuals and state agencies trying to sue the
drug's manufacturer, Purdue Pharma, for creating the problem. As someone
who has practiced in both the fields of addiction as well as pharmacy, I
must say "enough already!''

The problem is the disease of addiction, not one particular drug or drug
manufacturer. Drug addiction, although recognized as a treatable chronic
disease, still tends to be moralized by many in society. If we are talking
about alcohol, society imposes a "wet moral model" meaning it's OK to
drink, until you drink too much, and then the individual is deemed to be
immoral, rather than ill. With other drugs, it's a "dry moral model"
meaning any drug use is immoral.

The issue of pharmaceutical drug diversion is not a new phenomenon. In fact
the National Institute on Drug Abuse (NIDA) estimates that there are
roughly 4 million Americans currently abusing prescription drugs.

Prescription drugs, including controlled substances, require a prescription
because they have been determined by the FDA as being too dangerous to use
unsupervised, and therefore their use requires close medical supervision.

Controlled substances, by their very nature have the potential for causing
addiction. In fact, they are scheduled by the DEA according to their
addictive liability, with schedule II drugs having the greatest risk of
addiction. When talking about opioid narcotic pain relievers, there will
always be a risk of addiction because opioids inherently produce euphoria
along with pain relief. To that end, the drug manufacturers are constantly
trying to develop formulations that provide pain relief, with less
associated euphoric effects. Oxycontin, when used appropriately every 12
hours, produces significantly less euphoria than traditional opioids
because the active ingredient oxycodone is released over the 12-hour
period. Unfortunately, drug addicts have figured out how to compromise the
long-acting properties of the drug (with much assistance from the media),
which then provides them with a 12-hour dose within minutes.

It is true, that even when used appropriately Oxycontin can cause
addiction. The fact that it is a schedule II drug alerts prescribers to
that risk. But addiction can also occur with any of the opioids schedule
II-V used to treat pain, and in such cases should be viewed as an adverse
event to be monitored for, and dealt with when it occurs. To say that this
problem is unique to Oxycontin is ridiculous. In most cases however, when
addiction does occur, it is because the patient failed to take the drug as
prescribed (with or without a previous history of drug abuse), or was
buying the drug on the street.

In either case this is not the fault of the drug or its manufacturer.

All the while, as the media hypes the Oxycontin issue, it is estimated that
50 million Americans with chronic pain go untreated every day. As someone
who treats addicts on a daily basis, I see the personal, family, and
societal problems associated with addiction. As a pharmacist, I also see
the physical and emotional problems associated with untreated pain.
Long-acting opioids such as Oxycontin have been true wonder drugs when used
appropriately. Not only can these drugs be effective in giving pain
sufferers their life back, they can also do it with a lower risk of abuse
than what is seen with traditional immediate release products.

While it would be convenient to suggest that the drug is at fault, the
truth is that we as a society are the ones at fault, with our unwillingness
to treat addiction as a disease.

Until healthcare professionals are better trained about addiction, and
governments respond with drug treatment combined with law enforcement, we
will continue have a problem with drugs in this country.

Until we treat addiction as a disease, the drug problem will continue.
Today it is Oxycontin, yesterday it was ecstasy, and before that crack
cocaine and heroin.

It's time to start focusing on the solution, drug treatment, instead of the
problems with the drugs themselves.

Dr. David Marley, PharmD., is a registered addiction specialist. He is
executive director of the NC Pharmacist Recovery Network, Inc.