THE TRUTH ABOUT AMERICA'S OXY EPIDEMIC

As the White House Prepares to Launch a Billion-Dollar Anti-Oxy War, Here Are Some Crucial Facts About WHO Gets Addicted-and Why.

Egged on by the nation's media, The Obama administration seems keen to
start a full-fledged national panic over prescription painkillers. In
April, the nation's drug czar, flanked by the heads of the DEA and
FDA, announced a major new law-enforcement initiative at a
much-discussed press conference where he designated the widespread use
of prescription painkillers like OxyContin an "epidemic" and a
"crisis" comparable to crack in the '80s and heroin in the '70s.

But while it's true that prescription drug abuse has increased by 20
percent since 2002, with some 28,000 deaths by OD in 2007 alone, the
roots of the painkiller problem are widely misunderstood. For the most
part, opioid addicts are seen as victims of greedy doctors and
profiteering pharmaceutical companies. In reality, however, most
painkiller addictions don't start in doctors' offices, and it's
actually impossible to become addicted "by accident."

So why does the media insist on blaming physicians and Big Pharma? For
one thing, because greedy pharmaceutical companies and unscrupulous
physicians have been responsible for a lot of bad things things. But
the persistent myths that pervade the coverage of this epidemic
pervade because real-world addiction doesn't always fit into the neat
narratives preferred by journalists and politicians.

1. Most Painkiller Addicts Were Never Pain Patients.

Reporters love to tell the story of the poor pain patient who got
hooked on Oxys because he just couldn't stop taking them after an
accident or surgery. This tear-jerker is catnip to liberals who view
the pharmaceutical industry as dedicated to exploiting innocent
patients by bribing their doctors to overprescribe their expensive
(but potentially addictive and dangerous) brand-name drugs. And since
drug companies so often live down to their bad image, it's easy to
overlook cases that are not so black-and-white.

To make matters worse, this storyline is also beloved by addicts
seeking to elude responsibility: "It's not my fault! And it was an
accident! My doctor and Big Pharma did it to me!"

But as one Florida newspaper found out to its embarrassment, the
"accidental addict" narrative is rarely the full story. The man they'd
featured under that headline as a doctor's victim didn't begin his
life of crime because of pain treatment--he had a prior cocaine-dealing
conviction.

However unwittingly, the Orlando Sentinel had indeed chosen a
representative opioid addict: like their former coke dealer, the vast
majority of people addicted to prescription painkillers were addicts
before they ever "asked their doctor"--as pharma's TV drug ads
suggest--about OxyContin.

One study of some 28,000 found that 78% of people in treatment for Oxy
addiction had never--not once--received a legitimate prescription for
the drug!

And 80% of OxyContin addicts, according to research by the National
Institute on Drug Abuse, have also taken cocaine. By contrast, in the
general population over age 12, just 15% have even tried coke.

Unless you want to believe that pain patients are so delighted by
their medical Oxy buzz that they went out and found themselves cocaine
dealers, a more parsimonious explanation is that people with
pre-existing addictions sought doctors to get opioids. It wasn't the
doctor or pharma that done it.

2. Most pain patients given opioids for chronic pain never become
addicted.

I've written here before about the distinctions between physical
dependence and addiction--put simply, people who are physically
dependent on certain substance have a physical need for those
substances to function normally, while addiction is compulsive use
despite negative consequences.

People who take opioids daily for a month or more will inevitably
develop physical dependence. But contrary to conventional wisdom,
dependence has little to do with addiction, which is almost
exclusively driven by a person's psychological relationship with the
drug. This is why, for example, although some blood pressure
medications can cause potentially deadly withdrawal symptoms, no one
robs their grandmother to get more of them.

People who are dependent on--rather than addicted to--painkillers can
easily get relief by tapering off the drug. Indeed, many pain patients
go through withdrawal without even realizing that that's what's
causing their "flu." If you aren't psychologically attached to the
drug, kicking opioids is not the gothic ordeal portrayed in so many
movies.

In fact, the first time I quit heroin I was surprised at how mild the
withdrawal was, given what I'd heard about its horrors. Actually, it
was so easy that I picked up again a few weeks later--long after my
not-especially-dire symptoms had disappeared! It was that kind of
logic--and repeatedly making those kinds of choices--that made me not
only physically dependent but an addict.

My addiction was a result of my own decisions; it wasn't something
that mysteriously "happened" to me because I chanced to use heroin. I
may have had impaired control over the later choices I made, but it
was nonetheless I--not a dealer or a doctor--who made those decisions
for me.

Studies regularly show that the odds that a person with no prior
history of addiction will become hooked on prescription opiates are
incredibly small, rarely reaching even 3%. In a recent study of some
5,000 pain patients who took prescription opioids for more than six
months, a mere 0.27% showed any signs of addiction. Former addicts, of
course, have greater odds, but most can be safely treated with opioids
if there is no alternative to relieve their pain. The drugs by
themselves do not inevitably trigger a relapse or wreak havoc with
recovery.

And if they don't make repeated choices to abuse the drugs by upping
the dose or frequency, or popping them recreationally, people can't
"accidentally" slip, as if on a banana peel, into addiction.

To an opioid aficionado like me, it comes as a shock that most people
actually don't like the feeling they get from these drugs: research on
normal volunteers who aren't in pain finds that they typically don't
enjoy the experience. And about one third of subjects in clinical
trials and other research on opioid use for chronic pain actually drop
out due to side effects--a fact that doesn't exactly square with the
popular view that the drugs are irresistible or instantly addictive.
There's no doubt that addiction to opiates is growing. But in the
larger scheme of things, opioid addiction is relatively rare.
Oxycontin is not an unconquerable demon that destroys in its path.
People who are addicted to Oxy are generally pre-disposed to other
addictive behaviors. But if we continue to try to fight the problem by
ignoring this fact, we'll end up hurting pain patients who really need
the drug, while doing little to help Oxy addicts.

3. Even physically dependent soldiers mostly don't become lifelong
addicts.

During the Vietnam War, Department of Defense officials were shocked
when they learned how many U.S. soldiers had become physically hooked
on heroin and opium while serving. But just as shockingly, they
discovered that the vast majority did not become re-addicted when they
returned home. To those raised on heart-rending images of homeless
junkie vets panhandling on the streets of America, this fact may be
hard to believe. What's generally ignored but genuinely surprising is
the very high proportion of combat vets who used heroin during their
tour.

A study of nearly 900 returned vets conducted Dr. Lee Robins, a
sociologist and psychiatrist at Washington University in St. Louis,
found that a full 50% of U.S. soldiers tried opium or heroin in
Vietnam--and 20% of those who tried these opioids under the highly
stressful conditions of war+/-took them to the point of becoming
physically dependent.

But stunningly, just 1% continued to use to the point of addiction
after they returned home, even though a few did take heroin once or
twice in America. Though they used opioids recreationally under high
stress circumstances at a period in life when addiction risk is
highest (late adolescence and young adulthood), an overwhelming
majority of the soldiers did not become lifelong addicts.

The same will likely be true of our Afghanistan and Iraq war
vets--though the repeated tours of duty they undergo could increase
their long-term addiction risk.

So what does all this mean for the "painkiller epidemic"? The good
news is that opioid addiction is relatively rare, even when large
numbers of people are exposed to these drugs. The bad news is that we
continue to try to fight the problem by ignoring this fact. Virtually
all of the Obama administration's major news initiatives are focused
on "educating" doctors and tracking their patients and prescribing.
But given that most addicts aren't patients--and most patients aren't
addictd--this makes little practical sense.

If we want to develop drug policies that work, we need to base them on
what addiction is really like, not on the stereotypes the media
presents or on stories told by addicts who are spotlighted because
they represent those stereotypes. The media also needs to stop
exaggerating the size of the problem to make the story seem more important.

Next, we need to find out what makes people who get hooked
different--what makes some people compulsively use certain drugs
despite the damage they know they will inflict on their lives? Trying
to prevent opioid addiction by eliminating access will never work
because the very people who are most dedicated to obtaining drugs are
the least deterred by making them harder to get. We need to make
maintenance options available to those who need them and provide
treatment referrals--not expulsion from care--when doctors discover misuse.

Otherwise, we'll wind up following the same misguided policies used to
"fight" crack--with the same harmful and ineffective results.