A DOCTOR'S DILEMMA

OxyContin Epidemic Is Changing The Ways MDs Treat Patients

William Medwid has seen OxyContin's pain and its promise firsthand. In his
private practice in Hamilton, Medwid, a physician, has prescribed OxyContin
for countless sufferers of chronic pain. For some patients, the drugs are
the best way to get them out of bed and back into society. But in his work
at CAB Health and Recovery in Danvers, Medwid has met hundreds of people
whose lives have been ravaged by addictions to prescription opiates,
including OxyContin. He's seen them struggle through withdrawal - nausea,
sweats, insomnia - sometimes while trying to hold down a job and hide their
habit from loved ones.

That surge in abuse is putting doctors in a bind. And they are responding
by writing fewer prescriptions for opiates and in lower doses - some
believe to the point that patients may not be getting adequate treatment.
Purdue Pharma, the Stamford, Conn., company that makes OxyContin, says
sales of the drug have slackened in the Boston area. Patients, meanwhile,
are growing so afraid of prescription opiates that they are resisting
taking them, even when their doctors recommend it. "Prescription abuse has
become such a crisis that it's starting to get in the way of getting the
drugs to the people who need it," said Thomas Sullivan, a Danvers
cardiologist who is former president of the Massachusetts Medical Society.
"There's a big distinction between addiction and addiction with all the
criminal behavior that's associated with it."

There is no question prescription opiates, such as OxyContin, Vicodin and
Percocet, can be dangerous. Chemically similar to heroin and morphine, they
frequently serve as a gateway to those drugs. On the North Shore, abuse of
prescription painkillers like OxyContin by teenagers and young adults has
led to an upsurge in heroin addiction.

But for all the perils, doctors say prescription opiates remain an
important weapon in the medical arsenal.

"When (patients) have this chronic pain, it changes their life," said David
Newberg, director of pharmacy for Northeast Hospitals in Beverly. "The
feeling is that pain is undertreated. ... All of the industry journals, the
accrediting agencies have said we need to be attentive to chronic pain and
treat it." Sometimes patients are told to use prescription opiates
indefinitely. Sullivan recalls prescribing high levels of morphine to one
woman, an arthritis sufferer in her 90s, for four years.

Without the drug, she would have been unable to walk, Sullivan said, and by
the time she died - of old age - there was no way she could have lived
without it. But that trade-off was worthwhile, Sullivan said. "When you're
in your 90s and your entire life is focused on being pain-free, addiction
doesn't mean much," he said.

High penalties But the surge in abuse has forced doctors to change the way
they handle the drugs. They have started screening patients more carefully
to weed out the ones who are feigning injury, and they are writing smaller
prescriptions so patients have to check back frequently to get more.

They have also started asking patients to take drug tests and sign
guarantees that they won't abuse the drug or mix it with others. "I've had
to let some patients go because of continued violations of their pain
contract," Medwid said.

The shift is prompted in large part by concern for patients' well-being,
but doctors also face stiff penalties - including losing their medical
license - for carelessly prescribing opiates. Several said they now start
patients out on other drugs before moving to opiates.

"You won't get them to admit this, but there are physicians who won't
prescribe them at all," said Coleen Reid, a physician with Palliative Care
of the North Shore. "They're worried about the DEA (Drug Enforcement
Administration) getting involved."

Patients have also grown more cautious about taking opiates, doctors say.
"There's a fear of addiction, a stigma attached to these drugs," Reid said.
Doctors say they have to spend a lot of time convincing patients that there
is a difference between addiction and dependency.

Dependency is a physiological need for the drug. Patients can depend on a
prescription opiate for years - even to the point that they will suffer
from withdrawal if it is taken away - and still not be addicted to it,
doctors say. Addiction occurs when the focus of your life becomes getting
the drug, they say. A person who steals to buy OxyContin is an addict.

The distinction is lost on many patients. "Unfortunately, it's the people
that would benefit from it most that are scared of the drug," said Andrew
Kowad, director of the Pain Management Center at the Lahey Clinic. "It's
the little old lady who is terrified of the drug because of everything
she's read in the press."