THIN LINE SEPARATES PAIN, DRUG ADDICTION

Over the past two decades, two conflicting medical ideas have surfaced
about narcotic painkillers, the drugs that Rush Limbaugh blames for his
addiction while he was being treated for chronic back pain. And both of
them, not surprisingly, have centered on the bottom-line question: Just how
great a risk of abuse and addiction do narcotics pose to pain patients?

Throughout much of the last century, doctors believed that large numbers of
patients who used these drugs would become addicted to them. That incorrect
view meant that cancer sufferers and other patients with serious pain were
denied drugs that could have brought them relief.

But over the past decade, a very different viewpoint has emerged, one
championed by doctors specializing in pain treatment and by drug companies
eager to broaden the market for such drugs. It held that these medications
posed scant risk to pain patients, and some experts now believe that it
also had unfortunate consequences because it caused, among other things,
physicians to develop a false sense of security about these drugs.

"The pendulum went in two opposite directions," said Dr. Bradley S. Galer,
group vice president for scientific affairs at Endo Pharmaceuticals, which
manufactures two widely used narcotics, Percodan and Percocet. "Luckily,
now the pendulum is focusing where it should be, right in the middle."

The reassessment of narcotic risk comes at a time of skyrocketing rates of
misuse and abuse of such drugs. Medical experts agree that most pain
patients can successfully use narcotics without consequences. But the same
experts also say that much remains unknown about the number or types of
chronic pain sufferers who will become addicted as a result of medical
care, or "iatrogenically" addicted. The biggest risk appears to be to
patients who have abused drugs or to those who have an underlying,
undiagnosed vulnerability to abuse substances, a condition that may affect
an estimated 3 percent to 14 percent of the population.

It is not unusual for views about particular drugs and their hazards to
change over time.

But a look at the shift in medical thinking about the risk of addiction
shows a struggle that was waged both as a guerrilla war among doctors and a
high-powered drug industry initiative.

It also was an effort that, while seeking a laudable goal, inaccurately
portrayed science.

For its part, a spokeswoman for the federal Food and Drug Administration,
Kathleen K. Quinn, said the agency believed that "the risk of addiction to
chronic pain patients treated with narcotic analgesics has not been well
studied and is not well characterized."