OBSERVER EXPLOITS DRUG FEARS

Gerald M. Aronoff - Special To The Observer

As chairman of the Department of Pain Medicine at Presbyterian Hospital and
former president of the American Academy of Pain Medicine, I feel compelled
to respond to The Observer's series on OxyContin. The story was skewed
toward sensationalism at the expense of accuracy.

I spent considerable time with the writer in an attempt to put the issue of
opioid use for chronic pain into perspective. I sent her two medical
articles I wrote on opioid use in chronic pain, one specifically addressing
"Recent Publicity on Widespread Abuse of Pain Medication" (Mecklenburg
Medicine, May 2001). She apparently was not interested in the facts. I was
then quoted out of context.

The Observer has done a major disservice to pain patients who require
opioid analgesics, to physicians who appropriately treat these patients and
to pharmaceutical companies who spend billions of dollars through research
and development of pharmaceuticals to help pain sufferers and to support
pain research.

Research shows that on any given day up to 30 percent of our population can
be suffering from chronic pain. It is a major public health problem that
not only inflicts enormous suffering, but has a major economic impact for
society.

Recent publicity has targeted the sustained-action analgesic OxyContin as
contributing to widespread drug addiction and abuse. These articles raised
multiple points about the potential for abuse and diversion of potent
analgesics. These facts are partially accurate. All potent drugs can be
abused, whether they be narcotic analgesics, mood-altering tranquilizers,
psychostimulants, sleep medication, medications that enhance growth, curb
appetite or promote weight loss, etc.

All these medications were developed for specific uses, and each is
vulnerable to being abused. This is not the fault of the pharmaceutical
companies. Rather, it is a reflection of social problems and
counter-culture influences. The psychopathology (with perhaps some help
from genetics) that leads certain individuals to become drug
abusers/addicts occurs in about 6 percent to 13 percent of the population,
the highest number reflecting alcohol problems.

The Observer article exploits the public's fear of addiction. The public
should be reassured that there are established guidelines for the use of
opioids in chronic pain in most states, including North Carolina. These
guidelines include careful monitoring of clinical effectiveness
(improvement in pain and suffering), enhancement of function, improvement
in quality of life. This monitoring also watches for side effects, risk
factors for addiction and drug-seeking behaviors.

Opioids should be prescribed only after it is established that there is a
significant underlying pain condition not adequately controlled by other
treatments.

Pain medicine physicians have taken the lead in finding ways to improve
patient care. As president of the American Academy of Pain Medicine, I
convened a task force on end of life care. The task force addressed
inadequate pain treatment that, at times, has led patients to
physician-assisted suicide and euthanasia, rather than suffering
overwhelming pain and a diminished quality of life. Had physicians trained
in pain medicine evaluated them, many who chose suicide and euthanasia
would be alive today.

Increasingly in the field of pain medicine, when opioids are indicated for
chronic pain, those prescribed are the sustained-action type, which have
fewer side-effects, are better tolerated and more compatible with resuming
normal activities (including work and driving) without interfering with
mental status. Unfortunately, as with analgesics that preceded it (and, I
suspect, many that will follow), these have also found their way to the
street drug population.

OxyContin is not a "wonder drug." It is, however, an enormously effective
analgesic for chronic pain with a good safety profile and few adverse side
effects (when taken appropriately). My patients who are taking it are
grateful, have less pain and suffering and are able to have more normal lives.

On occasion, I have had patients who initially were felt to be appropriate
for chronic opioid therapy and subsequently I felt were drug seeking. I
stopped prescribing medication for them.

My clinical research is consistent with other evidence that there is a
subgroup of chronic pain sufferers who can safely be maintained on chronic
opioids. With them, these patients remain functional and productive;
without them, they are inactive and become disabled. Patient selection is
extremely important.

I believe we must attempt to better deal with problems of drug abuse,
addiction and preventing drug diversion. However, I am opposed to
withholding adequate pain treatment from patients who need and deserve that
treatment.

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Gerald Aronoff, M.D., chairs the Department of Pain Medicine at
Presbyterian Hospital. Write him at 1901 Randolph Road, Charlotte, NC 28207.
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