NO RELIEF

The War On Drugs Is Preventing Many Americans From Getting Desperately
Needed Pain Medicine

After three decades of chronic, searing pain, Marie Dabrowski was finally
able to sleep. She was able to think. And sometimes, thanks to her new
pills, she could almost forget about her fibromyalgia, a mysterious nerve
disorder characterized by fatigue, migraine headaches and full-body aches.

But Dabrowski's respite did not last. The medication responsible for her
two-year break from daily misery was OxyContin. And about a month ago,
Dabrowski's doctor cut her off. The move had nothing to do with callousness
or lack of concern, says Dabrowski, who asked that her doctor remain
anonymous. Instead, the doctor was spooked by a proposed Virginia law
designed to intensify scrutiny of physicians who prescribe the drug. In the
end, says Dabrowski, it was the prospect of police interrogation that
pushed her doctor over the edge.

"When I went in [to her office], her receptionist explained to me that it
was the DEA that was the problem and that my doctor was scared of getting
in trouble," she says. "I told them that this was dangerous. People on
[OxyContin] finally have something that keeps the pain away, and if the
pain comes back they're going to commit suicide."

Widespread abuse of OxyContin, a painkiller made by Purdue Pharma LP, was
first reported in the media about a year ago. Called "hillbilly heroin"
because early cases of addiction surfaced in Appalachia, the pills were
being crushed and then snorted or injected by users, who found the drug
cheap and easy to obtain. Once touted by its manufacturer as a safe and
effective alternative to highly addictive morphine, "Oxy" quickly became
the scourge of law enforcement, spreading across the country with lightning
speed, leaving hundreds of addicts in its wake.

Even as Purdue hastily promised to produce OxyContin in a form less
vulnerable to abuse, legislators in at least 17 states pushed to create
strict prescription tracking programs, while others took steps to limit the
number of OxyContin pills that people on Medicaid can receive. The
Department of Justice has proposed a national crackdown on painkiller
abuse, and some states are considering laws that would ban OxyContin, as
well as its main ingredient, oxycodone, a synthetic opiate prescribed to
millions of patients since 1916.

It is difficult to argue with laws intended to make it harder for addicts
to get drugs; and the DEA has said it does not want to limit the supply to
those with a legitimate need for relief. But there are dangerous side
effects to the new restrictive policies on prescription painkillers --
chief among them, widespread, unnecessary suffering. Patients with chronic
pain, routinely undertreated in the past, had in recent years begun to get
adequate relief, thanks, in part, to OxyContin, one of the few drugs that
reduces or eliminates pain without nausea or damage to vital organs. The
onslaught of regulations designed to curtail OxyContin abuse now threatens
to reverse these advances.

Increasing numbers of the estimated 30 to 50 million people in the country
who suffer from some form of chronic pain say the OxyContin crackdown means
they can no longer get adequate or sustained relief. For some, the new
rules and medical practices create frustrating delays in receiving
medication. But for others, there is no help at all.

Cancer patients and sufferers of debilitating diseases report that they are
getting ineffective dosages of OxyContin, running out of places to fill
legal prescriptions for it, or finding themselves without doctors, many of
whom choose to avoid OxyContin headaches by sending patients to overwhelmed
pain specialists struggling with the same regulations.

Our simmering fear of painkiller abuse, brought to a boil by the OxyContin
scare, has created a world of hurt for legitimate victims of illness: The
war on drugs has increasingly become a war on patients.

"I wake up crying every morning because I don't have anything for the
pain," Dabrowski says. "The law isn't even in place, but it's already
affecting me. I feel like I'm burning from the inside out."

Americans have something of a tortured relationship with opioids -- pain
relievers derived from real or synthetic opium that work on the central
nervous system. Doctors were the earliest targets of prescription drug
panic: As early as 1914, with the passage of the Harrison Narcotic Act, the
government identified doctors as agents of But experts question the
sincerity of law enforcement's dedication to those who truly need strong
pain medication. There have been no mitigating laws passed in the interest
of patients. Joranson, the pain policy expert, argues that in many states
new prescription laws amount to simple politics: "Politicians need to be
seen as doing something about drugs," he says. And others fear that
Hutchison's stated attempt to protect legitimate prescribing will go
unheeded. With press attention focused on doctor busts and new laws that
extend police powers, authorities may not curtail their efforts, but expand
them.

"While the DEA has strived to be sensitive in their central office to pain
medications, I question whether that commitment has trickled down to the
field," says John Giglio, one of several pain-management advocates who met
with Hutchison last fall to plead the pain patients' case. "I also question
whether the people in the office of diversion control have really gotten
that message, much less gotten the additional training that they need to
treat doctors and patients fairly."

Some patients are fighting back. Mike Schrader, for example, had his
prescription switched from OxyContin to methadone a month ago. At first,
the former X-ray technologist didn't mind. The methadone alleviated some of
the pain he suffers in his hips and back -- the result of 14 separate
surgeries -- and he was willing to give it a try. But eventually he
discovered that the new pills were weaker than expected.

"My pain level before OxyContin was an 8 out of 10," he says. "With
OxyContin it was on a 4-5 level. Now I'm back up around a 6."

Schrader figures that there's no reason to sit back and take the pain. He
says that for as long as the methadone fails him, he'll keep asking his
doctor for the same level of relief he received with OxyContin. "I'm not
going to let him force me to suffer just because he's scared to write the
prescription," he says.

Few victims of chronic pain have Schrader's energy or clarity of mind to
protest undertreatment, so pain advocates are trying to back them up -- to
little avail. "We are an opiophobic nation," says Barbara Coombs Lee,
president of the Compassion in Dying Federation, a nonprofit that is suing
U.S. Attorney General John Ashcroft for trying to overturn Oregon's
physician-assisted suicide law. "We have a craziness about this issue and
the effect is that it harms patients in pain and those at the end of their
life."

Adds Murray, "If [OxyContin] was taken off the market right now, it would
not hurt the drug addicts," she adds. "It would only hurt the people who
need it. The addicts will get another drug. It's gonna be us that pays."