DON'T BLAME THE DRUG FOR OXYCONTIN'S ABUSE

The Problem Is Addictive Disorders

I MUST take exception to a recent Roanoke Times editorial implying that
oxycodone - and not the abuse of the drug - has caused a "a wave of crime
and death." As a pain treatment specialist and co-chairman of the
Appalachian Pain Foundation, I simultaneously attempt to treat legitimate
pain sufferers while aggressively combating prescription drug abuse and
addictive disorders.

OxyContin, the slow-release formulation of oxy-codone, is one of many
valuable tools that doctors utilize to treat chronic pain. In my opinion,
oxycodone has too often been blamed as the cause for social disorder when
the real culprit is civilly inappropriate behavior generated by drug addiction.

In the past, propoxyphene, amphetamines, methaqualone, diazepam and
hydrocodone were the drugs of choice for addicts. Currently, oxycodone has
inherited this dubious title. Other drugs of choice will follow as addicts
move their obsessions from source to source of perverse need.

The real issues remain addictive disorders and the undertreatment of
legitimate patients. Unfortunately for chronic pain sufferers, many
physicians choose to "opt out" rather than confront perceived notions that
pain patients are "too much trouble" or that their needs are somehow
"disruptive to orderly conduct of medical office business."

Here in West Virginia, I must daily balance the use of prescription pain
medications for patients often injured in strenuous employment (coal
mining, gas fields, timbering, etc.) while simultaneously acknowledging a
patient population that may be at risk for abuse of a number of illicitly
consumed drugs. Finding that appropriate balance requires continual
diligence by all health care professionals involved in serving our
patients. Drugs such as OxyContin are not appropriate for everyone, but for
many, it provides the best option to manage their pain.

Physicians, pharmacists, nurses and all other licensed providers promote
reasonable solutions to better pain management as well as better
recognition and management of addiction issues. Limiting opioid
prescription writing to just a few specially trained pain therapists has
been suggested, but this well-intended effort would ultimately further
dilute access to legitimate providers in our distinctly rural region.

Rather than demonize a Food and Drug Administration-approved medication
formulation that has been prescribed to successfully treat pain for
millions of people, I propose better education of physicians and the public
at risk (teens, injured workers, prior abuse victims, etc.) At little or no
additional cost or bother, physician offices could utilize opiate access
agreements when controlled medications are indicated.

The same advice could extend to random urine drug screens, pill counts and
regular drug-abuse-focused conversations as a routine part of providing
primary care. All physicians should pay special attention to coordination
and co-management among pharmacists, primary care physicians and
specialists in order to recognize prescription drug abuse early enough to
intervene.

As members of specialty associations, we should cooperate with state boards
of medicine, payors and regulatory agencies to establish reasonable
treatment patterns and assure compliance with existing guidelines such as
those adopted by the Federation of State Boards of Medicine for Chronic Use
of Opioids in the Treatment of Chronic Non-malignant Pain. Treatment of
prescription drug abuse as a social and medical disorder needs better
funding - period.

I hope that these suggestions will help foster recognition of the fact that
narcotic prescription, especially oxy-codone, for chronic pain treatment is
not an evil thing.

J.K. LILLY, M.D. of Charleston, W.Va., is co-chairman of the Appalachian
Pain Foundation.