Binky
05-17-2005, 05:09 AM
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."
Salem News (MA)
Copyright: 2005 Essex County Newspapers
Contact: nbenton@ecnnews.com
Website: http://www.salemnews.com
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."
Salem News (MA)
Copyright: 2005 Essex County Newspapers
Contact: nbenton@ecnnews.com
Website: http://www.salemnews.com