Killing a painkiller

Posted: Dec 18, 2001 12:00 AM
Last May, a Kentucky physician reported that a former patient, a paraplegic with severe chronic pain, had killed himself. The man's new doctor, alarmed by official warnings about the prescription painkiller OxyContin, had drastically reduced his dose, leaving him in agony. Stinginess with pain medication is not a new phenomenon. For decades, pain experts have complained that many doctors are so worried about getting into trouble with state regulators or the Drug Enforcement Administration that they err on the side of letting patients suffer. The federal government's ongoing crackdown on OxyContin, egged on by a year of hysterical press coverage, is bound to make the problem worse. Introduced in 1995, OxyContin is a timed-release form of oxycodone, a narcotic that has long been available in many other medications, including Percocet, Percodan and Tylox. Unlike these products, OxyContin delivers a steady dose of the drug over a 12-hour period, which makes it a godsend for patients with disabling chronic pain. It has also found a niche among people looking to get high, who discovered that they could get all the oxycodone at once by crushing the tablets and swallowing, snorting, or injecting the powder. The habit was picked up in a few places around the country, especially in rural areas where other drugs are hard to come by. In a humane and sensible world, the fact that some people got their kicks this way would have no bearing on whether paraplegics and cancer patients could get the drugs they needed to relieve their suffering. But in a world warped by the crusade against unauthorized intoxication, a bunch of idiots snorting OxyContin powder can make life so unbearable for people in pain that they're driven to suicide. Here's how it works: Journalists hungry for a good scare story announce that OxyContin is the "drug of choice" in, say, Appalachia or the Midwest. Alerted to the trend, thrill seekers around the country decide to try the pharmaceutical that gives a "heroin-like high." The increase in use feeds the press coverage, which spreads the fashion further and reinforces the government's determination to do something about it, as illustrated by this month's congressional hearings on the issue. Some proposed responses to the nonmedical use of OxyContin, such as limiting production, would have a direct effect on the drug's availability to people in pain. But even seemingly innocuous efforts to prevent diversion can result in needless suffering. Last summer, for instance, the Food and Drug Administration slapped a "black box warning" onto OxyContin declaring that it has "an abuse potential similar to morphine." The FDA cautioned doctors to take into account "the severity of the pain that is being treated" before prescribing the drug. That may sound perfectly sensible. But since the severity of pain cannot be objectively verified, doctors have to decide whether to trust their patients. Every new warning discourages them from taking that chance. Even without concrete government action, the bad publicity is enough to scare already skittish doctors away from OxyContin. Shortly after the FDA announced its labeling change, The New York Times Magazine described the drug this way: "As a pill it brings potent pain relief. As a powder it brings euphoria. It takes about five seconds to effect the transformation -- and not much longer to create an addict." This sort of irresponsible, hyperbolic reporting, which simultaneously stimulates interest in the drug as an intoxicant and discourages its use as a painkiller, has been featured by many prominent media outlets, including Time, Newsweek, CBS, and even MTV (which recently aired "I'm Hooked on OxyContin" as an episode of its True Life series). Such scaremongering is especially galling coming from news organizations that also run stories bemoaning the inadequate treatment of pain. In the typical OxyContin story, the victims are people who choose to take the drug because they like the way it makes them feel. Taking a similar view, the DEA defends tighter controls by claiming that OxyContin is "a likely factor" in about 300 overdose deaths since January 2000. Such cases generally involve people who not only take a 12-hour dose of a strong narcotic all at once but combine it with other drugs. The message of the OxyContin crackdown, then, is that the government has an obligation to protect people from their own recklessness, no matter how many innocent bystanders are hurt in the process.