A new battlefront in the war on drugs

USA Today (Society for the Advancement of Education), March, 2005 by Giancarlo Barolat

SOME LAWMAKERS and various media outlets have been waging a very public war against the abusers of prescription painkillers, but they might be fighting for an unjust cause. The publicity surrounding radio personality Rush Limbaugh's personal battle with the prescription drugs OxyContin and hydrocodone served to open the floodgates of opposition against these medications and the doctors who prescribe them.

Physicians, however, are not the only ones being put under the microscope. Patients who take prescription medications oftentimes are painted as drug addicts, pill poppers, and "doctor chasers," and, in many cases, forced to justify their diseases or need for medications. Yet, for those with chronic pain, prescription painkillers often are the only thing offering relief and the ability to lead a somewhat normal life.

For the estimated 50,000,000 chronic pain sufferers, it is becoming increasingly more difficult to obtain prescriptions for painkillers and access to medications. Even more worrisome is the absence of alternatives offered by Federal regulators to patients in need. Rather than promoting advanced treatments, such as spinal cord stimulation, the Drug Enforcement Agency has set its sights on curtailing the nation's supply of prescription medications. A variety of proposed restrictions have pitted the agency against doctors, pharmacists, and patients. The question is, how can these potent chemicals be kept out of the hands of the abusers but still made available to legitimate patients?

The abuse of prescription painkillers certainly is not a new problem or, for that matter, one that seems to be showing any signs of slowing down. According to the National Household Survey on Drug Abuse, an estimated 1,600,000 Americans used prescription pain relievers nonmedically for the first time in 1999. This number has grown drastically since the 1980s, when statistics showed less than 500,000 first-time users per year. These numbers continue to skyrocket. In 2002, Federal statistics indicate that more than 6,000,000 Americans were classified as current abusers of prescription drugs.

When Limbaugh went public about his own personal battle with prescription drugs, it shed more light on this growing dilemma. However, the response by the DEA and the White House has been a little overzealous. Some critics call the DENs attempts a last-chance assault on the tailing war on drugs and believe politicians are going after physicians and pharmacists because they have been unsuccessful with drug lords and dealers. An unfortunate side effect is that the balance of power seems to be shifting to the point where medical decisions are being unduly influenced by Federal regulators. The American Association of Physicians and Surgeons suggests that we now live in a time where "drug agents set medical standards."

At the forefront of this debate is the prescription drug OxyContin, which received an onslaught of attention after Limbaugh's admission. The time-release version of oxycodone, OxyContin, is an opiate that is common in many other painkillers, such as Percocet. Opiates relieve pain by attaching to specific proteins in the brain, spinal cord, and gastrointestinal tract. OxyContin can be effective for up to 12 hours, making it the longest lasting oxycodone on the market.

The duration of relief OxyContin provides, combined with the strength of the drug, are two major reasons it is so appealing to abusers and actual patients. Abusers also have discovered the heightened effects of crushing the tablet and snorting the powder, or chewing it instead of swallowing it whole, which cancels out the time-release factor, channeling the drug directly into a person's bloodstream. The DEA maintains that at least 1,900,000 people have admitted to taking OxyContin illegitimately at least once.

Additionally, the Substance Abuse and Mental Health Services Administration reports that more Americans abuse prescription opiates than cocaine. Pain killer abusers also far outnumber those who misuse tranquilizers, stimulants, hallucinogens, heroin, inhalants, and sedatives. In fact, pain pills are second only to marijuana as the drug of choice for teenagers and young adults.

The Bush Administration promises to spend $138,000,000--a $20,000,000 increase from 2003--to reduce the abuse of opium and morphine-based painkillers. The initiative will heighten state monitoring programs that detect suspicious prescriptions and patients suspected of doctor shopping, as well as educate physicians on how to detect potential abusers. Steps also will be taken to curb the use of the Internet to purchase controlled substances.

The DEA and Justice Department specifically have targeted and prosecuted physicians and pharmacists accused of improperly prescribing and distributing prescription narcotics. Dozens of these individuals have been charged and several are serving prison time. These actions certainly are having a negative effect on the practice of medicine as we know it. A number of doctors are afraid to write prescriptions. In fact, many medical schools are urging students to stay out of the pain management practice because the prosecution risks far outweigh the satisfaction of treating patients in pain.