Stop Oxycontin abuse, not its use

September 06, 2001|By Peter S. Staats

RECENT MEDIA reports about abuse of the prescription painkiller Oxycontin are no doubt alarming.

Newspapers describe pharmacies being robbed, abusers shoplifting to pay for their habit and physicians afraid to prescribe it. Authorities are looking into restricting the drug and asking the manufacturer to alter the preparation to prevent abuse.

In regulating the drug, we must be diligent not to penalize our most vulnerable patients -- those who suffer chronic pain.

As physicians, we recognize that making Oxycontin and other opioid drugs available to patients who need them risks increasing access to abusers. Yet painkiller abuse occurs rarely. While estimates vary, we believe true addiction occurs in only 3 percent to 6 percent of the general population. There is no reason to suspect the prevalence is higher in the pain clinic population or general medical community, where opioids are administered in a controlled setting and carefully monitored.

Opioids occupy a vital position in the management of acute and chronic painful disorders. In fact, they provide the most effective treatment and could not be abandoned without grave ramifications. Instead of denying legitimate access to opioids, we must seek strategies to eliminate abuse.

Over the past decade, we have improved our understanding that opioids occupy a legitimate role in pain management. In the early 1990s, many state medical examination board members believed it was inappropriate to prescribe opioids for nonmalignant pain. They went so far as to investigate physicians who took such action. This policy instilled an undercurrent of fear in many physicians, making them less willing to prescribe opioids and leading to poor-quality treatment for pain nationwide.

Fortunately, these inaccurate and restrictive attitudes changed as a wealth of information accrued on the efficacy of opioids, including their low incidence of addiction and manageable side effects. To date, hundreds of thousands of patients have been monitored while receiving opioids. We now know we can improve the quality of pain care only if opioids remain part of the clinical regimen.

As we move forward, we must maintain a sense of balance. We must reassure physicians that it is legally safe to prescribe opioids, even as we investigate those who engage in criminal activity.

We need to assure our patients they will have access to the only medications that can manage their intractable pain, even as we prevent criminals from diverting them for illicit use. Finally, we need to instruct our patients that selling their medications is a criminal act with penalties.

Peter S. Staats, M.D., is director of the Division of Pain Medicine at the Johns Hopkins University School of Medicine. He also is president of the Southern Pain Society and president-elect of the American Neuromodulation Society.

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