OxyContin abuse puts medical personnel on alert

Heroin-like high results when time-release tablets are crushed

September 23, 2001|By Elisa Ung | Elisa Ung,KNIGHT RIDDER/TRIBUNE

PHILADELPHIA - Kim Bondarenko says her insurance company is making it harder for her to get OxyContin, the drug that annihilated her severe neurological pain and let her go back to work.

Orthopedic surgeon Norman A. Johanson has shied away from prescribing it after hearing about the region's recent spike in deaths linked to abuse of the drug.

And pain specialists across the country are concerned that increased vigilance in administering OxyContin may be causing people to suffer needlessly.

As officials scramble to curb abuse of OxyContin - coveted for the heroin-like high it delivers when the 12-hour, time-release tablets are crushed - it has become more difficult for legitimate patients to get it. For those struggling with relentless cancer pain, the obstacles have been especially cruel.

"I would say my prescriptions for OxyContin are less than 50 percent of what they were three months ago, just because of the fear factor," said Johanson, chairman of the orthopedic surgery department at Hahnemann University Hospital. He said he was now much more likely to prescribe other, weaker painkillers.

Pain centers across the region, meanwhile, have been deluged with calls from patients whose doctors have stopped prescribing OxyContin altogether.

"The pool of physicians willing to prescribe [OxyContin] is dwindling," said Andrea Cheville, director of cancer rehabilitation at the University of Pennsylvania Medical Center.

Cheville has spent hours reassuring her OxyContin patients, many of whom fear becoming addicted or being stigmatized. She says pharmacists have winked at some of her patients, telling them: "Hang on, I'll get your fix."

Purdue Pharma product

OxyContin was formulated by drug maker Purdue Pharma of Stamford, Conn., to deliver, with one tablet covering 12 hours, a sustained amount of the painkiller oxycodone for patients suffering moderate to severe pain. The tablets come in strengths of 10, 20, 40, and 80 milligrams, corresponding to their amount of oxycodone, a narcotic derived from opium that works by blocking pain receptors in the brain.

OxyContin's time-release formulation has made it wildly successful as a legitimate painkiller - and as an abused drug. The amount that is time-released allows patients to sleep through the night, but it also gives abusers a high when they crush a tablet, getting the full hit of oxycodone by chewing, snorting or injecting.

That high can shut down respiration and kill, especially when OxyContin is crushed and taken with alcohol or other prescription drugs. Medical examiners in the Philadelphia region report a rising oxycodone-related death toll; in the city alone, oxycodone was linked to 39 deaths by late June of this year, compared with 41 in all of 2000. Four area medical professionals have been arrested this year for illegally prescribing the drug, including Richard G. Paolino of Bensalem, a physician who authorities said was the number-one source of OxyContin as the drug ravaged Fishtown, Port Richmond and Kensington.

With reports of OxyContin addiction, abuse and deaths rising nationally, officials - among them Pennsylvania Attorney General Mike Fisher - have insisted that Purdue Pharma halt what they consider aggressive marketing of the drug, introduced in 1996. The manufacturer estimates about 1 million people took the drug last year. There were $1.2 billion in sales from May 2000 to May 2001.

Purdue announced last month that it would reformulate the drug to be abuse-proof, with an additive, naltrexone, that would block the drug's narcotic effect if tablets were crushed. That new version will not be available for at least three years, since naltrexone must undergo safety trials.

Critics said the manufacturer, too slow to react to OxyContin abuse in the first place, should offer a redesigned drug much sooner. Late last month, Purdue's senior medical director, J. David Haddox, said the company would try a quicker solution, adding naloxone, a chemical already tested and used in other painkillers to help prevent intravenous abuse.

In a recent interview, Haddox said the company could not predict when any new formulation might be available because of Food and Drug Administration testing requirements. And though Purdue has known it could use naloxone, he said there were concerns that it would add a ceiling effect to OxyContin.

"Our primary goal here is to make safe, effective medications for patients with pain," Haddox said. "The secondary goal is to try to make these medications in a formulation that will be resistant to abuse.

"When you look at the number of people who have benefited and continue to benefit from OxyContin, it would have been unethical for us to just have sat on that until we worked on every last technical glitch to make the drug abuse-resistant," he said. "Our primary obligation is to patients with legitimate medical need."

Plight of patients

Many of those legitimate patients, like Bondarenko, struggle to get their OxyContin prescriptions filled.

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