August 2001 • Volume 7 • Number 8
Two faces of OxyContin
AAFP concerned about abuse, diversion of drugBY TONI LAPP
To some patients, OxyContin is a miracle drug, an effective medication that relieves chronic, severe pain. To others, it's a potent, addictive narcotic -- and they'll lie and steal to get it.
The latter group has sparked concern among physicians and drug agency officials. Citing reports of the drug's abuse, the Drug Enforcement Administration says that physicians are overprescribing OxyContin, the time-released form of oxycodone. Abusers get an immediate high by crushing the pills and snorting or injecting the powder, compromising the safety conferred by the time-released coating.
The drug, which was labeled by the FDA in December 1995 and introduced in 1996, has been blamed for 120 overdose deaths.
As a result, the DEA is lobbying the FDA to limit prescribing privileges to pain management specialists -- in effect restricting family physicians' prescribing rights.
Academy officials are deeply concerned about reports of diversion and abuse, says Kevin Burke, director of the AAFP Government Relations Division. But AAFP officials think the solution is to educate FPs to ensure that they prescribe the drug appropriately, not to restrict their right to prescribe.
Diversion of OxyContin has been most widespread in Appalachian states and rural communities, "areas that would be the hardest hit if physicians' prescribing privileges were limited," says Burke. Only about 3,000 pain management specialists nation-wide would have the exclusive prescription rights under DEA's proposal, says Burke.
DEFENDING FP'S PRESCRIBING PRIVILEGES
The FDA will hold a fact-finding hearing Sept. 14; Board Chair Bruce Bagley, M.D., of Albany, N.Y., will testify on AAFP's behalf.
Academy officials are taking the DEA's proposals seriously, says Burke, who sees any attempt to limit FPs' prescribing privileges as diminishing their ability to care for patients.
Thus, the Academy is taking a two-pronged approach, Burke says. The first approach is to educate physicians about how powerful OxyContin is and how rarely it should be used. The second approach is to collect data on FPs' prescribing practices in order to defend their prescribing privileges.
Besides the DEA, other government agencies are starting to take action on OxyContin. Attorneys general from several states formed a task force in May with the goal of developing strategies to reduce the illegal use of prescription drugs -- particularly OxyContin -- through increased coordination of law enforcement efforts and community education.
AAFP staff will meet with task force staff members "to educate them about primary care and our concern about how important an issue access to pain medication is," says Fay Fulton, the Academy's senior manager on state government relations.
And in the courts, West Virginia's attorney general filed a complaint charging that Purdue Pharma, OxyContin's maker, used "highly coercive and inappropriate tactics" to encourage physicians to prescribe the drug.
Such developments cause Burke to bristle. "The lawsuit implies that physicians are merely tools of pharmaceutical companies, that they don't have the wherewithal" to prescribe appropriately, when that's not the case, says Burke.
WHO'S TO BLAME
OxyContin's maker is on the defensive as a result of recent developments. James Heins, Purdue's associate director of public affairs, blames much of the negative publicity on sensationalism.
"It's the drug du jour" in the consumer media, says Heins. The coverage creates an atmosphere in which doctors are less aggressive about treating pain out of fear of government reprisal, he says.
Purdue has met with the DEA and has announced several initiatives to prevent OxyContin's abuse. The company is giving tamper-resistant prescription pads, opioid documentation kits and brochures on stopping drug diversion to nearly 500,000 physicians in the states where the abuse is most prevalent.
Purdue has also established guidelines on prescribing OxyContin. According to Purdue, the drug should be prescribed to patients only in cases where opioid use is appropriate for moderate to severe pain lasting more than a few days, and it should be prescribed only by physicians who are knowledgeable about the use of opioids in pain management.
The DEA's proposal to limit prescribing of the drug doesn't sit well with Purdue."It basically takes a useful tool for pain control away from a large population of physicians," says Heins. "It could mean that a lot of people who rely on primary caregivers for pain management won't be able to get care if a 'specialist' doesn't practice in their region.
"We think the answer is to do education on proper assessment of pain; the whole use of the range of management tools, including opioids; and how to recognize addiction and diversion."
Use these tips to stop OxyContin diversion
The federal Center for Substance Abuse Treatment offers many protocols for improving the treatment of drug abuse. For more information, go to http://www.samhsa.gov/centers/csat/csat.html and scroll down to "Treatment Improvement Protocols" -- or contact CSAT at (800) 729-6686. Purdue Pharma has developed the following steps to stop diversion of OxyContin:
Protect your prescriptions:
- Keep prescription pads in your pocket or lock them up.
- Never sign an incomplete prescription.
- Use tamper-resistant prescription pads -- they can't be photocopied.
- Write the quantity and strength of drugs on your prescriptions in both numbers and letters (the way you write checks).
- Write on the prescription the name of the pharmacy the patient intends to use.
- Consider faxing the prescription to the pharmacy for authentication by pharmacists.
- Don't print your medical license number on the pad -- write it in when you write a prescription.
Be wary of the stranger who:
- wants an appointment toward the end of office hours or telephones/arrives after regular hours;
- insists on being seen immediately/demands immediate action;
- is not having a physical exam, giving permission to obtain past records or undergoing diagnostic tests;
- is extremely slovenly or is overdressed;
- is unwilling/unable to give name of regular physician -- may claim to have no health insurance;
- can't recall hospital/clinic where past records are kept or says it went out of business;
- claims to have lost a prescription or forgotten to pack a medication or says it was stolen;
- exaggerates/feigns medical problems;
- recites textbook symptoms/gives vague medical history;
- has no interest in diagnosis/referral -- wants a prescription now;
- shows unusual knowledge of controlled substances;
- requests a specific controlled drug and is unwilling to try another medication; or
- states that specific nonopioid analgesics do not work or that she or he is allergic to them.
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
FP Report | Headlines |AAFP Home | Search
