Excerpt from my upcoming book: Pain Pill Addiction: Prescription for Hope

 One doctor makes work for another.  ~English Proverb

 The increase in opioid addiction coincided not only with the movement toward aggressive treatment of chronic pain with opioids, but also with the release of OxyContin by its manufacturer, Purdue Pharma, in 1996. Their other drug for pain, MS Contin, had become well-established in the treatment of severe cancer pain, but this drug was due to come off patent. This meant the other drug companies could then manufacture and sell a generic version of the same drug at a cheaper price. Purdue obviously wanted physicians to switch to their new drug, still under their patent, to maintain their share of this market.

 OxyContin was marketed aggressively to small town family doctors who didn’t have much experience treating chronic pain with powerful opioids, or with identifying and treating pain pill addiction. In rural areas, family doctors had few places they could refer patients who developed problems with their opioid pain medications.  (1)

 The drug company marketed OxyContin as an appropriate treatment for chronic, moderate to severe, non-cancer pain. In the past, such strong opioids were used only for intractable, severe pain. OxyContin was marketed as the pain medicine to “start with and stay with.” OxyContin was even prescribed for such ailments as menstrual cramps, oddly mirroring the misuse of opioids like laudanum and morphine a century earlier.

 Purdue Pharma believed OxyContin was tamper-resistant and less likely to be abused, due to its time release coating. The drug company was still touting this as a selling point in 2001, when addiction medicine doctors all over the country were seeing hundreds of OxyContin addicts. These addicts described how easy it was to moisten the pill, crush it, snort it, inject it, or just file off the coating and chew it.

 Purdue Pharma didn’t do pre-release testing of their new drug, to assess its desirability to addicts seeking to get high. At first, they didn’t have a post-market release system to monitor for signs of abuse and diversion, as other companies have done.  In fact, Purdue Pharma seemed to go out of their way to ignore early warnings and complaints about the drug. Doctors, who tried to warn the drug company about the patients they were seeing who were addicted to OxyContin, were ignored and discounted. (1)

 Purdue Pharma trained its sales representatives to make deceptive statements. Besides telling doctors that the drug was less likely to be abused, the sales representatives also gave false information about the risks of opioid withdrawal after stopping the pill. (2)

 OxyContin became such a commonly known drug to both abusers and the media that the U.S. General Accounting Office (GAO) asked for a report about the promotion of OxyContin by Purdue Pharma, information on factors affecting its abuse and diversion, and recommendations of how to curtail its misuse. This report, released in 2003, stated that by 2001, the sales of OxyContin were over 1 billion dollars per year, making it the most commonly prescribed brand of opioid medication for moderate to severe pain. (2)

 By 2002, prescriptions written for OxyContin for non-cancer pain constituted eighty-five percent of its total sales. The type of non-cancer pain for which it was prescribed included both acute pain, like kidney stones, broken bones, and post-operative pain, and chronic pain like arthritis and fibromyalgia. By 2003, primary care doctors, with little or no experience or training in the treatment of long-term pain, were prescribing about half of all the OxyContin prescriptions written in the country. By 2003, the FDA had cited Purdue Pharma twice, for using misleading information in its promotional advertisements to these doctors. (2)

 The GAO’s report recognized the unique timing of the release of OxyContin. “Fortuitous timing may have contributed to this growth, as the launching of the drug occurred during the national focus on the inadequacy of patient pain treatment and management.” (2, Page 9)

 Purdue Pharma could have re-formulated their pill, to reduce the risk of abuse and addiction. Sterling Drug, manufacturer of the pain medication Talwin, re-formulated their medication, to make it less likely to be abused. The active drug in Talwin is pentazocine, an opioid that had a brief rise in abuse when it was first released in the 1980s. To prevent intravenous injection of their drug, Sterling re-formulated Talwin within a year, adding naloxone, a drug that reverses the effects of opioids. This is the same medication used by doctors to treat opioid overdoses. Naloxone is not absorbed when taken by mouth, because it is inactivated by stomach acid. But when the pentazocine/naloxone pill is ground and injected, it puts addicts into immediate withdrawal, thus making it a much less desirable drug for intravenous addicts. This action by Sterling curtailed the abuse of Talwin/NX, their new product.

 Other manufacturers have taken different precautions, when concerned about the abuse of a prescription drug. For example, the drug Rohypnol, commonly called the date rape drug, is illegal in the U.S., but is legally prescribed in Europe and Latin America. Because they were concerned that the drug was being used illicitly, to facilitate rapes, the manufacturer, Hoffman-LaRoche, re-formulated Rohypnol so that instead of being clear, colorless and tasteless, it becomes milky white when added to any other liquid. This can warn unsuspecting people that something has been added to their drink.

 A Purdue Pharma representative testified before congress in 2002, saying that the company was working on a re-formulation of OxyContin, to make it harder to use intravenously, and that they expected to have the re-formulated pill on the market within a few years. (3)  Eight years later, there still is no such re-formulation of OxyContin. Purdue Pharma said it would take three or four years to reformulate the drug, though Sterling, with Talwin, managed to accomplish this within a year, more than a decade earlier.

 In May of 2007, three officers of Purdue Pharma, a privately held company, pled guilty to misleading the public about the drug’s safety. Their chief executive officer, general counsel, and chief scientific officer pled guilty, as individuals, to misbranding a pharmaceutical. The executives did not serve jail time. Though they plead guilty, they claimed they personally had done nothing wrong, but accepted blame under the premise that an executive is responsible for the acts of the employees working under him. (4) The three executives’ fines totaled 34.5 million dollars, to be paid to Virginia, the state that brought the lawsuit.

 The Purdue Pharma company agreed to pay a fine of $600 million. Though this is one of the largest amounts paid by a drug company for illegal marketing, Purdue made 2.8 billion dollars in sales revenue, from the time of its release in 1996 until 2001 alone.

 To be fair, the drug company and addiction specialists had data that showed the most common opioid to be abused is actually hydrocodone, a short acting opioid, often marketed under the brand names of Vicodin or Lortab. While this is technically correct, the strength of a single hydrocodone pill is usually 5, 7.5, or 10 mg, while OxyContin came in 10, 20, 40, 80, and, for a brief time, 160mg. In addition, hydrocodone is slightly weaker, milligram per milligram, than oxycodone. In other words, the opioid firepower in one OxyContin is much higher than in one hydrocodone, so they are hardly comparable. An addict would need more than eight hydrocodone 5mg pills to equal one OxyContin 40mg.

 This much opioid, packed into one pill, produces a powerful high when it’s released all at once, as it is when the time release coating is removed. Many patients I’ve talked to have said they knew OxyContin would cause problems from the first use. “After that first high, I knew I would keep using. I wanted that feeling,” is an example of a typical quote.

 Since the debacle of OxyContin, Purdue Pharma has donated money towards helping communities treat opioid addicts, and has paid money as ordered by the court. Much of the $600 million award will go to states heavily afflicted by OxyContin addiction. This money will help to establish programs to help prevent and treat opioid addiction.

 OxyContin isn’t a bad or evil drug. It’s just a drug, capable giving great benefit and relief of suffering to those people in serious pain. And it’s also capable of being misused, and can cause great suffering and even death, if not used in the right way.

 1. Barry Meier, Pain Killer: A “Wonder” Drug’s Trail of Addiction and Death (Rodale Books, 2003)

2. General Accounting Office OxyContin Abuse and Diversion report GAO-04-110, 2003.

3. United States Senate. Congressional hearing of the Committee on Health, Education, Labor, and Pensions, on Examining the Effects of the Painkiller OxyContin, 107th Congress, Second Session, February, 2002.

4. Washington Times, “Company Admits Painkiller Deceit,” May 11, 2007, accessed online at http://washingtontimes.com/news/2007/may/10/20070510-103237-4952r/prinnt/ on 12/18/2008.

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7 responses to this post.

  1. Posted by Cindy on May 30, 2011 at 8:12 pm

    I read your blog and it is very informative. I am not a user but consider myself addicted due mainly to the fact that my son is an addict and it has consumed my life. Perdue Pharma is considered to me to be a killer……a blatant killer. Why they are allowed to keep producing the killer drug that is taking over the whole country is unbelievable and totally ignorant of the facts themselves. Even though they have supposedly given monies to help fight this growing problem it seems that its not helping enough. Could that be because we never see where it actually goes or what it goes for? The medication used to help treat this addiction, suboxone, is very expensive and most can’t afford the cost. Why not have Perdue step up to the plate and pay for it? All I know is that there is no treatment for the mothers and fathers and families who suffer from the effects of a drug that they have never even taken but are consumed by it every day. I say a prayer everyday for my son with the hope that one day he will be drug free and both his addiction and mine will be finally over. I also pray that the makers of this drug will pay for what they have done and know that they are the ones who will have to answer for the countless deaths of so many people.

    Reply

  2. Это должен прочитать каждый родитель!.

    Reply

  3. Posted by Tracy Williams on January 3, 2012 at 7:36 pm

    I read this material and seems to be researched. However, I disagree! I take oxycotin. Its the ONLY way I can manage to work, be a single mom and take care of my child. Couple of yrs ago I had a few serious accidents and was lucky I didnt die. But the pain was so severe that I wanted to die!! When my physician gave me this medication…I couldnt believe I could actually live and maintain a semi normal life! I still cant do the things I used to love and enjoy doing such as snow skiing, tennis, raquet ball etc. But the medication helps me to smile and enjoy life again as much as possible!!!! Thats what makes me so angry w people who BLAME the doctors!! Perhaps its WAY past time to look at the irresponsible people who ABUSE the medication!!! They screwed it up for people like myself who HAVE TO TAKE THE MEDS to live a semi normal life. Plus theres a reason doctors prescribe the medication…they assume their patients will be mature and responsible enough to take it the way its prescribed! And Im sure the reason the person wrote this article was to see both sides before publishing their book. Funny I’m working on a book as well and in law school. I still work and obtaining my degree. So, what dont the skeptical people look at people like myself who take the medication, and making something of their life and are responsible.There are 2 sides to every story!!
    Furthermore, the other little details of my life I left out are the following facts….My doctor has been on me about not working because I’m now in the beginning stages of M.S. which is VERY painful! But as long as the medication works I have goals I plan to complete. And not only do I have to take the medication and happy to take it because it allows me to care for my child, work on my goals etc. So, stop blamming the doctors!! They are merely trying to help what they believe to be responsible adults and ya get these “punks” out there that just want the high off it. Thats their dam fault for being idiots!!!! Again…people like myself who HAVE to take it just to have a semi normal life are grateful to not have that type of crippling pain. So yes Im angry when I hear or read anyone who blames the docs for the problem when soooooooo many people should look at themselves and their loved ones who are freaking idiots allowing themselves to abuse the medication!!!!!!!!!!!!!!

    Reply

    • Thanks for writing.
      I don’t think it’s helpful to blame the patient who develops addiction. Many people started on powerful opioids as prescribed by their doctors, but developed addiction as a complication of treatment of their pain. True, there are people who started using opioids to get high. But I suspect they never would have used either, had they known how easy it is to become addicted to opioids, and the misery addiction brings.
      Doctors need to prescribe opioids responsibly. Opioids aren’t like antibiotics, for example, because the latter doesn’t cause an incredibly good feeling when the average person takes them. Because opioids do cause this euphoria, doctors who prescribe opioids for pain should caution patients about the risk of addiction, and should screen for addiction often.
      Addiction means loss of control. In other words, many patients who abuse opioids may not be able to control their use, and deserve the same compassion as sufferers of any other disease.

      It sounds like you’re able to take your medications exactly as prescribed, and that’s good. But don’t become complacent; I’ve talked to patients who developed addiction after being able to take as prescribed for years. By being aware of this danger, hopefully you’ll never have to deal with addiction.

      Reply

  4. Posted by K Williams on January 3, 2012 at 7:44 pm

    I do have a few more significant comments…Doctors are doing their jobs… So its way past time to stop with the freakin witch hunt on doctors and start going after the dipshits who are abusing the medication, or selling the medication.The addicts and drug dealers are pretty obvious!!! Doctors are merly helping their patients. They can’t follow their patients home, hold their hand and every time its time to take their medication tell their patient “ok honey its time to take your medications” WTF??? SERIOUSLY!!! Blame the RIGHT people NOT the doctors!!!

    Reply

  5. Posted by Eric Jones on August 28, 2012 at 3:36 pm

    Doctors do help patients…in fact their compassion for those in pain keeps them increasing the dosage for pain every time the patient complains. The greatest problem is that when the supposed need for opioids is over, the prescription ends…but the addiction is left. The patient then goes doctor-shopping and begins a lifestyle of purchasing the pills on the street, taking money away from their family and bills. Don’t ever think that you are immuned to addiction. It is at epidemic proportions. The next problem is unintentional poisoning caused by the addiction and the patient attempting to deal with the addiction themselves.

    Reply

  6. Good blog you have got here.. It’s hard to find high quality writing like yours these days. I seriously appreciate people like you! Take care!!

    Reply

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