Monday, June 4, 2012

Prescription pill abuse 'a holocaust' in Kentucky, hitting 1 in 16; big drug firms and even well-meaning doctors are to blame

Another in-depth look at Kentucky's prescription drug abuse problem hit the pages of The Courier-Journal yesterday, this time exploring the history of OxyContin and how well-meaning doctors started over-prescribing opioids in the 1990s in response to vigorous marketing campaigns. 

The problem continues to be gargantuan, with Laura Ungar reporting about one in 16 Kentuckians misused prescription painkillers in the past year. Kentucky ranks "as the fourth-most-medicated state in a nation that fills enough painkiller prescriptions each year to keep every American adult medicated around the clock for a month," Ungar writes.

A review published in the journal Pain Physician last year found evidence is lacking for how effective opioids are in treating long-term pain. "They're not M&Ms," said Dr. Lee Tannenbaum, founder of the Bel Air Center for Addictions in Maryland. "As physicians, we need to be really, really, really careful as to when we put someone on these drugs. Cancer pain may need opioids, but someone out shoveling snow who hurt his back doesn't. We have created so many addicts."

A C-J investigation found physicians fuel the problem in three ways. First, they do not screen patients adequately. They prescribe powerful pills for moderate pain. And they do not use the state's monitoring program, Kentucky All Schedule Prescription Electronic Reporting, known as KASPER.

The problem started in the 1990s when "medical organizations, concerned that pain wasn't being treated adequately, encouraged doctors to do more to relieve suffering," Ungar reports. OxyContin was approved by the Federal Food and Drug Administration in 1995, with OxyContin prescriptions for noncancer pain increasing by tenfold between 1997 and 2002. A report found the drug's maker, Purdue Pharma "directed its drug representatives to focus on physicians in their sales territories who were high opioid prescribers, while also issuing OxyContin 'starter coupons' for patients and distributing promotional items, such as fishing hats and plush toys," Ungar reports.

In October 2007, Kentucky and Pike County sued Purdue Pharma for its deceptive marketing campaign, alleging it misled doctors about the potency of the drug, which is twice as powerful as morphine. U.S. Rep. Harold "Hal" Rogers, R-5th District, called OxyContin "the guilty party that got this epidemic going." In Kentucky, the retail distribution of oxycodone grew from 83,000 grams in 1997 to 950,000 grams in 2010.

Part of the problem is that doctors do not have the time they need to properly assess patients for potential abuse. "You've got an awful lot of doctors prescribing not out of ill intents. They've got a limited amount of time, and pain patients require a lot of time," said Robert Walker, assistant professor of behavioral science at University of Kentucky's Center on Drug and Alcohol Research. "The easiest solution is the opioid."

While easy, they are not necessarily effective for all pain. Evidence is "very, very mixed" on whether the drugs work in the long term on chronic pain and "the evidence is pretty scant" that they are effective against treating chronic lower back pain, said Dr. Timothy Ives of the University of North Carolina.

Though the problem is never expected to be solved completely, there are steps being taken to combat the issue. In 2010, the FDA approved a reformulation of OxyContin which makes it more resistant to being cut, chewed, crushed or dissolved — methods that make the drug more powerful. The Kentucky Board of Medical Licensure has spelled out "the steps physicians need to take as they seek to help patients control pain unrelated to terminal illness," Ungar reports. And the Kentucky General Assembly passed a comprehensive bill that requires doctors to use KASPER when prescribing certain drugs and take a full medical history of patients to whom they are considering prescribing drugs. (Read more)

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