OxyContin abuse felt locally

By | October 28, 2003 12:00 am

Kim Swindell Wood
“Euphoria is the biggest thing they experience,” said Alan Tatum, pharmacist and owner of Payless Family Pharmacy, as he spoke about the schedule II narcotic OxyContin. “The street value is general $1 per milligram, so one 40-milligram tablet, which is a relatively common strength, is $40 on the street.”
Tatum talked very candidly about the controversy surrounding the highly addictive drug. Noted talk-show host Rush Limbaugh recently admitted that he is addicted to painkillers, with OxyContin being one of the drugs he was allegedly purchasing illegally. Tatum said he is observing similar abuse in White County, and he even sought a warrant on a man who had forged a prescription for OxyContin.
“The temptation is there for abuse, and we’ve seen patients with legitimate pain and because of the quick money, they get into dealing it [OxyContin],” said Tatum. “They may go to two or three physicians and
to two or three drug stores. They will use some themselves and then sell the rest.”
OxyContin is a sustained-release form of OxyCodone and comes in various strengths. Tablets range from 10 milligrams to 80 milligrams, and 160-milligram tablet was produced, which created major concerns for the medical community. Tatum said the slow-release is strictly for chronic pain.
“This drug is not for acute pain like dental surgery or other types of surgery,” said Tatum. “It’s for people who have chronic pain. Most frequently you’d want to use it in your cancer patients who are terminal.”
However, Tatum said there are a certain group of patients with what is called chronic, non-malignant pain.
“It’s a more difficult patient population to treat because to them their pain is very, very real, but sometimes it’s not so easy to diagnose on an MRI or CAT Scan or X-ray,” said Tatum. “If you see a broken bone, you know that’s going to hurt. If somebody has low back pain, for instance, they may hurt, but it’s not so visible. So, typically you want to rule out any serious situations. Often times, you supplement the medication with physical therapy, and only as a last resort would you want to go to chronic pain management, which is best done by pain management specialists.”
According to the U.S. Drug Administration, since the introduction of OxyContin, in 1996, the number of prescriptions dispensed has increased 20-fold to about 6 million in 2000.
“OxyContin does relieve pain,” said Tatum. “My experience with the patients that are truly in pain, it helps them function, and they feel good, but they don’t have the euphoria or high that patients have who are abusing it.”
An article in the Wall Street Journal, on May 16, 2002, reported “the maker of OxyContin [Purdue Pharma] had so underestimated the sales potential of the widely abused painkiller that in 2000 the drug generated revenue that was eight times more than projected. Over the first five years of marketing, OxyContin sales totaled nearly $2 billion, sharply higher than the company’s initial forecast of about $350 million.”
“There’s a true physical withdrawal from this drug,” said Tatum. “Not only that, it’s very dangerous. “This is a sustained-release dosage form, so that means one tablet is gradually absorbed over a 12-hour period of time. What a lot of people do to intensify that rush or euphoria is crush the tablet and dissolve it in liquid and inject it in the veins. What happens is you’re getting a massive overdose, and with that comes the risk of death. There are even doctors that have been charged with second-degree murder or manslaughter for over-prescribing this medication. As healthcare professionals, we must be aware of this and police not only the patients, but also the physicians.”
Throughout the DEA’s examination of the abuse of OxyContin, numerous options have been explored and discussed with the healthcare community and pharmaceutical industry. None of these options will be instituted unilaterally by the DEA without considering the effects they may have on public health.
The DEA does not directly regulate the marketing of controlled substances. The Food and Drug Administration (FDA) is responsible for approving drugs for medical use. However, the DEA closely monitors marketing and advertising tactics, especially when they appear to create an increased possibility for misuse.
“The general rule-of-thumb is once you get to three times the average therapeutic dose, you’re physically addicted,” said Tatum. “The more you take, the more tolerance you build up, and then the more you need to take to get the same euphoric feeling and to avoid withdrawal.”
Tatum said once a person has been addicted to OxyContin, he or she has to stay away from any type of medication that might contain a narcotic. Even Robitussin DM, as an example, contains dextromethorphan, which is a chemical cousin of codeine and is in the same family as OxyCodone.
“What’s so sad is some of these people selling it on the street aren’t paying a dime for it, because our tax dollars are paying for it,” said Tatum. “There’s a lot of abuse of the system, but there are people watching and monitoring to make sure not only the patients, but the pharmacists and doctors, as well, are selling it and prescribing it for the appropriate use.”

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