Viewpoint: The OxyContin« Controversy
by Forest Tennant, MD, DrPH
 In the June issue of Practical
Pain Management (Vol 7; Issue 5), my colleague, Dr. Joseph Shurman, discussed the
Oxycontin« controversy. In this article Dr. Shurman quotes Dr. Sally Satel who stated in
the Wall Street Journal, “It’s a bad time to be in pain.” I agree with Dr.
Shurman and Dr. Satel’s assessment and am adding my thoughts.
I don’t know about you, but I’m getting awfully tired of the weekly headlines
plugging some egotistical prosecutor or government agency that get their kicks by kicking
around some doctor, pharmaceutical company, or opioid who can scarcely defend themselves.
The game seems to be which prosecutor can raise the most fines or get a notch on their
political belt by putting someone out of business or besmirching their reputation.
Newsweek, front cover and all, this past month wrote eloquently about the advances in pain
research. The whole article, however, failed to mention that prosecutors—like the
Attorney General in West Virginia—are doing their best to make sure that no physician
remains who will prescribe pain treatments, and no company is left who will make the
product. Is there any doctor left in West Virginia who will now prescribe Oxycontin?
Isn’t this the same state that a few years ago had so many malpractice suits that
pregnant women had to cross a state line to deliver?
Dr. Shurman succinctly describes the risks of persistent pain, “The effects of
under-treatment of pain can be devastating, including, for example, depression (suicide),
anxiety, loss of sleep, social and sexual dysfunction, loss of work, weakness, fatigue,
gastrointestinal distress, hypertension, and tachycardia.” Simply put, pain severe
enough to produce the biologic complications delineated by Dr. Shurman will give you a
short, suffering life. Dr. Shurman’s “right on” article with Dr. Sally
Satel’s pungent quotes raise these questions.
Did Purdue Pharma L.P. Make Some Mistakes?
Their public statement on May 10, 2007 says they did. My complaint—with not only
Purdue Pharma L.P. but some other pharmaceutical companies and many physicians—are
claims that long-acting opioids are always safer and more effective than short-acting
ones. Perhaps I’m biased from 25 years of operating methadone maintenance programs
for heroin addicts, but I don’t believe this is always true. Long-acting opioid
formulations hang around the blood stream so long that a person with a tendency to
over-drink, take a benzodiazepine, or consume any drug other than as prescribed, may
encounter the well-known potentiating effects of opioids plus a sedative. The end result,
of course, is the all-too-common overdose death.
In my opinion, long-acting opioids are only safe when prescribed in structured practice
settings in which the physician can give the time to properly educate families and
patients about overdose risks and provide on-going, regular, monitoring of the long-acting
opioid. In particular I don’t believe enough emphasis is put on the high risk of
sedatives when used with long-acting opioids.
Should Purdue Pharma L.P. Have Been Fined $635 Million?
Absolutely not. That’s just the headline grabber for an out-of-control government
prosecutor. Rather than dump $635 million into a politician’s “Look What I Did
Pot,” the money could have at least been directed to a good cause like teaching
generalist physicians how to structure their practice to safely prescribe long-acting
opioids.
Will This Event Hurt Pain Patients?
You bet it will. I concur with Drs. Shurman and Satel. Any physician who has treated many
severe, chronic pain patients knows that Oxycontin is simply indispensable and has truly
been, in Dr. Satel’s words, a godsend for millions of suffering pain patients. As a
result of this matter, many doctors will simply shy away from prescribing Oxycontin for
fear of being labeled and targeted by the next zealous prosecutor who wants a headline.
Worse, as a result of the Oxycontin controversy, many doctors are asking the question,
“Why should I even risk treating a pain patient at all?” After all, the country,
particularly in some locales, is beginning to run woefully short of doctors. So, why take
a risk to treat a pain patient when the risk is lower and the money higher to treat a sore
throat or dandruff?
What should be our collective response? Outrage and vocal, public condemnation of all
prosecutors, government agencies, insurance plans, and even professional groups who want
pharmaceutical companies out of business, doctors to stop prescribing opioids, and pain
patients to start suffering more and dying sooner. In particular we should condemn health
professionals who spread false information about opioids such as excessive risks or some
imaginary cap on dosages.
Physicians, nurses, pharmacists, and all other health practitioners have a moral,
ethical responsibility to advocate for the sick, suffering patient who is in pain.
Let’s not kowtow to any mean-spirited person or organization who believes otherwise.
— Jul/Aug 2007
The full article is now available as a PDF and may be
purchased for $5 and downloaded immediately:
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