Article From The DO
American Osteopathic Association / August 2001

Pain medication raises difficult questions

Purdue Pharmacia's best-selling controlled-release formulation of oxycodone hydrochloride,
used to relieve pain, has recently been in the media spotlight for its purported role in several
deaths.
 
While the media reported that most of the people who died had obtained the pain reliever
illegally, some of those who died allegedly had prescriptions for it.
 
Healthcare professionals fear that the adverse publicity about the drug will provoke
legislation taking the drug off the market.
 
Purdue Pharmacia's formulation of oxycodone, which is an opioid analgesic, was approved
by the US Food and Drug Administration in 1995.
 
Oxycodone provides very effective relief for patients who are suffering from pain caused
by chronic illness and terminal illness, says Richard T. Jermyn, DO, who is the director
of the Back Pain Center and the Comprehensive Pain Center at the University of Medicine
and Dentistry of New Jersey-School of Osteopathic Medicine (UMDNJ-SOM)
in Stratford.
 
"The problem is not with oxycodone itself. Rather, the problem is that people are
abusing the controlled-release formula," maintains Frederick J. Goldstein, PhD, a professor
of clinical pharmacology at the Philadelphia College of Osteopathic Medicine and an expert
in pain management.
 
Dr Jermyn concurs. "People are misusing oxycodone by crushing the tablets and then
snorting or injecting the powder," he explains. "The effect is an immediate high. Tampering
with the drug and breaking the long-acting seal greatly increase the dosage, and the medication
becomes fatal."
 
Who's responsible?
 
According to Lynne Carr Columbus, DO, some physicians are prescribing oxycodone incorrectly.
 
"I have personally encountered prescriptions written by physicians that call for the patient
to take V pills. When the structure of this controlled-release medication is compromised,
it becomes a bolus of narcotic that, when taken, puts the patient at risk for a narcotic
overdose," explains Dr Columbus, an anesthesiologist with Gulf Coast Pain
Management in Palm Harbor, Fla.
 
"What is even more disturbing is that pharmacies are actually dispensing the medication
as written, even though the prescription is clearly wrong," Dr Columbus reports.
 
"Physicians have the sole ability to prescribe medications," says Dr Columbus.
"Therefore, it is our responsibility to provent controlled-release oxycodone from being
inappropriately disseminated to the public."
 
Dr Columbus stresses that physicians should warn their patients to closely monitor their
oxycodone prescriptions. "I have posted a notice in my office encouraging patients to
keep this medication in a lockbox or other secure spot and to call the police if it is stolen,"
she says. "I do not give refills of 'stolen' oxycodone unless the patient shows me a
police report."
 
Dr Jermyn believes that the key to preventing deaths is to educate patients on the proper
use of controlled-release oxycodone and the consequences of misusing it.
 
"Patients need to be responsible," he says. "They need to understand that controlled-release
oxycodone is a powerful drug when used appropriately and a harmful drug when used
inappropriately.
 
"It's not a physician's responsibility if someone obtains this drug illegally and misuses it,"
Dr Jermyn maintains.
 
"People have been abusing opiate medications since their inception," Dr Jermyn observes.
"When used properly, these medications can decrease pain and improve function for patients.
Oxycodone is safe when it is prescribed correctly and taken correctly."
 
-Nancy Vitucci