Oxycontin
the
New
Drug
Plague?
Don't
Believe
the
Hype
5/25/01
Oxycontin, a highly effective opioid pain reliever (active ingredient oxycodone) manufactured by Purdue Pharma in Connecticut, has since its introduction in 1996 been a boon to cancer patients and others suffering intractable pain. It has also been a remarkable success for Purdue, accounting for 80% of the company's total sales, and was rung up to the tune of six million prescriptions last year alone. Oxycontin grossed Purdue a billion dollars in 2000, making it a more profitable drug than Viagra. But in the last year, isolated incidences of overdoses, diversion and pharmacy robberies began to appear, first in Maine and then in pockets up and down the Appalachians. Then, in February, police in Kentucky launched the highly-publicized Operation Oxyfest, pulling in more than 200 Bluegrass State oxycontin users and dealers. With the help of some law enforcement officials who knew how to turn a phrase and a national mass media always eager for a sensation, a new drug panic was born. "They'll kick a bag of cocaine out of the way to get to 'Oxy,'" Harlan County (Kentucky) sheriff's department detective Roger Hall, who knows a good sound bite when he mouths one, told the Associated Press in a story which ran in newspapers around the country. "It's becoming the prescription drug of choice from greater Cincinnati to rural Ohio," the Cincinnati pill squad's Sgt. Kerry Rowland told an eager New York Times. "It's become rampant because it offers such a pure high with less risk of arrest or overdose, and many times health care is picking up the cost." Crusading politicians also jumped on the bandwagon. Oxycontin abuse "was well beyond anything I imagined," said Joseph Famularo, the US Attorney for the Eastern District of Kentucky, who announced the Oxyfest busts. "It truly was an epidemic like some sort of locust plague rolling through southeastern Kentucky. I personally counted 59 deaths since January of last year that local police attributed to addicts using the drug, and I suspect that's pretty conservative," Famularo told the New York Times. By April, Oxycontin became the object of a full-blown media frenzy. Newsweek ran a cover story on the threat, joining coverage from other media bigfoots such as the New York Times, Time, US News & World Report and CBS News' 60 Minutes. The reporting typically featured scary anecdotes followed by unvarnished assertions as to the scope and rapid rise in Oyxcontin abuse, leavened with uncritical acceptance of the various Oxycontin death figures offered up by police and prosecutors. Local and regional newspapers, cued by the national media, promptly hopped on board, with sometimes ludicrous results. Pennsylvania's Daily Courier informed its gentle readers that Oxycontin was now "number one to drug addicts above crack cocaine and marijuana." The Indianapolis Star called it the "thrill pill," while the Cincinnati Enquirer called it "the heroin of the midwest." But the Port St. Lucie News wins the prize for idiotic reporting (so far), with a headline that called Oxycontin the "New Crack" with a "Heroin-Like High." The problem is that the numbers do not support the hype. In an investigative article in the Cleveland alternative weekly the Free Times, Sandeep Kaushik put the numbers under intense scrutiny, and they failed to hold up. The 59 dead in Eastern Kentucky to which US Attorney Famularo referred? Here is what Kaushik found. David W. Jones, executive director of the Kentucky State Medical Examiner's office told Kaushik that "as far as deaths go, I've heard different numbers in different places at different times; I have no idea where these people are getting their facts and figures." He told the Free Times his office was aware of 27 oxycodone-related deaths in the entire state last year. But wait. Of those 27 deaths, two had both oxycodone and alcohol in their bodies and 23 others were veritable human pharmacies, with a variety of drugs in their systems, including powerful opioid painkillers such as Dilaudid and Fentanyl. Kentucky's widely ballyhooed 59 Oxy deaths turn out to include just two persons who died from oxycodone alone. But wait. Even those two deaths cannot conclusively be tied to Oxycontin, because oxycodone is the active ingredient in a number of prescription painkillers, including Percocet and Tylox. Next Kaushik looked at Virginia, where the state's medical examiner had proclaimed an "epidemic" in his state, variously citing 32 or 39 Oxycontin deaths. Examiner Massello, so eager to be quoted earlier, stonewalled the Free Times, admitting only that a "significant number" of the victims had multiple drugs in their systems. Kaushik also parsed the numbers of drug deaths in Altoona, Pennsylvania. In Altoona, which reported seven oyxcodone-related deaths in the past five years, six of those deaths were of people using multiple drugs, often street heroin, and the seventh was a suicide. Under careful scrutiny, the Oxycontin menace suddenly seems not so menacing. Clearly, some of the drug is being diverted for non-medical uses -- with six million prescriptions last year alone, that can only be expected -- and a few people are dying from it, but both the extent of the "epidemic" and the number of deaths appear to be wildly overstated. But that hasn't stopped politicians and law enforcement officials from going to war against the drug. The Virginia Attorney General convened a confab to fight the menace, and the US Attorney in Maine has been another leading crusader. The DEA has also gotten into the act, pressuring Purdue Pharma to restrict the drug. In fact, Purdue has bowed to the pressure, altering its marketing plans, engaging in a program of doctor education, and recently announcing that it is removing the most powerful Oxycontin formulation from the market. Lost in the frenzy have been the patients. Dr. Dennis Doherty, an Alabama pain specialist, told the Mobile Register that law enforcement concern about Oxycontin was causing some doctors and pharmacists to shy away from the drug. "It would truly be a tragedy if public sentiment is allowed to run wild on this," Doherty said. Doherty also told the newspaper that a local police officer urged doctors not to prescribe Oxycontin because of its abuse potential. Other pain specialists contacted by the Register emphasized the drug's efficacy in pain relief. "I see patients of all ages who are disabled by pain, who are now able to live the life they want because of this," said Dr. John Rothrock, a neurologist and professor at the University of South Alabama College of Medicine, who has done extensive research on pain relief. Dr. Michael Meshad, a Mobile cancer specialist, told the newspaper that if police asked him to stop writing Oxycontin prescriptions, "I just wouldn't do it. I would continue to use it, because if it's not this one that's being abused, it's another drug. If a patient has a terminal disease, it's our job to prevent suffering, and this drug is very good at that." Dr. Phil Fisher of the Appalachian Pain Foundation, which was created to inform doctors about Oxycontin, told the Free Times any rise in Oxycontin abuse was predictable given the rapid rise in the number of prescriptions issued. Fisher told the Free Times Vicodin was a more serious prescription drug problem, because it is being abused at a much higher percentage of its total sales. "That's the real problem," he claims. "Compared to it, Oxy only accounts for 10 percent of the cases but gets 90 percent of the attention." Recipe for a panic: Start with one aggressively marketed, highly effective opioid painkiller. Add predictable non-medical use. Stir in media-hungry drug warriors. Baste with half-baked press coverage. Let stew. Serves: the interests of law enforcement and sales-happy media. The pain patients for which the drug was created are not included in this recipe.
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