Sunday, Sep 7, 2008
The war on drugs is preventing many Americans from getting desperately needed pain medicine.
Apr 4, 2002 | After three decades of chronic, searing pain, Marie Dabrowski was finally able to sleep. She was able to think. And sometimes, thanks to her new pills, she could almost forget about her fibromyalgia, a mysterious nerve disorder characterized by fatigue, migraine headaches and full-body aches.
But Dabrowski's respite did not last. The medication responsible for her two-year break from daily misery was OxyContin. And about a month ago, Dabrowski's doctor cut her off. The move had nothing to do with callousness or lack of concern, says Dabrowski, who asked that her doctor remain anonymous. Instead, the doctor was spooked by a proposed Virginia law designed to intensify scrutiny of physicians who prescribe the drug. In the end, says Dabrowski, it was the prospect of police interrogation that pushed her doctor over the edge.
"When I went in [to her office], her receptionist explained to me that it was the DEA that was the problem and that my doctor was scared of getting in trouble," she says. "I told them that this was dangerous. People on [OxyContin] finally have something that keeps the pain away, and if the pain comes back they're going to commit suicide."
Widespread abuse of OxyContin, a painkiller made by Purdue Pharma LP, was first reported in the media about a year ago. Called "hillbilly heroin" because early cases of addiction surfaced in Appalachia, the pills were being crushed and then snorted or injected by users, who found the drug cheap and easy to obtain. Once touted by its manufacturer as a safe and effective alternative to highly addictive morphine, "Oxy" quickly became the scourge of law enforcement, spreading across the country with lightning speed, leaving hundreds of addicts in its wake.
Even as Purdue hastily promised to produce OxyContin in a form less vulnerable to abuse, legislators in at least 17 states pushed to create strict prescription tracking programs, while others took steps to limit the number of OxyContin pills that people on Medicaid can receive. The Department of Justice has proposed a national crackdown on painkiller abuse, and some states are considering laws that would ban OxyContin, as well as its main ingredient, oxycodone, a synthetic opiate prescribed to millions of patients since 1916.
It is difficult to argue with laws intended to make it harder for addicts to get drugs; and the DEA has said it does not want to limit the supply to those with a legitimate need for relief. But there are dangerous side effects to the new restrictive policies on prescription painkillers -- chief among them, widespread, unnecessary suffering. Patients with chronic pain, routinely undertreated in the past, had in recent years begun to get adequate relief, thanks, in part, to OxyContin, one of the few drugs that reduces or eliminates pain without nausea or damage to vital organs. The onslaught of regulations designed to curtail OxyContin abuse now threatens to reverse these advances.
Increasing numbers of the estimated 30 to 50 million people in the country who suffer from some form of chronic pain say the OxyContin crackdown means they can no longer get adequate or sustained relief. For some, the new rules and medical practices create frustrating delays in receiving medication. But for others, there is no help at all.
Cancer patients and sufferers of debilitating diseases report that they are getting ineffective dosages of OxyContin, running out of places to fill legal prescriptions for it, or finding themselves without doctors, many of whom choose to avoid OxyContin headaches by sending patients to overwhelmed pain specialists struggling with the same regulations.
Our simmering fear of painkiller abuse, brought to a boil by the OxyContin scare, has created a world of hurt for legitimate victims of illness: The war on drugs has increasingly become a war on patients.
"I wake up crying every morning because I don't have anything for the pain," Dabrowski says. "The law isn't even in place, but it's already affecting me. I feel like I'm burning from the inside out."
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Americans have something of a tortured relationship with opioids -- pain relievers derived from real or synthetic opium that work on the central nervous system. Doctors were the earliest targets of prescription drug panic: As early as 1914, with the passage of the Harrison Narcotic Act, the government identified doctors as agents of addiction who needed to be controlled if narcotic abuse was to be abolished. The law, refined by a Supreme Court decision in 1919, made it illegal for doctors to prescribe opioids to addicted patients and required doctors who prescribed the drugs to register with the IRS.
"There was a lot of zealous law enforcement activity after the decision," says June Dahl, a pain policy researcher and pharmacology professor at the University of Wisconsin. "The police went out to get docs and a lot of them were thrown in prison. That's the origin of this whole concept that physicians are the cause of addiction -- that they're the ones who should be held accountable."
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