OxyContin dilemma: Allowing pain control while stopping abuse

A popular painkiller's misuse leads to headaches between law enforcement and medical communities.

By Andis Robeznieks, amednews staff. Jan. 28, 2002.

Last month, federal authorities charged an Indianapolis doctor with unlawful distribution of OxyContin and health care fraud. In New Jersey, police reported that $800,000 worth of the drug was stolen from a cargo hangar at Newark Airport. And in Florida, the manslaughter trial has begun for a Pensacola-area doctor whose OxyContin prescriptions were linked to the overdose deaths of four patients.

As the worlds of medicine and law enforcement collide over the issue of OxyContin, arguments arise over whether monitoring prescriptions will save lives or impede a doctor's ability to treat patients with chronic pain.

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"Anyone who is practicing within the confines of accepted medical practices doesn't have anything to fear," said U.S. Drug Enforcement Administration spokeswoman Rogene Waite.

The agency put into place an oxycodone action plan in April 2001, Waite said, and it concentrates on investigating forged and fraudulent prescriptions, pharmacy thefts, patient "doctor shopping," and unscrupulous medical professionals.

Other parts of the plan include an educational outreach program with doctors on the proper use of OxyContin and data collection on prescriptions, thefts, arrests and oxycodone-related emergency department episodes.

"DEA does not intend to restrict legitimate use of OxyContin, nor prevent practitioners acting in the usual course of medical practice from prescribing OxyContin for patients with a legitimate medical purpose," said DEA Administrator Asa Hutchinson during testimony before a U.S. House subcommittee last month.

17 states have prescription-monitoring programs.

Despite this assurance, Mary Baluss, with the Judge David L. Bazelon Center for Mental Health Law in Washington, D.C., said scrutiny from the DEA and state law enforcement agencies had led to doctors dropping pain management patients. "The way [DEA agents] do it, according to discussions I've had with doctors, is pretty darn chilling," Baluss said. "The DEA comes into town and says, 'Dr. Jones, do you know you're the leading prescriber of OxyContin and other opioids?' Then you know what happens? The doctors stop prescribing."

The DEA Web site identifies 17 states that have prescription-monitoring programs and says states reporting "significant abuse and diversion issues" do not have such programs.

Illinois began its monitoring program in 1963 and changed from a triplicate paper form to electronic filing in April 2000. Stan Tillman, who supervises the Illinois Dept. of Human Services prescription-monitoring program, said the new system was designed to remove some of the inhibitions doctors had toward prescribing OxyContin and other painkillers.

"What we're trying to do is remove the chilling effect, because we believe there was one," he said. "I don't think the DEA can prove there isn't one."

Under the old system, physicians had to purchase triplicate paper forms from the state for prescribing narcotics, Tillman said. Doctors kept one copy for their records and gave the other two to the patient, who then gave both to a pharmacist. The pharmacist kept one copy and sent the other to state officials.

The new electronic system takes doctors out of the equation and requires pharmacists to report all Schedule II drug prescriptions to the state twice a month. Because the old system required doctors to order the triplicate forms from the state, Tillman said it made them feel like "the government was watching them."

"We found it was not necessary to track doctors," he said. "It doesn't make sense to beat up on these folks, we just keep an eye on the numbers. But all doctors in Illinois know OxyContin prescriptions are being monitored -- we've made that very clear."

Whether it's because of government monitoring or negative news, there is definitely a chill in the air, said James Heins, a spokesman for Purdue Pharma, the Connecticut-based manufacturer of OxyContin.

Heins is encouraged by reports of collaborative efforts between the law enforcement and medical communities to curb abuse, but the negativity surrounding the drug "is definitely having an impact on physicians prescribing OxyContin."

He suggested the following criteria for monitoring programs: They should be overseen by health care agencies, they should protect patient confidentiality and they should reflect data from people who doctor-shop for prescriptions in neighboring states.

Heins had particular praise for the programs in Kentucky and Nevada and said they could serve as models for other states.