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After a 15-year lull, abuse of prescription narcotic analgesics splashed onto the front pages of the nation’s newspapers this winter. People looking for highs — and high profits — robbed and burglarized pharmacies in certain parts of the country to divert prescription drugs into the illicit market.As in the past, adequate treatment of intractable pain is again at risk as a result of these developments. Pharmacies are removing products from inventory, forcing patients who need the medications to look elsewhere. Physicians are suspicious of patients who seem to be seeking narcotic analgesics. Patients in pain are suffering, and fair numbers of those abusing the drugs are dying of overdoses.

The target of many criminals is Purdue Pharma’s OxyContin, a sustained-release oxycodone product. Specifically formulated to meet the needs of patients with chronic, intractable pain, OxyContin is being crushed by abusers to make the full dose immediately available when they inhale, swallow, or inject it.

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Some clinicians are concerned that, at a time when adequate pain relief was becoming a reality for patients with chronic and unremitting pain, the sudden abuse problem and related break-ins could set the pain relief movement back several years. “OxyContin is great drug when used appropriately,” noted Greg Wood, health care fraud investigator at the U.S. Attorney’s office in Roanoke, Va. “Unfortunately,” he continued, “it’s the drug of the day for the abuse community.”

A Regional Problem

Break-ins and robberies have thus far been concentrated in Appalachia and other rural areas in the eastern United States. Maine, Alaska, and Louisiana have also been affected, and problems have recently been reported in Philadelphia and the District of Columbia.Emergency room visits for oxycodone overdose are increasing, and at least 59 oxycodone abuse-related deaths have been reported in eastern Kentucky, Wood said. Law enforcement officials call 160 mg OxyContin tablets “O-Coffins,” a reference to the effect the high dose has on people who have not developed tolerance to the drug.

A single 160 mg OxyContin tablet sells for about $200 in some parts of the country, according to Wood. The habit can easily cost addicts hundreds of dollars a day.”It hits you like a tidal wave,” said Wood. “One day you don’t have an OxyContin problem; the next day, you are counting bodies. It’s a real bad situation.”

Purdue Pharma has taken several measures to combat abuse of OxyContin and other narcotic analgesics:

The company has developed and distributed more than 400,000 brochures to pharmacists and health care professionals to help educate them on how to prevent diversion.Purdue is conducting a pilot program in Maine and Virginia to distribute free tamper-resistant prescription pads to physicians to help curb diversion of OxyContin and other controlled drugs.The company has initiated meetings with the U.S. attorneys in Maine and Virginia and has also met with the attorneys general of Virginia and Maryland, and numerous other law enforcement officers, to combat the problem of abuse and diversion of OxyContin — even to the point of supplying these officers with placebo OxyContin tablets so that they could engage in “buy and bust” activities.The company has made a $25,000 challenge grant to the Appalachian Pain Foundation for multistate education and outreach efforts and a $20,000 grant to Beans and Rice Incorporated in the New River Valley of Virginia to support drug abuse prevention programs for teens.

Purdue has also pledged $100,000 to fund a study of the best practices in Prescription Monitoring Programs (PMPs) in the hope of developing an ideal program that will frustrate doctor shopping while not interfering with the delivery of medical services. Purdue is working with Virginia’s attorney general on this project and will also co-sponsor, with the attorney general’s office, a series of Continuing Medical Education Programs in southwestern Virginia that will cover the laws governing the prescribing of controlled substances, responsible pain assessment, the appropriate uses of pain medications, and techniques to prevent people from illegally obtaining controlled substances from practitioners.

Jim Heins, Purdue’s assistant director of public relations, is careful to point out that linking the problem solely to OxyContin may be unfair. Police reports can identify oxycodone in the blood, but it is not possible to link the drug to a particular brand like OxyContin, which currently has 25% of the oxycodone market. Heins also believes the number of deaths linked strictly to oxycodone has been exaggerated in the press, noting that in most cases abusers die from taking many drugs at the same time and adding alcohol to the mix. Oxycodone just happens to be one of them.