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Doctors tighten controls on pain drug OxyContin Potential for abuse leads to tamper-proof prescriptions Monday, August 06, 2001 By Virginia Linn, Post-Gazette Staff Writer
As more restrictions are placed on the prescription painkiller OxyContin, and law enforcement agencies assail its potential for abuse, the drug's maker and local doctors are scrambling to shore up controls to ensure it stays on the market.
The slow-release opioid that came on the market in December 1995 is considered a miracle drug among pain doctors and patients because it has few side effects. But when chewed, snorted or injected, OxyContin produces a quick and potentially lethal high. It has been linked to more than 100 deaths, including several in Western Pennsylvania.
In some cases, doctors are summoning patients into their offices between regular visits for a random pill count to make sure none is missing.
Dr. Jack Kabazie, director of the Institute for Pain Medicine at the Western Pennsylvania Hospital, said he had to discharge a patient from his care last month when the pills didn't add up.
While he said such incidents don't occur very often, he needs to be vigilant to safeguard its proper use. Other doctors have become more selective in prescribing the medication, which is intended for moderate or severe pain.
"We need every weapon we can get," Kabazie said about pain control. "You don't go to a gunfight with a knife. If OxyContin is the medication you should use, it would be terrible to lose that."
Just two weeks ago, the drug maker Purdue Pharma of Stamford, Conn., under an agreement with the Food and Drug Administration, placed the strongest warning possible on the medication -- a black box describing OxyContin as potentially as addictive as morphine and explaining that chewing, snorting or injecting it can kill. Purdue wrote 800,000 doctors about the warnings.
Unlike heroin and cocaine, which got their start in the inner cities, the abuse of OxyContin began in Appalachia and other rural areas in the late 1990s, where it was prescribed to workers for diseases or injuries stemming from mill or mine work.
Last year, U.S. doctors wrote 6.5 million prescriptions for OxyContin. In June, Purdue began distributing tamper-resistant prescription pads that contain six ways to prevent fraud. For example, if a person tried to photocopy the form, the word VOID shows up on the copy. Roughly 500 physicians in Pennsylvania are using these.
Company representatives also are holding forums for doctors and the public to educate them about proper use and handling of OxyContin and other prescription drugs.
"We want them in the hands of the patients who need them and to keep them out of the hands of those who abuse them," said Pamela Bennett, a registered nurse who is leading Purdue's educational efforts.
Matthew Mangino, district attorney for Lawrence County, invited Purdue representatives to a recent community forum, one of a series of educational sessions he's holding for police, health professionals and school employees since problems with OxyContin surfaced in the New Castle area earlier this year.
He cited cases of a 69-year-old woman selling OxyContin and a couple of business owners illegally selling it from their storefronts. A county resident with a history of abusing OxyContin recently overdosed on heroin, which Mangino said is unusual for that area. OxyContin users often switch to heroin because it's cheaper.
"We're doing what we can do to at least educate the people in Lawrence County," he said.
Michael Fornataro, a New Castle pharmacist, said he was seeing forged prescriptions for OxyContin about once a week before authorities cracked down on the abuse and the tamper-resistant prescriptions became available. He generally could recognize stolen scripts if a doctors' writing was "too neat" or didn't match familiar signatures.
"We get an uneasy feeling. You've never seen the people before, they're really fidgety. Then when you reach for the phone to verify the prescription with the doctor, they run out."
West Penn's Kabazie prescribes OxyContin, as well as other opioids, for chronic pain that may stem from cancer, orthopedic problems or even shingles. First, patients are evaluated for the cause of their pain. If surgical techniques, nerve blocks, physical therapy or medications such as Motrin don't ease the pain, he may turn to opioids.
OxyContin is part of an arsenal that includes the slow-release morphine pill called MS Contin, methadone and the fentanyl patch.
The advantage of OxyContin, Kabazie said, is that most people, including older people, can take it without suffering serious side effects. It is more potent per milligram than morphine and comes in several strengths. In addition, one pill lasts 12 hours, so patients don't risk stomach upset by popping several pills a day.
Dr. Edward Heres, director of the pain center at Allegheny General Hospital, said his office has reduced the number of OxyContin prescriptions it writes in response to the problems. Since switching to drugs such as MS Contin and methadone, "we have a renewed appreciation on how well-tolerated and effective OxyContin can be in the right patient."
To reduce the potential for abuse, Kabazie's office works with only one pharmacy and uses that pharmacy's tamper-resistant prescription sheets. In addition, each patient signs an "opioid contract" agreeing to seek the medication only from that doctor. The office also won't fill prescriptions after hours, on weekends and requires a five-day notice from patients.
Colleen Dunwoody, a clinical nurse specialist for pain management at UPMC Presbyterian who is past president of the American Society of Pain Management Nurses, said she continually has to address misconceptions patients have about the OxyContin.
"This whole OxyContin furor has made it necessary to explain to patients that if they have to take the drug, they won't become addicted [if they follow the prescribed dosage]," she said.
"They were very relieved to know it was safe."
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