oxys and roxys…

Posted on Saturday 5 January 2013

I was perusing my usual haunts this evening, sort of catching up after a fairly busy holiday season that ate up my leisure time. Pharmagossip had a number of interesting finds. But this one caught my eye because of a particular experience:
File under "Perverse Incentives"
Pharmagossip
by Jack Friday
December 31, 2012

You’ve probably heard of ‘OxyContin'; the heavy duty ‘narcotic painkiller’, the one that’s driven the ‘prescription drug addiction’ problem so high in the last few years. It has been proven highly addictive. In fact, it’s so addictive it’s said to “lead people to start using heroin in order to get a cheaper high when their budget can’t keep up with their Oxycontin habit.” [This fact became pronounced when the producer of Oxy switched their formula to supposedly discourage addiction].

The maker of this terrible-drug, which is responsible for numerous overdose deaths, is so afraid of their patent-date running out, they resorted to “test the drug on children as young as six years old.” Purdue Pharma LP is the company’s name. We know their real concern is not to help children overcome a debilitating pain or illness, but really lies only with their bottom line. August, 2013 is the date the patent for OxyContin is set to expire on; when that happens, other Big Pharmaceutical companies will jump into the marketplace with their own ‘generic versions’ of the pricey narcotic and be able to sell them much cheaper, taking profit away from Purdue’s pockets.

By using new trials [on children], Purdue Pharma is able to extend their patent by six months. That’s their ‘sneaky trick” They can do this via a program of the Food and Drug Administration [FDA] that “actually encourages drug companies to test their “poisons” on the [youngest children] in our communities.”

Some years back, I got a call from a former patient. Since I’d seen him, he had developed a throat cancer and had radiation treatment. His wife, a physician, was worried about his pain management as he had in the past gotten in trouble with alcohol, so she suggested they use Oxycontin. It was newly on the market and touted to have a low addiction potential. He was worried about drug dependence too. The dose had been escalated quickly, and by the time he called me, he was taking almost 200 mg a day, and [I can’t think of a better way to say this] he was bat-shit crazy. It looked for all the world like Mania, except he had no history of mood disorder and no history in his family. He had seen me for some dramatic symptomatology, but not this.

We played it for a drug induced illness, and ultimately had to replace the Oxycontin with Morphine, then tiptoe down to get him drug-free. It took months. When we tried to detox him slowly from the Oxycontin, he would develop intolerable physical withdrawal at any decrease in dose – thus the plan to cross-addict him to Morphine first, and then detox him. I’ve seen a lot of drug withdrawal in my day, but this was the worst. Both his wife and I wrote the company and FDA.

Since then, most of the cases I’ve seen of people getting "hooked" on pain medication after surgery have involved this drug. Given that there are so many alternatives, I wonder why this particular drug is still even available? It’s a street favorite…
  1.  
    January 5, 2013 | 3:14 PM
     

    Hmmm. I was cutting down on morphine because I hated it when I had my one and only psychotic episode. Since then I’ve been taking oxycodone and I know I’m hooked, but I have chronic pain that prevents me from sleeping when not treated. I don’t see what kind of “high” people get from it.

    Except for Ibuprofen, aspirin, and acetaminophen; aren’t all pain killers opiates? Alpha lipoic acid helps with my nerve pain, but that’s not surgical pain. Perhaps the patients need to be informed beforehand, and medical personnel need to work out a discontinuing schedule. Also pharma manufacturers need to make smaller doses with which to discontinue, and to raise (come to think about it).

    About six years after I suffered a grand mal seizure discontinuing temazepam as instructed I had a talk with a nurse who said they had changed the schedule to slow it down by lowering the dose every other day, then every third day, etc.

  2.  
    January 5, 2013 | 3:32 PM
     

    Wiley,

    I’m glad it helps. I guess my perspective is from seeing the post-surgical patients who can’t stop when the pain stops, and the kids buying it on the streets – even here in the Appalachian woods [where there aren’t that many streets]. I’m afraid that the meaning of “controlled substances” has changed in a modern world.

  3.  
    January 6, 2013 | 2:19 PM
     

    Isn’t it odd that all medications that cause physical dependency, not to mention outright addiction, are initially touted as not causing dependency?

    They’re only later found to be dependency problems, after many people are on them chronically.

    If restricting addictive drugs is so important, why aren’t clinical trials structured to identify them early, to inform doctors and protect patients before they’re widely marketed?

  4.  
    Catalyzt
    January 12, 2013 | 11:13 PM
     

    I am at a loss to understand why some narcotics seem to have such steep tolerance curves, and terrible addiction potential, while others do not seem to seem to have this characteristic.

    Example: While I understand that the *abuse* potential of hydrocodone is quite significant, in terms of tolerance, it always seemed to stabilize at a reasonable level for most people I know. However, the one time I had to take dilaudid (dry socket tooth extraction), it was absolutely terrifying; by the third dose, it was half as effective, but I could not take Vicodin because of the acetaminophen and I needed to dose at least three times a day. I thought I’d have to drop out of grad school. Thank God that resolved.

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