What's Causing America's Oxy Epidemic?

By Walter Armstrong 04/07/11

In the past decade, the number of patients admitted to rehab for opioid addiction has increased by a factor of five. Do pill-pushing doctors deserve some of the blame?

Some abusers seek out dozens of doctors in their
hunt for pills.

OxyContin, Vicodin, and other prescription opioids have flooded the pain market over the past two decades, proving a blessing to many patients in dire pain but a curse to those who get hooked. With some 200 million opioid prescriptions written in 2009, recreational popping of these potent doozies has become a big public health problem—and a big business opportunity. Over the past decade, admissions to rehabs for opioid addiction have increased by a factor of five, according to the National Institute of Drug Abuse (NIDA).

Now the University of Pennsylvania's School of Medicine is launching the Center for Substance Abuse Solutions. As part of the fanfare to accompany the center's debut, the school released findings from a major study led by NIDA and Penn. The surrising study,  coupled with a second study by University of Michigan, are making headlines, and reinforcing the vast scope of the pill-popping problem American youts. The two studies were published on April 6th in the Journal of the American Medical Association.

After spending months examining national prescribing patterns, McLellan and his team tunneled through a mountain of data—80 million prescriptions, or 40% of the national total. They found that 56% of painkiller prescriptions were filled by patients who had, within the previous month, already purchased another painkiller—often prescribed ny a different doctor. While no one is suggesting that all of these millions of double-dipped scrips were suffering from drug abuse or addiction, it’s worth noting that vecause of their addictive potential, opiods like OxyContin and its ilk were originally approved only for short-term use—typically two to three weeks. Since then, however, a majority of patients have gone on to have long-lasting relationship with their pain pills. Doctors in the U.S. prescribe opiates at triple the rate than doctors in Western Europe. Can America really be  wracked by that much chronic pain? Other notable stats singled out in the study: 46% of the scrips went to people ages 40 to 59; 12% to those 10 to 29. Bonus fact: Dentists were the biggest writers of painkiller scrips for teens.

Overdoses always attract attention, and opioids don't disappoint on this score, either. They kill pain, but increasingly they kill people, too. Painkiller overdoses are second only to automobile accidebts as the leading cause of America's accidental deaths. With that in mind, a team from the University of Michigan set their statistical skills loose on another massive database, examining 115,000 painkiller-using patients at VA hospitals nationwide in 2004 and 2005. But while only 0.04%, or 1 in 2,500 people, died as a result of taking opiods, the media fixated on a different finding in the study—one that proved the researchers’ starting hypothesis that the main risk factor in accidental deaths from opioid drugs was the amount that patients consumed. Not surprisingly, the more drugs that patients ingested, the bigger hazards they faced. People who were prescribed OxyContin, Vicodin, Percocet, or other opioids or sedatives in 100 milligram doses were up to 12 times more likely to die from overdose than patients whose scrips were limited to 20 milligrams or less. Those who got the high-dose scrip for a substance-abuse problem had the lowest risk of death (4.5), followed by acute pain (6.6) and chronic pain (7.2) Cancer patients who received high dosage opiods suffered the greatest risk of dying from the drug's effects (12).

Not long ago, most doctors believed that OD’ing on OxyContin was all but impossible.

Not long ago, most doctors believed that OD’ing on OxyContin was all but impossible. "In the past, patients and physicians thought that the solution to pain was to give ever increasing doses of opioid medications, and the risk of higher doses has been viewed as ‘only’ sleepiness or sedation, and rarely respiratory problems," says Dr. Timothy Collins, assistant professor of Medicine/Neurology at Duke University. This study shots a hole in that assumption.

The medical profession can be forgiven for thinking that OxyContin, the most prescribed narcotic in the nation, was safe because the company that developed the drug, Purdue Pharma, hid its negative data from the FDA. The drug was approved, and quickly sold, as a less addictive drug than other painkillers on the market—less subject to abuse, and less likely to cause withdrawal symptoms than the competition. Juat a year late,  OxyContin had become a blockbuster by the time a sufficient number of reports of deaths and other adverse reactions had revealed its dark underside. The FDA slapped a black-box warning on the label, and state prosecutors, faced with the scope of Purdue’s deceptions, decided to arrest not merely the corporation but also its CEO, the chief medical officer, and the general counse, charging them all with serious felonies. It was the first time in memory that pharmaceutical big-wigs were held personally liable for their company’s crimes.

Fifteen years later, as OxyContin has become one of the most widely abused black-market  drugs in the country, Purdue's new leaders are bankrolling attempts to limit the Oxy epedemic. As The Fix recently  reported, in Florida, where Oxy abuse was particularly prevalent, the drug company pledged  $1 million to help launch  the state’s prescription monitoring database, which would have helped law eforcementofficials track patients who were abusing prescription painkillers. While the bill enjoyed unanimous support in the legislature and had already been signed into law, soon after he was sworn in, the state's new GOP governor Rick Scott stunned his citizenry by vetoing the software surveillance, claiming that the system's threat to the privacy of patients outweighed the dangers posed by Florida's runaway industry of pill mills and doctor shopping.

But law enforcement is not the only way to stem the problem. Far from Miami storefronts and strip malls that make millions byselling illicit opioids, Penn’s Center for Substance Abuse Solutions is trying to develop a new model to care foe patients with chronic pain problems. By setting up centers known as "Patient-Centered Medical Homes," Penn's program will endeavor to close the gaps that allow for the abuse of painkillers, while improving pain care with new healthcare information technology. “The scope of the problem is vast,” said Thomas McLellan, who co-authored the study and directs the new center for solutions. “But we believe this study provides valuable information about factors contributing to the high rates of opioid analgesics, and identifies areas ripe for intervention.”

Walter Armstrong is Deputy Editor of The Fix and the former Editor-in-Chief of Poz Magazine. He also wrote The Truth About the New Coke Vaccine.

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