Should doctors give more Oxycontin to chronic pain patients?

by Christopher, BA

We all know of the folly “Just Say No” as it just does not work. I disagree that a physician should ignore the requests of her or his patients, based solely on the perceivable abuse of the drug Oxycontin.

This is an opiate that works wonders for patients in chronic pain situations, and with proper monitoring by an able health care provider — as well as one who is “into” their patients and their well-being — addiction rates can be low among users.

Using anecdotal accounts of “hillbilly heroine” to make the social construction and demonization of this drug (and others) clearly indicate there is a problem. However, the drug and the people who abuse it are taking blame away from policy makers, community leaders, drug companies, and physicians who do not monitor patients effectively.

The real issue here is pain, and millions of people may benefit from regimens of opiate therapy for chronic, acute, and post-op cases. Reagan’s “Just Say No” failed — miserably. Putting one’s outdated slogans to work is an excuse. Doctors in other countries treat pain by listening to their patients. Instead of criminalizing and demonizing individuals, why not address other issues of a structural nature, such as drug policy itself. If drugs were legal, there would be no problem with selling prescription pills. While this issue is touchy and widely debated, I have seen the low addiction rates in countries with legalized drug policies.

Making individuals into criminals furthers our prison industrial complex, and only complicates the real issue: people are hurting. People are in pain. If Oxycontin works, then so be it; let your patients have it. The McDonaldization of our health care industry may prevent physicians from investing in their patients, opting for more bodies and less time with each; this is a problem.

My advice: be a pioneer. Be an advocate. Fight this trend and make our health care shy away from a tertiary, DEA riddled, slogan-brandishing excuses to treat people. We should have the right to get what prescriptions we want when we want them. My grandmother benefited greatly from Oxycontin and is not addicted, or was she ever.

The bottom line: people are going to get drugs if they want them. It is up to us as a community, state, country, and society to decide who is responsible for social ills, and looking to blame citizens is simply a side show. Responsibility goes much higher than those who are abusing drugs. Why are they “abusing” drugs? Is it pseudo addiction? Are doctors getting it wrong? Can you see how one may feel helpless if in pain, due to strict laws and tight lipped health care providers willing to stutter a “Just Say No” at them? I find this not conducive to the health of our nation. You want to look at problems? Look at the DEA; they are more of a problem then any city full of drug abusers. Look at our policies for drug abuse. Why is the U.S. so far behind European countries? Japan? Should we not call off our old, tired slogans and just say, “what do you think we should do for your pain sir?”

“Christopher” is a sociologist.

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  • Paul Weiss

    My opinion differs from the author regarding the use of Oxycontin.

    In my experience, I have seen many people given narcotic opiates to treat chronic pain before being given an adequate trial of physical therapy and other less risky measures. A recent study has shown that in North Carolina, less than a third of people with chronic low back pain have seen a physical therapist in the past year. Of those people seeing a physical therapist, not all received evidence based treatments.

    Improving access to and quality of physical therapy can decrease the need for narcotics in many cases.

  • doctorjay

    Be a pioneer in losing your livelihood and perhaps ending up in Federal prison? Take the case of Joseph Zolot, MD, a pain management specialist who was recently indicted for 6 drug-related fatalities. I know Dr. Zolot personally and had referred patients to him for chronic pain management before his license was suspended. He’s neither a pill pusher nor a criminal – the worst you could say is that he was too easily duped. His reward for adhering to the philosophy you espouse was to have his life ruined. Until the DEA stops criminalizing and demonizing physicians for being fooled by substance abusers/drug dealers, you are suggesting professional suicide

    • carol

      Unfortunately I just found out, thru the internet, that a doc I respected and had no reason to suspect was ‘mishandling’ drugs. He was found to have 5,000 of them in a desk drawer for his patients “who could not afford them.” (He runs a pricey clinic, if you could afford to see him, you have insurance and can afford meds.) Not all are ‘fooled’ by substance abusers, drug dealers as you write. My neurologist from a number of years back lost his writing privileges (for narcotic meds). He refused to say why. My belief was that his compassion caused him to write for more than the DEA thght was appropriate (I could be wrong of course) and he was trying to be a good doc, no more no less.
      Doctors, patients, and those who love those in pain must start to fight back against the DEA. Write your congressperson, advocate. No, everyone should not be able to get any drug they want, that is why you have doctors – to dx , treat, and prescribe but to place the ‘war on drugs’ on the back of pain doctors and their patients is the highest of folly.

      • stitch

        I was called today by a director of a methadone clinic who informed me that a patient I had been seeing for less than 3 weeks, and who told me s/he had been on higher dose benzos, was in fact on the methadone program. I still get fooled, and I think I’m pretty savvy on this point.

        Every time something like this happens, I get even more suspicious.

        So, no, I’m not going to fight back against the DEA. And I am willing to provide pain meds, but I’m not going to develop the reputation as the candy man, as is likely the case with the doc you described.

  • Diane D’Angelo

    There is a bigger issue here, too: the lack of seeing beyond drugging or attempting to remove pain with surgery. Greater use of physical therapy and mindfulness techinques greatly decrease the need for narcotic use. Too few physicians are knowledgeable of either discipline.

  • Dr Prater

    Good luck getting physical therapy for chronic pain covered by insurance. That’s why many opt for prescription relief, because they can at least afford that if they get what’s covered by their plan!

    Most insurance companies (I’m looking at Aetna’s disclaimers for what physical therapy is covered) consider therapy to “develop or restore physical functions lost or impaired as a result of a disease, injury or surgical procedure.” as ok, but none of these cover chronic, pathological pain of unknown origin – which is what chronic pain is for many people. Unless they get a diagnosis of fibromyalgia or some other vague syndrome, and the insurance company covers that particular disorder, people are stuck – they aren’t going to get physical therapy unless they pay for it out of pocket. So why not let them have a prescription rather than be in pain?!

  • SteveBMD

    I agree with the author that the “just say no” approach is bound to fail. In fact, saying “no”– or constructing unnecessarily harsh limits on the use of a substance– increases the mystique of the substance and makes the user want it more (potentially turning the “user” into an “addict”– although that’s a gross oversimplification of the notion of addiction).

    Saying “no” is great in theory. But it only works if “no” really means no. As the author points out, people are going to get drugs if they want them. And once they do– and they’ve “beat the system” in the process– we’ve demonized the patient and destroyed any possibility of a therapeutic, compassionate relationship.

    Interestingly enough, I blogged about this exact issue not too long ago:

    • carol

      Most pain patients do not ‘want’ opiates. They do want what helps them and for many of them it is a narcotic medication. Your terms show the problem with some of this discussion. User usually means abuser, pain patient means someone in chronic intractable pain looking for help and relief.
      I usually don;t write 2 blog posts in one day but this made one necessary.

      • stitch

        And again, and again, and again, studies a benefit for chronic narcotics in non-cancer pain. A new study comes out at least once a month.

        Don’t like that? Find a better way to deal with those who are addicts/diverters/fakers/criminals. Until then, realize that we practitioners have been forced to be suspicious.

  • Dr. J

    The author asserts that oxycontin ‘works wonders’ for patients in chronic pain, and offers as proof his grandmothers excellent response to this drug. Although there certainly are patients with chronic non-malignant pain who benefit from drugs like oxycontin, there is really no great literature or evidence that these drugs ‘work wonders’ very often. The author also states that anyone should be able to get whatever drug they want, when they want it.

    As a physician many of the drugs I use to treat patients have serious potential side effects, and medicine requires deep consideration of the risks and benefits of treatment, and re-evaluation of the efficacy of treatment when side effects appear. The side effects of drugs like oxycontin include sedation, death and addiction. Certainly some patients may exhibit pseudo-addiction due to uncontrolled pain, but the assertion that this is the majority of patients who use the drug other than as prescribed is incorrect.
    As a physician I must always think beyond what is obvious and consider a range of diagnostic possibilities. When careful consideration leads me to believe that a patient has an addiction problem I must bring this up with the patient, in part because addiction is a treatable problem, that is devastating if ignored. The idea that I would ignore addiction and treat an addicted patient with oxycontin because they have a ‘right to what they want, when they want’ or because they will get it somewhere else anyways is abhorrent.

  • Dr. Jennifer Gunter

    OxyContin does not work wonders for chronic pain. I have practiced chronic pain medicine for almost 15 years. I don’t think the author has that clinical experience. The US consumes 99% of the world OxyContin supply. Considering we have 4% of the population I would say many of our patients are over “OxyContinized.”

    OPioids have a specific role for specific patients. There must be improvement in function to continue and benefits must be > than risks. In addition, non medication approaches should be embraced, though sadly they are rarely paid for by insurances (expect in my model, where we have a full complement of mind body and PT as well as meds and surgery).

    Patients on chronic opioids have a shorter life expectancy and these are very common causes of unintentional deaths. Giving more is sometimes the right answer, but most often it is not.

    • Air Assault Medic

      What a great assertion Dr. Jenn,

      But… where is your data to back up your claim; you know… the evidence one would have to present at any university or professional organization? Have you even been out of the United States and made those observations, written a paper on it or gathered that information from the W.H.O. or World Health Organization? Is this data you assert juried and if so by whom? I mean really ‘99% of the world’s oxycontin’ is a magical attempt at sophistry and a veiled attempt to say ‘all pain medications’ but really, we are talking about treating pain with opiates and not just Eli Lily’s or the big U.S Pharm brands.

      Point taken though Dr. Jenn, and one would posit the question… just how many practicing American ‘M.D.’s’ are governed by their little pda’s given out and programmed by the drug companies. Heuristics and rules of thumb like yours exist and indeed thrive in Amerika. One cannot but smile at novice professionals who attempt to throw statistics around. You might look up the Black Swan Theory Dr. Jenn and while you are at it, if you are going to use stats to argue your case…lets try not to dupe those who haven’t done their graduate and post graduate work.

      On the other hand, it is too bad the American civilian system does not treat the whole patient and instead is focused toward a schizophrenic capitalistic system of medicine.
      Lastly, I am grateful you aren’t one of the colleagues we have to deal with at the V.A..

  • M.

    I see valid points in the author’s posting & in all comments that followed. “Chronic Pain” must first be thoroughly and competently validated by a practitioner after the underlying diagnosis is found by whatever means of diagnostic testing is done. I believe that a thorough family history must be done to aid in this processes & I do not mean by means of glancing over initial intake forms that are completed by the patient. I also believe that before any narcotic is prescribed by a physician there should be some sort of mental evaluation done to help evaluate a patient’s level for potential addiction.

    Complaints of LBP are common & I do not believe that jumping straight to an opiate such as Oxycotin is ‘good medicine’. If a patient is prescribed other methods of treatment, such as physical therapy, and refuses to adhere to the prescription or recommendation, than narcotics are not the answer. Granted, not all insurance companies are contracted with the policy holder to cover alternative or non-pharmaceutical treatments, that financial responsibility lies with the patient. Then again, the “What else can I do” attitude lies with the practitioner and how they chose to deal with it (to give a script or not to give a script…THAT is the question).

    I am a firm believer that health plans need to cover more treatments than they actually do. For example, if it is imperative that a patient lose X amount of pounds and reduce their BMI for a serious medical issue, but they cannot exercise or have limited mobility, I feel that a health plan should cover a program, such as Jenny Craig, for an example, for a limited amount of time to help the patient drop the initial X amount of pounds until they get to a weight in which the patient is capable of physical exercise. But they [health plans] do not & I doubt they ever will.

    There are always alternatives & serious narcotics should only be prescribed for legitimate, competent, medically diagnosed health issues based on objective findings, not subjective complaints. Last year I was diagnosed (through many objective diagnostic procedures) with Rheumatoid Arthritis at the ripe old age of 35. I refused pain medication for the first 11 months of my treatment, until my pain became unbearable. When I finally asked my physician for ‘something to take the edge off’ so I could engage in day to day activities without pain, he initially prescribed Vicodin. I had an idiosyncratic reaction. I react to Vicodin by means of getting the jitters, insomnia, as if I had taken an amphetamine. I ONLY took the medication if absolutely necessary because of the unwanted physical reaction I had to it. Recently, he prescribed Oxycodone 5mg immediate release tablets (2 tablets PRN). They have been working just fine. Doing just enough to take the edge off and make my daily activities tolerable. I am not in anyway ‘pain free’. I did tell my doctor that I cannot take pain medication while at work because I am a teacher. My doctor offered my Oxycotin, strictly because of it’s time release properties. I declined because I am not in need of such necessities thus far. I say this because my doctor did a full family history, complete diagnostic testing for my illness, did not immediately offer me narcotic for pain, and DID do a verbal survey with me to ‘test’ my potential for abuse of narcotics. My doctor knows that I have 14 years experience working in the field & I could have easily manipulated the ‘system’. I feel that my provider has the same trust in me that I have in him, because of his thorough knowledge of my disease and his taking the time to get to know me as a person, not just a patient.

  • BobBapaso

    Just say no to Oxycontin. It is probably the most abused, and probably the most addicting opioid on the market. It should be taken off the market, and so save us so much trouble. There are plenty of other opioids that relieve pain just as well. Of course, first we need a diagnosis and failure of non opioid treatments before we prescribe them.

  • Sarah Hill

    Oxycontin is great for short term or if it’s taken in controlled moderation. I agree with you that it shouldn’t be taken long-term, but I also know that there are people in chronic pain conditions that have no other options but to take it or suffer.

  • M.

    I am seeing the same thing over and over. Opioid treatments should be given to REDUCE pain, not to relieve it. Patients would chronic pain will probably never become pain free. Patients should be taught that in some/most cases, they will never become ‘pain free’, but rather be taught tolerance to reduced levels of pain.

    • carol

      The issue is needing the medications, for some patients, in order to reduce the pain. Many folk here talk about PT for instance. For those with neuropathies, no amount of PT will help. Opiates may, and if the patient does benefit then they need to be kept on them unless and until other therapies are available.
      Chronic pain is just that, chronic. The name defines the lack of probable resolution.

      • stitch

        Narcotics are not the drugs of choice for neuropathic pain. There are multiple other choices, including many different types of anti-seizure meds and anti-depressants. Be careful talking about all the “side effects” of such meds; it’s a red flag in and of itself.

  • Larry

    The author exposes his lack of understanding of
    addiction ,pain treatment, and clinical care. This drug is
    overutilized ,undercontrlled and is causing deaths due
    to overdose in every state. Anyone who has confronted
    chronic pain ,has a far firmer grasp of how to help patients
    and it certainly is not oxycontin for anyone who asks.
    The patients are entitled to a more sophisticated and nuanced approach to care, with a real pain specialist.

  • Dr Joe

    It seems that there has been a huge increase in the use of opiates over the last decade. Are we collectively in more pain or has the oral form just made it easier to prescribe tablets rather than deal with chronic pain in other ways. the drug benefits some people but does harm to many others. Its widespread use may have something to do with industry input.

  • Dr. T

    The April 2011 issue of Pain reviewed the topic and found “poor evidence” for the use of narcotics in non cancer pain. If we start selling narcotics at the grocery store, I doubt that the sociologists will be available to treat the addiction, hypersensitivity issues, withdrawal and overdoses that will inevitably occur. That is why physicians have medical licences, and should be the only ones to make thses difficult decisions.

  • carol

    As someone with an over 30 year experience oif living with chronic pain (trigeminal neuralgia) I have had 12 brain surgeries including experimental brain stimulation. I have also been prescribed narcotics including codeine, percoset, demerol, morphine, tincture of opium. Most of these were prescribed over a few years of experience with me. I never had a problem with dependence (and I wish that these discussions would include the differentiation between addiction, something most pain patients do not experience vs dependence which may affect some who have been on opiod therapy). Opiods should be the court of last resort. Oxycontin should not be the first prescribed. Try the lesser than go to the stronger if and when necessary.
    The DEA has decided the ‘war on drugs’, a failure should now be directed at the pain specialist and pain patient. because of this everyine loses.
    Thank you
    Carol Jay Levy, B.A., CH.t
    author A PAINED LIFE, a chronic pain journey
    Women In Pain Awareness
    member, cofounder with Linda Misek-Falkoff, PWPI, Persons With Pain International,
    accredited to the U.N. Convention on the Rights of Persons with Disabilities member U.N. NGO group, Persons With Disabilities

  • gzuckier

    My only personal experience with the subject was decades ago when i broke my leg and the MD prescribed whatever was the current popular opiate. i found that Advil did a better job dulling the pain. maybe cancer is different.

  • Greg

    You write: “We should have the right to get what prescriptions we want when we want them.”

    Does no one else think that’s a bad idea? That we have a “right” to Oxycontin or Xanax or Phenobarb whenever when we want them? Not when I have discussed it with a professional who has prescribed these medications before thousands of times has my best interests in mind, but when I want them? Does that not make prescription a moot point? Given that passing around prescription drugs “when I want them” is a nationwide crisis so rampant that neonates are born addicted to Vicodin, is that really a step in the right direction?

  • Mel

    This drug is given to freely by many doctors. This drug has caused a serious epidemic leading towards heroin. My husband was in a serious accident which in result shattered his right pelvic. This drug along with other pain killers was prescribed to him. I feel like many doctors are drug pushers and have cause many people to become drug addicts. This drug is legalized heroin and is so difficult to come off of. I truly feel that this drug destroyed my husband and my life. Something needs to be done since it is destroying too many lives. Say No to oxy

  • Melissa

    In the absence of regularly interfacing with individuals who desire narcotic prescriptions when it clinically is not in their best interest, it is hard to truly understand the phenomenon. I have recently stumbled upon some Youtube “accounts’ between animated characters that characterize some common behaviors seen in these patients. I was amazed at the uniformity of the dialogue despite the diverse number of creators. Although, these depictions are geared to be humorous melodramas, you have to suspect that this patient profile is indigenous and constitutes a strong, frequent presence in many ERs thoughout the nation.

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