I share Maia’s concern about pain patients getting adequate pain management, but the narrative she offers doesn’t fit with my experience. The people that I have contact with who are concerned about oxycontin are parents. They don’t see it as a “bad” drug, and their concern is not that doctors are getting people addicted. They are concerned their kids getting prescription opiates from friends who get them from someone’s medicine cabinet. Their focus is on raising parental and community awareness about the problem and to encourage people to secure their meds and dispose of them properly when they are no longer needed. They’re not especially sophisticated about drugs or medicine, so it would surprise me if they’re very unusual. Hardly marauding “drug warriors.”
She also points to low treatment admission rates for primary oxycontin dependence. This misses the point. It’s not that I’m seeing people present with oxycontin as their primary problem. (It’s too expensive on the street.) The problem is that we’re seeing more young people presenting with heroin or Rx opiate addiction who initiated their opiate use with oxycontin or a similar drug. Granted, the number of people who will develop an addiction is small and the fact that some people will develop addiction doesn’t mean it should be made inaccessible to pain patients. However, with 12% of 18 to 25 year olds reporting non-medical use of Rx pain relievers in the last year, it’s not a small problem.
As for Public Citizen, they’re in the business of providing accountability for corporate fraud or mistreatment of consumers. Isn’t a case of misleading marketing like this exactly what they exist for?
Butterworth says that the data provides a basis for concern about misuse of the drug but blames the media for the problem:
Yet the real data on OxyContin makes a strong argument for holding the media responsible for the rise in OxyContin abuse. According to the Drug Abuse Warning Network, the number of times OxyContin was recorded in an emergency department visit due to drug abuse or a suicide attempt went from zero in 1996 to four in 1997 to 527 in 1998 to 1,178 in 1999. The most dramatic increase occurred between 2000 and 2002, when the number of mentions went from 2,772 to 9,998 in 2001 and then to 14, 087 in 2002.
This shows a correlation between the media’s frenetic coverage of OxyContin, which began during the February 2001 sweeps, and the sharp increase in emergency room mentions of abuse during and after this time period. Naturally, reporters explained how to defeat OxyContin’s time delay mechanism so as to get high. As the Washington Post’s Tom Shales observed in a 2001 article in Electronic Media:
“…in the course of ‘reporting’ on abuse of the drug, they’ve all aired how-to pieces that include handy, easy-to-follow instructions on the correct abuse procedure. They tell you how to get high. Then the correspondents do follow-up reports expressing shock and dismay that the abuse is becoming more popular.“
But while the manufacturer of OxyContin can be taken to court for misbranding, the major source of information about how to actually abuse the drug not only remains free of accountability – many of its practitioners continue to mislead the public on a drug whose value to people suffering acute, chronic pain is beyond medical dispute.