January 17, 2005

Why not ask someone with chronic pain??!!

MANAGING PAIN WITH NARCOTICS - OXYCONTIN AND ITS ALTERNATIVES
By Howard LeWine, M.D. Brigham and Women's Hospital

Narcotics are an essential part of pain management for many people. Doctors and their patients need to balance the improved quality of life pain relief brings against the potential for abuse and misuse. Narcotic abuse refers to a pattern of behavior where someone uses a drug to get "high," and as a result runs into problems at home, school or work. Someone abusing narcotics is prone to hazardous behavior, such as driving while intoxicated, getting into fights or running into trouble with the law. Narcotic misuse includes giving narcotics to others for whom they are not prescribed, selling prescription drugs, and stealing them.

Drug dependence is different. Dependence refers to the physical and psychological changes that occur when someone regularly takes a narcotic. A person may need larger amounts of a drug to achieve the same effect. The person could develop withdrawal symptoms if the drug is suddenly stopped.

There are situations in which the potential for drug dependence should be taken out of the equation. The most glaring example is end-of-life care. Increasing the dose of narcotics to relieve pain in a terminal patient might be limited by side effects and the risk of halting breathing, but worrying about the patient's becoming dependent on the drug should never be an issue.

Doctors sometimes will need to prescribe narcotics for a prolonged painful illness, postoperative pain, or a chronic pain syndrome. The patient may become dependent on the drug, but dependence is not always a bad thing as long as the gains are worth it. Doctors do pay attention to the possibility that healthy dependence could become unhealthy abuse.

Of the many narcotic pain relievers, OxyContin has been getting the most publicity. OxyContin, when prescribed and used appropriately, can be an important part of a successful pain-management program. When the pill is swallowed whole as designed, the active ingredient oxycodone is slowly released to relieve pain without creating a "high." This allows people to function in daily life.

But OxyContin can easily be misused. It has more abuse potential than many other narcotics because it is pure oxycodone, the tablets can contain very high doses of narcotic, and the tablets can be crushed to release the ingredients in a powder form that provides a much more immediately potent dose. So if you are taking this medication, never chew the tablets, and store them in a special, safe place.

OxyContin should usually be limited to the treatment of pain that is expected to last more than a few weeks. For most people with new severe pain, shorter-acting narcotics can be used. There are many choices, most of which contain a combination of two ingredients. Acetaminophen, aspirin, or ibuprofen is often combined with a narcotic such as codeine, hydrocodone, or small doses of oxycodone. Examples are acetaminophen with codeine, Vicodin, Vicoprofen, Percocet, and Percodan. People with gastritis and peptic-ulcer disease should note that Vicoprofen contains ibuprofen and Percodan contains aspirin. These medications also are used in people with chronic pain to help manage what is called breakthrough pain.

In people with cancer or chronic pain syndromes, using a long acting, slow-release narcotic preparation can prevent, or at least significantly decrease, the frequency and severity of breakthrough pain. The long-acting alternatives to OxyContin are oral sustained-release morphine sulfate (MS Contin, Avinza), methadone, and the fentanyl (Duragesic) skin patch. The morphine-sulfate preparations share similar problems with OxyContin in that they can be opened or chewed, but the incidence of abuse with MS Contin and Avinza has been much lower. Methadone works well for many people to provide steady pain relief with less of the "high." The fentanyl skin patch is expensive, but provides a steady amount of drug delivered to the bloodstream and, presumably, a steady amount of pain relief.

Because all of the narcotics work in essentially the same way, they all share the same side effects and potential for dependence. When used under careful medical supervision, these drugs can provide great relief and improve the quality of life in people with cancer or chronic pain conditions.

The company that makes OxyContin is working on a new tablet design. The goal is to create an easy-to-take oral medicine that continues to slowly release oxycodone over eight to 12 hours, but one that cannot be altered by chewing or crushing to release pure, short-acting oxycodone.

Howard LeWine, M.D., is chief editor of Internet publishing, Harvard Health Publications. He is a clinical instructor of medicine at Harvard Medical School and Brigham and Women's Hospital. Dr. LeWine has been a primary care internist and teacher of internal medicine since 1978.

I know some people abuse narcotics but it is wrong to hold all accuntable for the actions of a few! Some of us are trying so hard to get some relief even if it is short term relief we will do it because it wears you our to hurt so badly. Am I an addict, no, have I become dependent for a better quality of life, yes, is there a BIG difference-YES

Posted by Lisa on January 17, 2005 10:47 AM

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