Rush Limbaugh's recent admission that he has an addiction to prescription narcotics has thrust OxyContin back into the spotlight. The potent painkiller has been in and out of the headlines for about two years, ever since addicts began injecting it to get a heroin-like high.
A Newsweek headline blared, "Rush's World Of Pain: His Path To Pill Addiction . . . The Scourge of OxyContin." Elsewhere, the medication has been demonized as "hillbilly heroin;" Fox's Bill O'Reilly called it "liquid heroin."
It's an undeserved bad rap for OxyContin, which offers relief to hundreds of thousands of patients with searing, prolonged agony due to diseases such as cancer, neurological illness and degenerative discs. OxyContin can literally make life livable again for such patients.
One never would know this from the hype that has been swirling around the medication since Limbaugh's confession. It is important to get the facts straight, or pain sufferers who might benefit from OxyContin could be scared away.
Don't Blame Drug
The problem isn't with OxyContin itself, but with deliberate criminal misuse. OxyContin is a controlled drug in the same category as morphine. Available since 1995, the medication is now the most widely prescribed narcotic, in large part because it is taken only twice a day. Other narcotic painkillers have to be taken every three to six hours, which increases their addictive potential. The 12-hour controlled delivery keeps blood levels steady, an important feature when pain is constant and severe.
But half-truths abound:
- OxyContin is very addictive.
When abused, it most certainly is. Addicts typically crush the tablet, inactivating the slow-release feature, then snort the powder or inject it with water for a euphoric, heroin-like rush. But pain patients who take OxyContin as prescribed don't require increasingly higher doses and don't feel a high.
- Long-term use for pain equals addiction.
There is a difference. Physical dependence happens to almost everyone who takes a narcotic medication regularly for about two weeks. Your body becomes used to the drug; if it is stopped abruptly, you experience withdrawal symptoms. Doctors taper pain medication to avoid this.
Addiction, by contrast, is the compulsive use of increasing doses of a substance to regulate mood. Most people who abuse OxyContin have had problems with excessive use of alcohol, heroin or other habit-forming pills. Those abusers who have not generally are struggling with emotional demons.
Narcotics are an excellent short-term salve for depression, numbing boredom, self-loathing or fear. This is why doctors should ask patients about prior problems with drugs or alcohol before prescribing potentially addictive pain medications and carefully supervise those with histories of addiction.
- OxyContin is responsible for hundreds of overdose deaths.
Last month, the New York Times reported that a federal drug advisory panel member said "OxyContin is responsible for 500 to 1,000 deaths a year." Not so. A March article in The Journal of Analytical Toxicology examined records of the 919 deaths related to oxycodone (the painkiller in OxyContin) in 23 states over about three years. In only 12 cases was OxyContin alone found. The remaining victims had taken either an overdose of other oxycodone-containing drugs (such as Percocet) or a combination of drugs. Almost all had at least three other drugs in their systems, mostly alcohol, Valium-type tranquilizers, cocaine or other narcotics. These deaths overwhelmingly occurred in drug-abusing individuals; rarely was OxyContin an exclusive cause of death.
OxyContin, like other powerful medications, can be a godsend when used correctly. Now, however, the American Pain Foundation has received calls from patients who are doing well on the medication but are afraid to continue. The foundation also has heard that some doctors are nervous about prescribing it, lest patients risk addiction or sue them.
One of the worst things a doctor can hear a patient say is: "I'd rather be in pain than have people think I'm an addict." We can't let half-truths about OxyContin set back progress against horrible pain.
Sally Satel is the staff psychiatrist at the Oasis Clinic in Washington and a resident fellow at the American Enterprise Institute.