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Caught in the crossfire of the drug war

Oxycontin is almost a Janus-like drug. One face is beneficient; an incredibly powerful painkiller, the salvation of many people suffering tremendous pain -- often dying. The other face is malefic, as the "hillbilly heroin" snarls countless people in its addictive web, driving them to increasing acts of crime and desperation to obtain their fix.

The increasing popularity of "Oxy" among addicts has led many pharmacies to simply stop carrying it, only special-ordering it when a patient presents a prescription -- or refusing to order it at all.

That's the situation Evelyn Daniel finds herself in. Just released from the hospital after a mastectomy, she took her prescription for Oxycontin down to her local pharmacy -- and was told to just grit her teeth and bear the pain of having her breast cut off and rebuilt for 24 hours while the pharmacy got her the medication. She called around, trying to see if any pharmacy could fill it faster, and was repeatedly denied -- one refused to even discuss it over the phone.

I don't have a ready answer for this one, but it outrages me that simply because some people abuse the drug, we deny it to everyone -- even those like Ms. Daniel, who desperately need its benefit.


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Comments (25)

I've got a ready answer for... (Below threshold)
Ken:

I've got a ready answer for this one.

It's not right to inflict suffering on innocent people in order to stop idiots from hurting themselves. I don't give a damn how many of each are involved.

If those idiots hurt other people... throw their asses in jail and don't let them out. Let out the ones being sent up the river for drug "crimes" instead.

I heard that the problem is... (Below threshold)
joe:

I heard that the problem is when the time-release function of the tablet is removed by crushing it; then it's abused.

I hope whatever company makes it is trying to come up with a better time-release function that's not so easily bypassed.

Funny, but when laws are pa... (Below threshold)

Funny, but when laws are passed making it harder for me to get the sinus medication that works best for me, I direct my anger at the meth-lab operators whose use of pseudephedrine is leading to these laws.

I mean, I'm annoyed by the politicians, but people who make and sell meth are pure slime.

I hope whatever company makes it is trying to come up with a better time-release function that's not so easily bypassed.

That would seem to be the right approach, which probably means it's not happening.

Oxycontin is not the only d... (Below threshold)
Steve:

Oxycontin is not the only drug that can be used for post surgical pain, nor is it the most appropriate. It is a good drug for cancer patients with chronic pain. In this particular case another narcotic would work well for the patient.

My pharmacologist friend te... (Below threshold)
mantis:

My pharmacologist friend tells me it's very difficult to make time-release drugs that cannot be abused (crushed, snorted, injected, etc), if not impossible. However, one way to deal with this problem is to get samples to doctors who can give them to patients to cover the first 24 hours until they get their prescription filled. Of course, this can have its own problems (doctors are people too).

Why did she not go back to ... (Below threshold)
Robert:

Why did she not go back to the hospital almost every hospital I have been in has had a pharmacy in them. As they also supply the hospital it is likely they will have it in stock.

The "War on Drugs" is turni... (Below threshold)

The "War on Drugs" is turning into the "War on Americans."

Steve is right, there are p... (Below threshold)

Steve is right, there are plenty of other pain pills (vicodin being my personal favorite) that do a wonderful job of masking post-surgical pain.

And where was the pharmacist on this? Any competent pharmacist should have been able to advise her on her short-term options and work with her doctor to get the prescription changed.

Someone in charge of her me... (Below threshold)
anne:

Someone in charge of her medical case should have lined up the appropriate painkillers before she left, maybe even before the surgery. Geez.

Jay Tea,You know t... (Below threshold)

Jay Tea,

You know that I agree with you on some topics, and disagree on others.

Have to disagree on this one.

Pharmacists are hesitant to stock Oxycontin because they are being killed and robbed left and right by people addicted to it.

Few pharmacists keep it in stock anymore. That was not true even a few years ago. Thankfully so, too ... as addicts of this terrible drug will go to any length to get it. Stocking it in the local CVS puts the general public at risk.

I think if you delve a little deeper into this story, you'll find that Ms. Daniel could have had her prescription filled by the hospital before she left it.

McGehee,You're put... (Below threshold)

McGehee,

You're putting the blame on the wrong party. The people you ought to be angry at are the politicians who refuse to accept the fact that the only way to curb drug use is to eliminate the excessive force laws and make it at least a misdemeanor to mention in court that you were intoxicated while committing a crime. Personally, I'd like to see a law that makes mentioning intoxication in court a felony on par with purjury. Let the meth and oxycontin addicts get punished like everyone else, then you'll have less crime.

Of course legalization followed by a ABC store-like regulatory scheme would help a lot too.

I don´t know...... (Below threshold)

I don´t know...

All I can say is thanks a l... (Below threshold)
whocares:

All I can say is thanks a lot Rush, you fat bastard for ruining it for everybody. Did anybody ever hear if he used the infamous crushing technique to overstep the time lapse aspects of the drug?

Down here in Mexico they ha... (Below threshold)

Down here in Mexico they have very little problem with prescription drug abuse, and a lot of drugs that you need a prescription for in the US are over the counter here. Valium sits on the shelf about three spaces down from Tylenol, which is right next to the Viagra and Levitra. I'm guessing Oxycontin is presription only, unless you know the pharmacist. Must be because of all the cocaine and pot that washes up on the beach, what we call the Mexican lottery.

Yeah, I knew it would only ... (Below threshold)
OregonMuse:

Yeah, I knew it would only be a matter of time on an oxycontin thread before some clown uses it as an excuse to take a swipe at Rush.

Jay: "oxycontin"
whocares: "Rush... fat bastard"

I mean, really, it's almost like Pavlov's dog:

Pavlov's dog was understand... (Below threshold)

Pavlov's dog was understandable, it got nourishment out of the deal, what does whocares get?

From a doc with 30 years ex... (Below threshold)
epador:

From a doc with 30 years experience including oncology, hospice, battlefield, primary care, ER, wilderness, etc.

Steves: Oxycodone is a fine and potent narcotic. Use of a sustained release product for moderate to severe post operative pain (as for a mastectomy) is not only appropriate but state of the art care. The immediate release forms of eith oxycodone alone or oxycodone with acetaminophen or ibuprofen are strong enough for the pain, but their short length of action, and the potential toxicity of either of the other added drugs makes a long acting oxycodone preparation preferable. The only other oral sustained release product is morphine, which generally has more unpleasant side effects to the narcotic naive individual. The transdermal drugs, methadone, and other oral narcotics are not as good choices for short term (a few days) post op pain. Vicodin (or Percocet), if taken every three to four hours to maintain a decent narcotic effect delivers more acetaminophen than is appropriate. Its a bad choice for round the clock pain the first day or two post op mastectomy.

Just because you've been doing something a particular way for a few or many years doesn't make it the right way. Then maybe you've voted a straight Democratic ticket for decades too...

OxyContin has the added benefit of having an immediate and delayed onset, so one pill can cover 12 hours of pain. The doctor who prescribed it had a great plan. Just poor execution. Yes, the patient should have been able to get a supply from the hospital pharmacy, IF:
her insurance allowed her to purchase the medication there
the outpatient pharmacy there was open when she was discharged
her discharge planner had been on the ball

It's no secret getting the scripts filled can be a hassel (it isn't where I live, but its a small place where meth is the preferred drug of abuse, not narcotic). Still, the real blame goes to the doc and the hospital discharge planner/nurse (or the patient who might have failed to follow the advice they may have given). Not the addicts, pharmacies that refused to carry the drug, etc.

Personally, I say make all the drugs legal to use on Reservations only. Let our Native Americans suck in all the profits they want - but folks would be screened as they leave to avoid removing drugs to the rest of the nation, or leaving the Reservation while intoxicated. Would probably boost proits for the casinos there as well.

Forgive the typos above<br ... (Below threshold)
epador:

Forgive the typos above

to Mantis: Sampling out narcotics is illegal. Not a solution.

I find it hard to believe t... (Below threshold)
BorgQueen:

I find it hard to believe that her doctor didn't have the hospital pharmacy fill the scrip for her with at least enough for a day's doses. What state was this in? The link's not working for me. At any rate, she ought to have been able to call her doctor and have him authorize the hospital to fill the scrip for her after all this happened.

BTW, "whocares," you have THE most appropriate sig I've ever seen!

It's easy to believe that t... (Below threshold)

It's easy to believe that the hospital pharmacy wasn't used. When filled predischarge, the insurance company will [around here, anyway] treat it as part of the hospitalization, which means it comes out of the per diem, which means the hospital probably won't get paid.

Post discharge, it's likely to be less convenient than a regular pharmacy.

The original link didnt wor... (Below threshold)
epador:

The original link didnt work, but it was to Boston Herald.

http://news.bostonherald.com/localRegional/view.bg?articleid=101793


She's from Cambridge.

Again, this is a discharge planning faux paux. Used to have the same problem with MS Contin.

There's no comparison betwe... (Below threshold)
-S-:

There's no comparison between the pain management provided by Vicodin/Hydrocodone and Oxycontin/Morphine Sulfate. The first provides a short term relief of mostly skeletal and soft tissue sort -- even the 750ml tab, which is close to knock-out for most sober adults -- while Morphine affects the central nervous system. And, accordingly, the successful model of Oxycontin is that it's a time release formula (thus, should not be crushed or modified but swallowed whole to reap the benefits for pain management, to experience the sustained release over time of the medication -- crushing the pills eliminates the sustained release, which is what the meds are intended to provide, and when crushed, a person does not experience pain management but a stuporous effect instead only to be left with chronic pain ongoing if that's among their problems).

Meaning, if/when a person has to contend with the effects of chronic pain of a shortterm type, like dental surgery recovery or a compound fracture of a large bone in the body, then they can take Vicodin/Hydrocodone to a certain extent for shortterm pain management -- every few hours, a pill for shortterm relief of a shortterm pain mamagement issue; but, if there's an ongoing condition that creates the need for pain management of an aggressive sort (longterm, something that isn't anticipated to become milder as time passes, at least, for a while), there's reason to use a time release formula that is only taken once or twice a day, every ten-to-twelve hours. Vicodin/Hydrocodone has to be ingested every four hours and sometimes more often, which is bad for the liver among other things -- while Oxycontin/Morphine Sulfate remains present in someone's system for about ten/twelve hours such that less of the medication is needed and needed less often when it's administered correctly.

The psychological effects are that a person on a shortterm pain management course will experience more cyclical pain issues related to the shortterm effects of the medication, while the time-release meds provide a more "level" or consistent, non fluctuating pain relief.

It's thought that the fluctuating, cyclical effects of shortterm pain management meds leads to the experience that "more" is necessary and motivates some people to seek an increase in their medications' amounts -- because they are in pain, they take a pill, they begin to feel pain again three hours later, they want another pill, are supposed to wait another hour (four hours between doses), they want relief, so they start advancing the hourly limit a bit more and more and more and...this is why some people experience a problem of abuse, ongoing dependence on Vicodin/Hydrocodone, because they do, in fact, "acclimate" to a dose and experience a motivation "for more" in less and less time, and it's often brought about by pain but unless that person is moved onto a longterm pain management regiment, they're likely to exhaust the benefits of Vicodin/Hydrocodone over time. And, too much of that damages the liver, as I wrote earlier, so a person can and will result in a worse health problem than the original pain condition itself when Vicodin is used longterm, which it isn't designed to be.

Thus, if someone has chronic pain caused by an ongoing condition (something that isn't short lived like recovery from dental surgery or even a broken bone that will successfully heal, instead), a timerelease treatment is advisable -- and far kinder to those who suffer chronic pain. And, Oxycontin/Morphine Sulfate suppresses the cardiovascular rate so it's a case of trading off one level of fitness to counter another concern (the condition of pain -- long term, chronic pain, untreated, creates permanent changes in the brain so it's best to try to avoid that and treat the chronic pain instead).

Not everyone has an addictive response to pain medication. A lot of people are able and willing to stop the medication if/when the painful conditions cease. But, with addictive personalities, there are other motivations involved, most of it psychological. Try suggesting to a heroine addict or a meth addict that they curtail their activities, or even an alcoholic...maybe I make my point, because it's a case of psychology that leads to addictions, more than anything. And pain management for chronic pain shouldn't be lumped in with the negative assumptions about addictions, because these are two very different areas of human conditions and treatments.

Long story longer here is that pain management is a complex issue, and addictions are a complex issue and they are two entirely different areas of medicine. People who abuse pain medication for pscyhological reasons should be examined for chronic pain issues but the motivations for pain management and addictions are two different issues altogether.

If it wasn't Oxycontin for some who are addicts, it'd be heroin or meth or alcohol or...it's the same issue of addictions, while, people with chronic pain or even shorterm pain management requirements have entirely other needs as to care and treatments.

Man, this Pavlov's dog thin... (Below threshold)
whocares:

Man, this Pavlov's dog thing has become almost a talking point for you tighty rightys. Does it make you feel smarter using that reference on me while you guys pounce on every asinine reason well pass the point of redundant tedium to knock a liberal. What, were you trying to shame me for stating the obvious? Actually, you gave me that little "what a fucking hypocrite" tickle that I get in my belly from such sad attempts to insult someone, especially me. Thanks, I'm sure you tried your hardest.

One of the funniest sites r... (Below threshold)

One of the funniest sites related to drug prohibition is http://www.waronjunk.com/warning.htm

Considering the current political climate, this author is practically begging to be arrested.

thanks... (Below threshold)

thanks




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