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Drug Makers Hope to Kill the Kick in Pain Relief

KMarsha59KKMarsha59 Posts: 31
edited 06/11/2012 - 8:19 AM in Pain Medications
I found this article which was released about the same time I went off PM in 2004 and Oxycontin. I was wondering if you guys know whether they ever went thru with all this propaganda. Just curious. Read On...
Drug Makers Hope to Kill the Kick in Pain Relief
Posted by CN Staff on April 19, 2004 at 16:36:52 PT
By Sandra Blakeslee
Source: New York Times

Worried that millions of Americans are using prescription opiate painkillers to get high rather than to ease severe chronic pain, drug makers are working on ways to prevent abuse.
Cooperating closely with government officials and pain specialists, the companies are educating doctors, rewriting warning labels and tracking pills as they move from pharmacy to patient.

They are also reformulating pills with added ingredients. One combination blocks euphoria. Another produces a nasty burning sensation.

"The problem of prescription painkiller abuse is much bigger than people realize," said Dr. Clifford Woolf, director of the neural plasticity group and professor of anesthesia research at Massachusetts General Hospital in Boston and Harvard Medical School.

"No other drug type in the last 20 years had been so abused in such a short period of time," he said. "It's an epidemic."

According to the Substance Abuse and Mental Health Services Administration, more Americans abuse prescription opiates than cocaine and the abusers far outnumber those who misuse tranquilizers, stimulants, hallucinogens, heroin, inhalants or sedatives. After marijuana, pain pills are the drug of choice for America's teenagers and young adults.

How modern painkillers came to be abused is a story of good intentions gone awry. The painkilling action of the opium poppy has been known for thousands of years. Misuse of painkillers also has a long history. A century ago, mothers routinely rubbed tincture of opium on the gums of teething babies to soothe the pain, then took a nip for themselves.

If the medicine was not locked up, other family members often helped themselves. Indeed, the problem got so bad that makers of paregoric, the most popular liquid opiate, added camphor to their formulations to set off a gag reflex.

In recent decades, doctors stopped prescribing opiates because 5 to 10 percent of people who took them became addicted.

Fear of addiction led to the undertreatment of pain and to untold suffering, said Dr. Russ Portenoy, chairman of the department of pain medicine and palliative care at Beth Israel Medical Center in New York.

The 50 million Americans with chronic pain needed help. It arrived five or six years ago when pharmaceutical companies put very large doses of opiates into slow-release formulations. A person who swallows such a pill feels no euphoria but is relieved of pain for up to 24 hours.

The new painkillers were heavily marketed to primary care physicians, Dr. Portenoy said. It was thought that the drugs would not be abused because addicts would not be tempted by sustained release painkillers.

Unfortunately, addicts quickly found that they could grind the pills, swallow or snort the powder and get a high dose of opiates delivered directly into their bloodstreams. They also liked the fact that the drugs were pure and the exact dosage was known.

To counter abuse, drug makers are developing ways to reformulate prescription painkillers. Purdue Pharma in Stamford, Conn., which makes OxyContin, is thinking of adding a second drug, called an opiate antagonist, that neutralizes the effects of the opiate.

The antagonist would be walled off using polymers or some other sequestering technique, said Dr. David Haddox, the company's vice president of health policy.

A patient who swallowed the drug would get full pain relief, as intended. But if someone tampered with the pills, the antagonist would be released.

Then, Dr. Haddox said, one of two things would happen: "If you are a recreational drug user, you feel nothing. The effect is canceled out.

"Why abuse something that has the same effects as a glass of water?"

"But if you are physically dependent," he continued, "you get no euphoria and it might cause withdrawal. You'd get a double whammy."

A second approach is to mix in a chemical irritant like capsaicin, the main ingredient of hot chili peppers, said Dr. Woolf, who has a patent on the idea.

Because the esophagus and stomach do not have many receptors for hot peppers, patients could take the pills as prescribed and find relief, he said. But the lining of the nose and cheeks are loaded with pepper receptors, and anyone who ground up such a pill would get a burning feeling in the chest, face, rectum and extremities, as well as paroxysmal coughing.

Reformulations are a promising avenue, but there are risks.

"We want to make sure that a patient who has need of an opioid does not suffer side effects from a second drug for which he or she has no need," Dr. Haddox said.

"We need to make sure the antagonist doesn't leak," he added.

Approaching the problem from another direction, drug companies and the federal authorities are trying to educate doctors and crack down on doctors who, for whatever reason, dispense painkillers inappropriately.

The Food and Drug Administration, Dr. Portenoy said, is going after doctors who are "duped, dishonest, disabled or dated."

For example, the agency is relabeling prescription painkillers to warn primary physicians of the risks involved. Some doctors, he said, are using the new drugs for broken fingers rather than devastating chronic pain.

New labels are also being introduced to tell doctors how to recognize patients who may be prone to abuse — those with a personal or family history of alcohol or prior drug abuse or mental health problems like bipolar disease, for example — and if the doctor is suspicious, how to monitor those patients with urine tests or other methods.

Some patients go doctor shopping, obtaining prescriptions from a dozen or more family physicians. Others tamper with prescriptions. To address this, drug manufacturers are providing doctors with tamperproof prescription pads that make forgeries difficult. When a prescription is photocopied, the copies say "void."

Doctors are also being taught how to write prescriptions more carefully. Instead of writing 14 pills, which a patient could alter to 140, the doctor writes out the word fourteen. Doctors are also being urged to lock up their prescription pads in the same way they would personal checks.

The Drug Enforcement Administration registers all people who handle opiates, inspects the documentation of opiate distribution, controls imports and exports and oversees the amount of the drugs produced, bought, sold or otherwise transferred. Yet, despite these controls, large amounts of prescription painkillers are being stolen once the drugs move into the hands of pharmacies, doctors and patients. Armed robberies, night break-ins and employee thefts are common.

In the face of so much criminal activity, the drug agency is stepping up efforts to prosecute dishonest pharmacists and doctors who sell opiates for personal profit and to use computer search programs and other means to close down so-called pill mills on the Internet. Electronic prescription monitoring systems are being enlisted. If the same prescription goes to 15 pharmacies, the computer system will sound an alarm.

Still, drug addicts will continue to find ways to foil the efforts to foil them.

People who came to like paregoric learned to boil the liquid, which removed all traces of camphor. The dregs were pure tincture of opium.

Source: New York Times (NY)
Author: Sandra Blakeslee
Published: April 20, 2004
Copyright: 2004 The New York Times Co.
Contact: letters@nytimes.com
Website: http://www.nytimes.com/

Related Articles:

Drug-Fighters Turn To Prescription Abuse

Bush Expands War on Drugs

Anti-Drug Strategy To Include Pain Killers



  • I left out screen names of those who posted.

    Comment #6 posted April 25, 2004 at 09:31:44 PT
    Who Do You Trust...
    now that the pharmaceutical companies are adding poison to their drugs, and the medical cannabis gardeners and providers are growing organic herb?
    Disband the FDA (agribusiness and pharmaceutical shills). MFA for 2004!

    [ Post Comment ]

    Comment #5 posted on April 20, 2004 at 09:18:14 PT
    Put new side effects in everything
    Cause if it has no aparent ill effects it must be made by Satan.
    This pretty much sums up the entire philosiphy of the modern day prohibitionist. Alcohol has a host of problems but most of all the hangover, Cigarrets have bad breath cancer and lots of other nasties. Pot=almost none, provided you take a breathmint afterward opiods=no aparent ill effects provided that the "drugs were pure and the exact dosage was known".

    I pose a question, Why is addiction to a substance that does almost no damage to a person physically so bad? Aside from not going anywhere without it (like grandmas heart pills) I have many friends who cant go to sleep without 3-6 beers in their belly. Whats the difference?

    [ Post Comment ]

    Comment #4 posted on April 20, 2004 at 05:25:37 PT:

    Sad but true....................
    ALL ill-side effects are acceptable to the anti's. Diarreah, nausea, rash, thoughts of suicide, etc. etc. etc.......All acceptable until a euphoric feeling is experienced. Then, it is condemned. period.

    [ Post Comment ]

    Comment #3 posted on April 19, 2004 at 21:53:49 PT
    Sheesh, what about the Hippocratic oath?
    Whatever happened to "do no harm"? Putting an agonist in with an opiod to cause withdrawals can be hazardous to the addicts very life. For actual "Medical Professionals" to advocate causing pain and suffering, even in abusers of drugs, is horrendous. Maybe the Medical Boards should be investigating these guys instead of MMJ prescribers?

    [ Post Comment ]

    Comment #2 posted on April 19, 2004 at 17:29:46 PT
    The control freaks are out of control
    OCD, the national disease.

    Comment #1 April 19, posted 2004 at 17:10:26 PT
    That's the problem we might enjoy something and that's not a good thing. I remember being told that medicine that will help a person often makes a person feel sick and that's how you can tell it's working or something close to that. It's just too much!

  • Some ppl are really defending it and it is hard to really tell..for what reasons...? I don't know I just saw this and thought I'd break the monotony and give someone a little fun food for thought...no harm here, right? I'm off to bed..you all have a good night and g-day tomorrow..

    I saw an act of faith today. A man was on his knees, not in a pew in a Church, but in a garden
    planting seeds. ~~Unknown
  • I just wanted to reiterate on this to let the above poster know that I wasn't posting this to sound political and I certainly DON'T believe in the BS at all. I think she may have thought that since I noted that I had gone off pain meds in 2004..that maybe I was trying to get an affect from someone on here..But most of you who have posted with me know that's not the case. I just was trying to ask a question since I really didn't know whether this had been done to Oxycontin since I had not taken it since 2004. I have been on Fentanyl and Morphine Sulphate ER, tramadol, and Gabapentin this round of Pain mgmt. I posted privately to the poster and tried to explain and apologized for any misunderstanding.
  • Thats about all I can say. Some of those people made good points. I am currently taking Kadian, extended release morphine. No "euphoric" sensation whatsoever. Just a long list of nasty side affects, that are quite unbearable. I told my friends about this new med, which is actually working wonders. They all freaked out about me taking morphine... but if they drink a bottle of wine, or a 12 pack of beer a day... theres no problem in that.

    I'm not really sure what to think about this topic. I've been told that while there is no "euphoric" sensation, I may still become dependent on the med, and risk withdrawal when coming off of it.

    So I'm thinking the only thing this will do, is prevent the theft and sale of these particular drugs... until addicts find a way around it, which they always do.

  • This is getting to be ridiculous, no matter what they do the addict wins and the CP patient pays in the end.


    Sorry for the misunderstanding-I meant that my reply would veer off into a political nature.Which I wanted to avoid doing.
  • It absolutely makes me so sick how a minority of people can have such a devastating impact on chronic pain sufferers. :jawdrop:
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