Posted on 04/23/2004 4:22:42 PM PDT by neverdem
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.
They can harm kidney function. It doesn't happen to everyone. It also depends on the dose and duration. Many people with auto-immune diseases like rheumatoid arthritis have to take non-steroidal anti-inflammatory drugs(NSAIDS) on a chronic basis. Aspirin was the first in this class of drugs. Vioxx, Celebrex and Bextra are the latest generation of NSAIDs. This latest class was designed to minimize the chance of having major internal bleeding from gastro-intestinal ulcers, but they still happen. That's why people need to visit their docs regularly if they take medicine on a chronic basis.
Such as taking too much of it can depress breathing, dangerously especially if you drink alcohol with it.
One time I took a couple when I was drinking beer and I noticed my breathing kept slowing down and stopping intermittantly. I keep having to tell myself to breath. It was freaky.
All drugs have their risks and people need to know what they are. If you want to stay alive.
When people are in genuine pain, whether from trauma or chronic illness, they can have their pain relieved and maintain all their mental faculties if their docs are careful not to give too much. Do you need professional citations?
Pardon my spelling and grammer, Here in Colorado our power was out for 10 hours do to heavy snow and broken power lines. I'm depending a lot on my UPS at the moment.
When "a 20 year admitted pothead" is posting challenges to your posts which you are either unable or unwilling to respond to... anything's fair I guess...including ignoring me.
Just don't think it will stop me from commenting on your posts.
I must take exception to this statement. I've suffered from chronic pain since 11/94 and have been on numerous anti-depressants (paxil, serzone, elavile and deseril at different times) as well as pain medication and muscle relaxers. Anti-depressants are a recognized treatment(along with pain meds) for chronic pain. Being in chronic pain 24/7/365 can depress one to the point of suicide and so anti-depressants are routinely prescribed in addition to pain medication.
After being on pain meds for as long as I've been, I experience only a very short 'high'. For me it's an 'immediate' notice the medication has kicked in. As an example, back when I used to have garden variety headaches, it would take me awhile before I realized the aspirin were starting to work. That high is a short-lived trigger letting me know the paid meds are about to kick in.
For the most part, I agree with your post.
Not all medical treatment is limited to a cure or simple resumption of normal life.
Some/many conditions are not curable. Many treatments have NOTHING to do with resuming "normal life" but with making a person more comfortable in what is ANYTHING BUT normal life.
Including the week or two after an operation where a person is not expected nor recommended to resume normal life.
We apparently have a serious moral discord here. That's fine. But, I know you're tainted by your past.
It's really sad that when you can't respond to what I post on the issue you have to make personal attacks.
Am I really tainted by my past? Because I smoked pot?
How about my past accomplishments? Such as graduating first in my college class with a perfect 4.0 GPA? How many people do you know who've achieved that?
AND guess what? I smoked pot all through college.
You should stick to the issues we are discussing instead of resorting to personal attacks.
Where have I ever attacked you over anything you've done in your personal life?
NO Doctor would prescribe antidepressants in combination with pain killers. That would be stupid.
Opiate analgesics and antidepressants are frequently given to chronic pain patients, especially terminal patients that are expected to live for more than a little while. They work by completely different mechanisms.
Are the pain meds you've been on opiates? I've had anti-depressants as well (since I have a teminal disease) such a Welbutrin but they were stimulants.
Quite the opposite effect of opiate pain killers.
The fact is using opiates such as herion and speed together are considered deadly.
Chris Farley died of such a combination. Being in chronic pain 24/7/365 can depress one to the point of suicide and so anti-depressants are routinely prescribed in addition to pain medication.
"chronic pain 24/7/365" is NOT the usual situation for administering pain meds.
My bet is you are not on the usual opiate type pain killers such as vicodin, oxycodone etc. Otherwise the typical antidepressants would be very dangerous.
After being on pain meds for as long as I've been, I experience only a very short 'high'. For me it's an 'immediate' notice the medication has kicked in.
This sounds typical for tolerance of pain meds. The "high" feels like "normal" EXCEPT during the period the meds kick in to reduce the pain.
This is what happens when you have to take pain meds for long period of time.
I'm very sorry to hear about what you are going through.
I pray that you will be able to keep the faith and know this is all temporary...God has better things in store for you.
Jorge wrote: I don't see what's wrong with a person who's had some traumatic injury that's scared the crap out of them and put them in a state of mental trauma as well, not only to get the effects of relief from the physical pain but also the psycholical relief of the "high" to help them switch to a "everything's going to be alright" state of mind.
Monty22 replied: For emotional trauma, they can get treatment tuned for it, such as antidepressants that are effective.
Jorge was referring to an acute traumatic situation needing acute relief. How long does it take antidepressants to begin working?
My doctors have told me that this is generally true. During one of the bouts with a pulmonary embolism, the doctor pointed out that eventually, I would find the painkiller would make me feel worse, not better; that would be the last one. He was correct.
I think that there are cases of physical withdrawal symptoms that need some detoxification.
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