| |
Mr.
Chairman:
On behalf
of Purdue Pharma L.P., the distributor of OxyContin® tablets, thank
you for taking the time to hold this hearing.
We are more distressed than anyone that this drug, which is providing so
much relief to so many people, is being abused. The availability of OxyContin® is critical for
countless patients who are suffering from moderate to severe pain where a
continuous around-the-clock analgesic is needed for an extended period of time.
Unfortunately for those patients, concern generated by the abuse of
OxyContin® has mushroomed to the point of hysteria in some
locations, with the result that some patients are asking their doctors to switch
them to less effective drugs, some doctors are refusing to renew patients’
prescriptions for OxyContin® and some pharmacies are no longer
willing to carry OxyContin® for their patients.
Purdue receives alarming reports every day from such physicians and
patients. This hearing is important and timely.
Today’s testimony bears on a significant question of health
policy: how to address the
problems of abuse and diversion which accompany the sale of a controlled
drug like OxyContin®
without restricting its availability to meet the needs of doctors
and patients for the effective management of pain? This question is neither new nor unique to OxyContin®.
It has existed as long as opioid analgesics have been available.
It is a critical question, and we are confident that Purdue has devoted
more resources and efforts than has any pharmaceutical company in attempting
to answer that question. Purdue
has provided, and continues to provide, extensive assistance to the medical and
law enforcement communities in preventing and policing abuse of OxyContin®.
While all of the voices in this debate are
important, we must be especially careful to listen to the patients who, without
drugs like OxyContin®, would be left untreated. Purdue frequently
hears stories of how OxyContin® has
enabled people to return to their families and to productive lives after
suffering disabling pain. We urge
you to hear directly from some of these patients at future hearings.
They are not addicts. They
are not criminals. They are people
who, because of cancer, sickle cell anemia, severe back injuries, or some other
physical insult, have had their lives taken away from them by unrelenting pain.
Amidst all the publicity and controversy, a few
facts stand out.
-
First,
the problem of chronic pain in this country is enormous and expensive.
According to organizations like the American Pain Foundation, an
estimated 50 million Americans suffer from chronic pain, with a cost
approximating $100 billion a year attributable to lost workdays, excessive
or unnecessary hospitalizations, unnecessary surgical procedures,
inappropriate medication and patient-incurred expenses from self-treatment.
-
Second,
chronic pain has been historically undertreated.
In this past decade, for the first time, public and medical opinion
has swung decisively in the other direction, based on the proven
effectiveness of opioid therapy in treating pain and the startling
improvement in quality of life such therapy can offer to patients.
-
In
1994, the Department of Health and Human Services issued new guidelines
encouraging the use of opioids in the treatment of cancer pain.
-
In
February of 1999, the Veterans Administration added pain as a fifth vital
sign (along with pulse, temperature, respiration, and blood pressure) that
should be checked regularly as major indicators of health.
“VA
officials said the change in routine is designed to call physicians’ attention
to what is widely considered one of the most unrecognized and untreated symptoms
in American health care. In a study
of 10,000 dying patients published in 1995 in the Journal of the American
Medical Association, for instance, researchers found that almost half died in
severe pain; other studies report that as many as three-quarters of advanced
cancer patients are in pain.”
Washington
Post, February 1, 1999
Many other healthcare professionals and
organizations have adopted this practice of
checking pain as a fifth vital sign.
-
On
October 28, 2000, Public Law 106-386 was enacted declaring the decade
commencing on January 1, 2001 to be the “Decade of Pain Control and
Research.” Bills currently
pending in both the House and Senate (The Conquering Pain Act of 2001, S.
1024 and H.R. 2156) recognize that “chronic pain is a chronic health
problem affecting at least 50,000,000 Americans,” and seek long-lasting
changes that would enable all Americans to effectively manage medical
conditions associated with chronic pain.
-
Third,
OxyContin® is widely recognized as a highly effective treatment
for pain. Its twelve-hour
controlled-release mechanism affords an extended dose of pain medication,
allowing patients to sleep through the night and to avoid sharp spikes in
blood levels of the medicine that can cause side effects.
Even the most vocal critics of opioid therapy concede the value of
OxyContin® in the legitimate treatment of pain.
And many patients tell their doctors and Purdue that OxyContin®
has given them back their lives. Purdue
is furnishing for the Record several documents that it has received from
patients and their families describing the importance of OxyContin®
in managing their pain, along with a paper prepared by Pinney Associates,
Inc. that describes OxyContin’s® importance to public health.
Purdue shares this Committee’s commitment to
fighting abuse and diversion of controlled medicines.
Abuse and diversion harm patients with pain. They harm the abusers.
They harm the cause of pain management, and they harm Purdue and its
products. Importantly, abuse and
diversion threaten sound health policy, whose course should be driven by the
health needs of millions of patients, not the crimes of diverters.
1.
The Company: Purdue
Pharma.
Purdue Pharma is a privately held
pharmaceutical company, founded by physicians.
Purdue’s headquarters are in Stamford, Connecticut.
OxyContin® is manufactured at facilities in Totowa, New
Jersey and Wilson, North Carolina.
Family ownership of Purdue and its associated
companies began with the purchase of The Purdue Frederick Company in 1952.
In those early days, Purdue’s main products were Betadine®
antiseptics and Senokot®
laxatives. Since the early 1980s,
Purdue has focused its research and development efforts primarily on medications
for pain management. One of the most significant advances introduced by Purdue is
the use of controlled-release opioid analgesics for the treatment of moderate to
severe pain. Controlled-release
opioid analgesics, pain medicines which last for 12 hours or more, enable
patients to sleep through the night and reduce the cycles of dosing which
provide better control of pain than drugs that require dosing every 4 to 6
hours. Purdue introduced MS-Contin®
tablets, a controlled-release form of morphine, in 1984, and a
controlled-release oxycodone product, OxyContin® tablets, in January
1996.
Since 1984, Purdue has worked diligently to
inform doctors and other healthcare professionals about appropriate use of
opioid based medicines. This has
required a significant investment, as medical schools have traditionally spent
little time teaching doctors how to assess and treat pain or how to use our best
medicines for moderate to severe pain. For
example, when Purdue started selling opioid analgesics in 1984, many doctors
were not aware that morphine could be given orally as a treatment for pain.
Today, administration of oral controlled-release morphine is considered
standard practice for the treatment of cancer pain.
Purdue
has extensively studied the use of these drugs in the treatment of moderate to
severe pain associated with various non-malignant diseases.
Often, this type of pain will only respond adequately to opioid
analgesics. Without opioid therapy,
many of these patients suffer and are disabled.
Purdue’s clinical research has provided valuable experience and data to
guide physicians in properly using these medicines; for example, on determining
the proper dose and dealing with side effects.
2.
The Product: OxyContin®
Tablets.
No legal drug in the United States is more
rigorously regulated than OxyContin®.
It is a Schedule II drug under the federal Controlled Substances Act .
OxyContin® is monitored by state and federal health officials
in its production, marketing, and distribution.
Both the FDA and DEA oversee OxyContin®.
The sole active ingredient in OxyContin®
is oxycodone, a synthetic opioid (narcotic) first developed in 1916.
Oxycodone has been sold in various forms in the United States for over 60
years. Percodan®,
Percocet®, and Tylox® are examples of oxycodone
products. Typically, but not
always, these forms of oxycodone have been combined with a co-analgesic agent
such as aspirin or acetaminophen, and they are
referred to as “combination analgesic products”.
In large doses those
non-opioid analgesics may be toxic to the liver, stomach and kidneys. Therefore, drugs containing either aspirin or acetaminophen are limited in
their usefulness because a patient can only take up to a set amount per day to
avoid aspirin or acetaminophen toxicity. Even
if a patient needs more pain relief, the maximum dose of a combination analgesic
cannot be exceeded. Purdue’s
contribution was to introduce oxycodone in a timed controlled-release form
without any other active ingredients that
could impose limits on the amount a patient could take in a day.
Because of the efficacy of this single entity, controlled-released
product,
doctors have found OxyContin® extremely effective in properly
managed programs of pain treatment. That
effectiveness -- not abuse and diversion -- led to the commercial success of the
product.
3.
Purdue’s Promotion and Marketing of OxyContin® Tablets.
Certain media reports have been critical of
Purdue’s promotion of OxyContin® tablets.
The criticisms have ranged from Purdue’s provision of pain management
training to doctors to the individual promotion of OxyContin® by
Purdue’s sales representatives. These
reports are unfair to Purdue and squarely at odds with the facts.
Purdue's marketing efforts for OxyContin®
have been conservative by any standard. OxyContin®
tablets are not promoted to consumers. The
few advertisements that appear are solely in medical journals.
Purdue is scrupulous in training its field sales force to promote
OxyContin® only for its approved indications.
Purdue managers monitor its field force for compliance with these
policies. Sales representatives are
told that in the event of a
violation of our marketing policies, the offender will be subject to discipline,
up to and including termination.
Purdue does not believe that aggressive
marketing played any role whatsoever in the abuse and diversion of OxyContin®.
The physicians who were victims of “doctor-shopping” or prescription
fraud were hardly in this position because of our marketing. The physicians who
have been convicted of improperly prescribing OxyContin®
in exchange for cash or other inducements were hardly motivated to
do so by our marketing. And
robberies from patients with proper prescriptions were hardly encouraged by our
marketing. To the contrary, our
marketing has encouraged physicians to take actions that would reduce the abuse
and diversion of OxyContin®. Purdue
has asked physicians to carefully:
-
Prescribe
only the quantity of product that the physician deems is necessary based
upon a complete history and physical examination and careful assessment of
the patient’s pain,
-
Determine
that the nature and severity of the patient’s pain requires an opioid
analgesic for an extended duration,
-
Prescribe
a quantity of medicine based upon the dosage that the patient requires, and
-
Follow
up carefully with each and every patient on a regular basis.
(a)
Purdue’s training of its sales representatives.
Virtually all of Purdue’s field force is
recruited from within the pharmaceutical industry.
New sales representatives, despite their prior experience, are enrolled
in a 26 week training program, which includes three weeks of class room training
at the home office. Sales
representatives are given extensive training in the principles of proper
promotion of pharmaceutical products. They
are directed to promote only those uses of our products which are approved by
the FDA and to use only those promotional materials which are approved for use
after rigorous medical, regulatory and legal review.
During this training, representatives are told that our standard of
conduct is that during every sales call they should act as if they were
accompanied by an FDA inspector. Upon returning from their home office training,
new representatives are closely monitored by their managers who will spend time
in the field visiting doctors with them. In
addition, field trainers from the local area and the home office will often ride
with new representatives.
Moreover,
in July, 2001, Purdue established a telephone “hot line” to receive comments
from any physician who believes a Purdue sales representative has in any way
promoted our products in an inappropriate manner.
Purdue knows of no other pharmaceutical company that has gone to such
lengths to insure that on a day-to-day basis its sales representatives comply
with the high standards that are established during their training.
The results have been reassuring; rather than being critical, the vast
majority of calls to the hot line have complimented the professionalism of our
sales representatives.
(b)
Physician Education.
There is widespread consensus that medical
practitioners, in the course of their medical education, have received limited
and often inadequate training in the management of chronic pain.
Physician education has always been a principal feature of Purdue’s
marketing and medical education efforts. As
early as 1984 we saw that physicians wanted and needed more information about
how to assess pain in their patients, how
to determine the right dose of pain medicine, how to treat side effects, and
more recently, how to deal with the risks of abuse and diversion.
At the outset we realized that this task called for a highly professional
and highly trained field force supported by an extensive medical education
effort.
Purdue sponsors extensive training for the
medical professional community. Specifically,
Purdue sponsors local lectures at hospitals and other institutions as part of
Purdue’s lecture programs. These lectures are typically attended by 40 or 50
physicians or other healthcare professionals and deal with topics of interest to
physicians such as pain assessment, dosing, abuse and diversion, managing pain
caused by different diseases, and side effects. The lectures are often given by experts and opinion leaders
in the field of pain treatment. They
are held locally and Purdue does not pay physicians attending these meetings for
their participation.
Purdue also sponsors symposia and lectures at
larger medical meetings that are hosted by others.
Purdue does not pay physicians attending these meetings for their
participation.
Until
a year ago, Purdue also sponsored programs
to train experienced doctors and other healthcare professionals to serve as
lecturers to instruct other health care professionals in pain management.
These are the only trips for which Purdue provided expenses for the
travel and accommodations of physicians. It
would have been impractical to provide such training individually to
participating doctors in their home cities rather than in one central location.
These meetings were intensive working sessions that focused on issues of pain
management, and also trained and evaluated the participants in effective
speaking and communication skills.
4.
What is the Nature of the Problem?
OxyContin® is an opioid analgesic
used to treat pain. Each tablet of
OxyContin® delivers to the patient over a period of twelve hours, a
controlled-release of oxycodone. Like
morphine, OxyContin® is a Schedule II drug with recognized abuse
potential. From inception, the
package insert and all promotional material for OxyContin® has
cautioned:
"TABLETS
ARE TO BE SWALLOWED WHOLE, AND ARE NOT TO BE BROKEN, CHEWED OR CRUSHED.
TAKING BROKEN, CHEWED OR CRUSHED OxyContin TABLETS COULD LEAD TO THE
RAPID RELEASE AND ABSORPTION OF A POTENTIALLY TOXIC DOSE OF OXYCODONE."
Since early in the year 2000 there have been a number of reports of OxyContin®
tablets being diverted and abused by drug abusers. The patterns of abuse involve crushing the tablets to obtain
immediately the full dose of oxycodone and then ingesting, snorting or injecting
the drug. In a number of cases,
there have been overdoses and deaths.
Virtually all of these reports involve people who are abusing the
medication, not patients with legitimate medical needs under the treatment of a
healthcare professional. Further,
the vast majority of those deaths involve the use of multiple medications - not
oxycodone alone.
5.
What is the Source of Diverted OxyContin® ?
According
to law enforcement experts, OxyContin® and other legitimate
prescription drugs find their way into illicit channels by means of prescription
fraud, "doctor shopping" or other methods of receiving inappropriate
prescriptions from a doctor, theft, diversion from Mexico, and Internet
pharmacies. You have seen stories
in your local newspapers describing some of these practices.
Unfortunately, Purdue recently had an incident
that we are aggressively addressing. Purdue
manufactures OxyContin tablets in two locations.
These factories operate under FDA guidelines for Good Manufacturing
Practices and are routinely inspected by the Food and Drug Administration and
the Drug Enforcement Administration. Despite
a 17 year history of manufacturing controlled substances without an incident of
theft, last month Purdue discovered
that two company employees had stolen OxyContin®
tablets from the production
line at its Totowa, New Jersey plant. Company officials immediately notified
local police and the DEA and terminated the employment of these individuals, who
were taken into custody by the police. Purdue
as well as the local police, DEA, and
FDA are conducting further investigations and Purdue is committed to full
cooperation with these law enforcement agencies.
All internal security procedures are being analyzed, and any weaknesses
will be addressed. At this point in
the investigations, we feel it would be inappropriate to comment further.
6.
How Widespread is the
Problem?
Both Purdue and law enforcement are trying to understand
the extent of this problem. Initially,
the abuse of OxyContin® tablets was concentrated in a few parts of a
few states, generally along the spine of Appalachia, where abuse of other
prescription drugs has long been a problem due to many factors, including
poverty and lack of opportunity. In
those areas the problem of the abuse of OxyContin® is serious.
The geographic scope is now broader.
Regrettably, widespread media attention may have contributed to this
wider geographic scope by calling to the attention of potential abusers in all
parts of the country that OxyContin® is a desirable drug of abuse,
along with providing detailed instructions on how to obtain the drug and how to
abuse it.
Nevertheless, it remains difficult to obtain
hard evidence on the extent of OxyContin® abuse.
For example, media accounts regularly attribute large numbers of overdose
deaths to OxyContin®, even though the only toxicological evidence is
that the decedent has oxycodone
in his/her blood. OxyContin®
is but one of many available products that contain oxycodone.
Indeed, OxyContin® tablets accounted for only 25% of the
prescriptions written for oxycodone products in this country in the year 2000.
Some toxicological screens of these decedents also detect the presence of
acetaminophen or aspirin, a signal that some other form of oxycodone may have
been ingested. In the vast majority
of these so called “OxyContin deaths”, toxicological screens reflect
ingestion of a “cocktail” of
legal and illegal drugs, and frequently alcohol as well, in the blood of the
decedent. In these cases, death is
usually attributed to the abuse of multiple drugs.
While even one death associated with the abuse
of OxyContin® is tragic, based on our preliminary analysis of the
data, it appears that the media has significantly misreported the problem.
This is most clearly shown by referring to the numbers of deaths the
press has attributed to the abuse of OxyContin® Tablets.
A few representative
examples follow:
-
The
press indicated that Blair County, Pennsylvania was an area of high
OxyContin® abuse and that a large number of people had died as a
result. However, the County
Coroner reported to us that there were 58 deaths in the county from January
1996 through December of 2000 and that none of them were attributed
to oxycodone alone. Of the 58
deaths, 50 involved multiple drugs. Oxycodone
(although not necessarily OxyContin®) was one of the drugs found
in only seven cases, and was not listed as the cause of death in any case.
-
The
press has reported and repeated over two hundred times that in Kentucky,
OxyContin® caused the deaths of 59 people.
Our contacts with the State Medical Examiner and local coroners
establish that a number of deaths resulted from combinations of illegal and
legal drugs, which occasionally included oxycodone, the active ingredient in
OxyContin®. Thus
far, these local authorities have not asserted that a single death was
attributable to the abuse of OxyContin® alone.
-
The
press reported 35 deaths from OxyContin® use in Maine.
Similar information from the Office of the Chief Medical Examiner
showed that there were two cases where abuse of OxyContin® was
the sole cause of death, one of these a suicide.
These statistics are provided not to minimize
the tragedy of even a single loss of life, but as examples of how the media
coverage has made it difficult to obtain an understanding of what is actually
occurring. We are gathering the
facts as noted from local medical examiners and coroners. In addition, according to the most recently available annual
data published by the US Government's Drug Abuse Warning Network (DAWN),
oxycodone in all forms, including OxyContin®, was mentioned in fewer
than 1% of all prescription drug-related Emergency Room visits in which abuse
was suspected. This compares with
8.7% for marijuana, 1.7% for hydrocodone (another opioid analgesic), and 3% for
acetaminophen.
7.
Could Purdue have foreseen the problem?
In some 17 years of marketing MS-Contin®
Tablets, a controlled-release form of morphine -- a powerful opioid analgesic
related to oxycodone -- Purdue was aware of no unusual experience of abuse or
diversion. Purdue had no reason to
expect otherwise with OxyContin.® As
late as January of 2000, US Attorneys Jay McCloskey of Maine and Joe Famularo of
Kentucky were advised by the DEA that abuse of OxyContin® did not
appear to be a national problem. It
was early in April of 2000 that Purdue was first alerted to reports of abuse and
diversion of OxyContin® by accounts in Maine newspapers claiming
that OxyContin® was the subject of recreational use in Maine.
Purdue immediately implemented a response team that included some of the
Company’s top executives and scientists, including those who are here today.
That team has committed Purdue to an unprecedented program to combat
abuse and diversion.
8.
What is Purdue doing about this situation?
A long term solution to the problem of
prescription drug abuse includes the development of medicines that are
inherently resistant to such abuse. Purdue
actually has been working to develop such opioid medicines since 1996, but had
originally targeted oral abuse, not injection.
In 1997, Purdue met with representatives of the DEA, NIDA, and FDA to
discuss this subject and seek information and advice.
At that meeting, Purdue presented a plan to develop a medicine containing
hydrocodone and an agent to prevent abuse by injection.
Purdue was told, however, that the principal method of abuse of
hydrocodone was by mouth, and not injection.
As a result of this advice, Purdue launched an effort to develop
medicines that would be resistant to oral abuse.
This was and is a formidable undertaking as there was no existing proven
technology to achieve this goal. As
a result of this effort, Purdue developed several technologies that should
enable us to achieve the goal of having an opioid medicine that is resistant to
abuse by the oral route as well as by injection.
This was recently announced in the press.
The majority of law enforcement officials who
have commented have lauded Purdue's initiatives described below. The Attorney General of Virginia said that as soon as Purdue
learned of the problem, "it jumped in with both feet" to solve it.
The Attorney General of Maryland praised Purdue's efforts and proposals
and expressed concern that adverse publicity might make it more difficult for
patients in need to obtain the product. Several
United States Attorneys have complimented Purdue for its cooperation and have
requested that Purdue bring its anti-abuse and diversion programs to their
region. In several cases the United
States Attorney or his assistant has actually appeared on such programs.
Purdue's
efforts to solve the problem have included the following:
-
Purdue
approached and worked with FDA on labeling changes to emphasize the abuse
potential of OxyContin®. Those
changes were effected on July 18, 2001.
FDA has called for other drug companies to follow Purdue’s lead in
making such changes.
-
To
reduce the incidence of diversion caused by physician prescribing errors or
“scams”, Purdue has supported continuing medical education programs of
the highest quality in the areas of abuse and diversion.
These are non-promotional programs which teach doctors how to avoid
being "scammed" by abusers, how to properly assess and treat
patients with real pain and how to prevent diversion.
-
To
encourage physicians and pharmacists to take measures to prevent abuse and
diversion, Purdue has communicated extensively on this subject with
healthcare professionals. Abuse
and diversion brochures, developed in cooperation with law enforcement
authorities, have been distributed to over 500,000 doctors and pharmacists.
These brochures have been praised by law enforcement and welcomed by
healthcare providers.
-
To
encourage physicians to properly assess pain and monitor the use of these
drugs in patients with pain, and avoid inappropriate prescribing or being
misled by diverters, Purdue has distributed "opioid documentation
kits" for years.
-
To
reduce the fraud that is generated by diverters altering or copying
prescriptions, in 16 states, Purdue has provided at no cost to physicians,
prescription pads utilizing special technologies that make such alteration
and copying extremely difficult. 4667
physicians had ordered these pads as of August 17, 2001.
-
To
stop diversion that results from doctor shopping, Purdue has supported the
implementation of Prescription Monitoring programs and federal government
incentives to states to encourage them to implement such programs to a
federal standard that insures accurate gathering of data, together with
limited access to the databases only by authorized law enforcement officials
and health care professional. We understand that these programs, which would
provide physicians and pharmacists with a resource they could utilize to
check up on questionable patients, have been highly useful to physicians and
law enforcement authorities in those states where they have been implemented
to a high standard.
-
Purdue
has taken strong measures to prevent diversion of its product from Mexico.
We believe that these steps are unprecedented in the pharmaceutical
industry. Purdue has stopped
shipping the 40 mg strength to Mexico and changed the markings on the 20 mg
and 10 mg tablets sold in Mexico, so that law enforcement will be in a
position to identify tablets that are brought in from Mexico.
In addition, Purdue has made arrangements so that OxyContin® sold in
Mexico will have limited distribution only through pharmacies that handle
the most restricted category of opioid analgesics available in Mexico.
-
To
better our understanding of the problem, and to participate in solutions,
some of the most senior executives from Purdue have traveled to states where
abuse and diversion have been reported to hold briefing meetings with law
enforcement officials, including U.S. Attorneys and Attorneys General.
We have also met with the DEA, FDA and NIDA.
-
Due
to a paucity of reliable data on the nature and extent of the problem of
prescription drug abuse, Purdue has been working with government and
independently to develop hard data. Purdue has assembled a team of experts to guide us in the
development of a system that will enable us to monitor abuse and diversion
and allow constructive intervention, when possible.
-
As
discussed above, Purdue is spending tens of millions of dollars to research
and develop new forms of strong pain relievers which would be resistant to
abuse while at the same time provide safe and effective pain relief to
legitimate patients. We are
working with the FDA to accelerate the availability of these drugs.
9.
Is Restricting the Use of
OxyContin® the Solution?
Some have suggested that restricting
availability of OxyContin® will help alleviate the problem.
We are convinced this is not so. Those
intimately involved with the problem agree.
Local law enforcement officers have told us that in most of the reported
cases of overdose and death, OxyContin® was neither the first nor
the sole drug abused. Knowledgeable
law enforcement officers have said that if OxyContin® were not
available, those abusing and diverting drugs would not stop their practices, but
would simply transfer to other legal and illegal drugs.
We are advised by law enforcement that in at least one area where
effective measures have reduced the availability of OxyContin®,
abusers and diverters have in fact returned to their prior drugs of abuse. The only real impact of restricting the availability of
OxyContin® tablets would
be to make it more difficult for the patients who benefit from this drug to
obtain it.
10.
What is the Solution?
Solving
the problem of drug abuse requires the cooperation of many elements in our
community: law enforcement, the
schools, religious institutions, parents and family, the courts, the medical
community, the press, federal and state legislators, government agencies, social
services providers, and the pharmaceutical industry.
Purdue is trying to help through our specific programs and our
cooperation with the other elements in the community.
Prescription Monitoring Programs can reduce doctor shopping and diversion
from medical practices. Tamper
resistant prescriptions can reduce copying or alteration.
Education of responsible doctors can arm them with the tools they need to
stop diversion from their practices. A
better information system can allow us to know where abuse and diversion is
cropping up and allow medical education and law enforcement to act earlier to
“nip these problems in the bud.” Development
of abuse resistant products can reduce the incidence of abuse.
What is needed is cooperation and common purpose.
This is a long-standing societal problem that requires a reasoned
solution.
11.
Conclusion.
The management of chronic pain is a critical
priority of healthcare in this country. Chronic
pain affects as many as 50 million Americans and costs the country $100 billion
annually. OxyContin®
has proven itself an effective weapon in the fight against pain, returning many
patients to their families, to their work, and to their ability to enjoy life.
That advance should not be stunted or reversed because of the illegal
activities of those who divert and abuse the drug.
The answer to these problems is increased education, information and
enforcement, not restrictions that will deny patients effective treatment of
their pain.
|
|
