Oxycontin to be pulled from the market in 2012

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M. Spector M. Spector's picture

Is heroin better than methadone?

Sineed

M. Spector wrote:

Is heroin better than methadone?

You mean as treatment? There are some data saying heroin is better for patients who have failed methadone. But I'd be hesitant to give heroin to Oxycontin addicts, especially those who have never injected drugs. Some people injected Oxycontin, but many chewed or inhaled it like "chasing the dragon."

It has been my observation that Oxycontin created addicts where there were none before. Early days, but maybe now that it's gone, some people may be able to stop using altogether.

M. Spector M. Spector's picture

Sineed wrote:

I've got the fewest number of patients on methadone since 1999. Talking to a methadone patient today, he said, some people are going to heroin or other opioids, but "They aren't the same as Oxycontin. So people are kicking."

This sounds to me as if oxycontin addicts are switching to heroin, instead of going on methadone, and thus "kicking" the oxycontin addiction.

I don't understand the basis for your expression of (cautious) optimism, unless you see heroin as preferable to methadone treatment.

Hence my question.

kropotkin1951

It has been my experience with drugs that some drugs grab some people but not the same drugs for all people.  So one might be able to drink without being addicted, do coke recreationally or smoke pot occasionally.  Others can and do get addicted to the same things.  Oxycontin addicted people who were not into the street culture so kicking the drug is not a major lifestyle change.  The problem is those people all had real pain before they went on Oxycontin so what can they take now for the pain that is not addictive to some.

Sineed

M. Spector wrote:
This sounds to me as if oxycontin addicts are switching to heroin, instead of going on methadone, and thus "kicking" the oxycontin addiction.

I don't understand the basis for your expression of (cautious) optimism, unless you see heroin as preferable to methadone treatment.

Hence my question.

And a reasonable question it is - we all presumed that the withdrawal of Oxycontin meant that Oxycontin addicts would either switch to another drug, such as heroin, or seek treatment, resulting in a rise in demand for methadone maintenance. But instead I've seen the opposite: a drop in the number of people on methadone.

Generally, the number of people on methadone reflects the number of addicts there are, as a certain percentage will seek treatment. Fewer methadone patients implies fewer addicts.

Kropotkin1951 wrote:

Oxycontin addicted people who were not into the street culture so kicking the drug is not a major lifestyle change.  The problem is those people all had real pain before they went on Oxycontin so what can they take now for the pain that is not addictive to some.

This.

Though like I said, it's early days.

M. Spector M. Spector's picture

Sineed wrote:

Generally, the number of people on methadone reflects the number of addicts there are, as a certain percentage will seek treatment. Fewer methadone patients implies fewer addicts.

I still don't get it. What happened to the addicts? If there are fewer addicts, and also fewer methadone patients, where did the addicts go? Did they die? Or did they kick the addiction without methadone treatment? 

If the rules of the game suddenly change, as they have now, couldn't the "percentage" of addicts seeking methadone treatment change as well? For example, if oxycontin addicts are switching to heroin and other opioids rather than seeking methadone treatment, doesn't that imply that more, rather than fewer, people are choosing to remain addicts instead of seeking methadone treatments?

 

MegB

There are some fairly effective non-narcotic non-addictive pain meds out there that, in my opinion, don't get prescribed enough.  For those of us who can't take NSAIDs (non-steroid anti-inflamatory drugs) there are combinations of acetaminophen and narcotics that, while effective, do have addictive qualities.  Percocet, for example.  For serious pain, like post-surgical pain above 6 on the 1-10 pain scale, there's morphine.  Neither is ideal. 

Morphine, while more judiciously administered now, is awful on withdrawal.  You haven't had nightmares until you've been subjected to morphine withdrawal nightmares.  Percocet is effective, but the initial euphoria is enough to hook people for life.  There's nothing like the cessation of severe pain, combined with the "everything is lovely and I don't give a shit" feeling to haul the least addictive personality into a hell of substance abuse.

Clearly, there must be better ways to control pain -- chronic or acute -- that don't involve opiates or other addictive substances.  The question is, what do pharmaceutical companies have to gain by marketing those? How much of their R&D will be recovered if they produce pain meds that don't addict people? What's the profit margin?

M. Spector M. Spector's picture

Rebecca West wrote:

The question is, what do pharmaceutical companies have to gain by marketing those? How much of their R&D will be recovered if they produce pain meds that don't addict people? What's the profit margin?

And the answer is, that's why we need a nationalized pharmaceutical industry in Canada - one that doesn't need to make a profit in order to provide the safe and effective medications that we need.

Sineed

As of a month ago, there was still a lot of Oxycontin on the streets of Toronto, according to my patients. But there has been this development in Alberta. This article is from a pharmacy journal behind a subscription firewall, so I'll just quote the pertinent section:

Quote:
Pharmacy robberies decline in Edmonton, according to police

Pharmacy robberies have significantly declined in Edmonton and this decline has coincided with the phasing out of Oxycontin, according to Edmonton’s Police Service. Oxycontin was phased out from March 1 2012; it was replaced with OxyNEO.

Less theft means less demand. I still don't know if heroin has picked up the slack, however.

Here's an excerpt from a pharmacist's comment on the site:

Quote:

Wow…..

When I think of how many times as a profession, we begged regulators and the manufacturer of OxyContin to modify or replace the formulation of this product only to be told that it was just a coincidence that all the drug users had an insatiable appetite for this particular product

...

why there aren’t some pharma execs in jail right now over this is beyond me ….

 

 

Nola-chick

I just had to give my opinion on this topic for a few reasons. 1. Why should a generic OxyContin be available along with the Oxy-Neo, btw, the first time I've heard the Neo added, I am a chronic pain sufferer. I have been for 15 years. I am not a candidate for surgery currently; however, I'm aware of new procedures being tested to assist with my problems and relieve my pain. I was never aware of how addicting opiode meds were until about six years ago. When the pain first began I took Tylenol or Aleeve; Motrin for swelling. The pain eventually got worse and I was prescribed Vicoden, then Lorcet. However, after being on these meds for a number of years my dr was concerned about the Tylenol in the meds and damage to my liver. I was placed on Roxicodone, which is Oxy immediate release. After a terrible accident, my pain tripled. To give u an idea, I cannot walk my dogs, because I can't walk farther than 2 blocks, while I can walk 2 blocks, I cannot make the 2 block walk back. This was something I enjoyed daily. I cannot sit or stand for extended periods of time. To give u an idea of my pain tolerance- I have 3 daughters, after giving birth I was prescribed Percocet, instead I took Tylenol, including with my last daughter when forceps were tried and ultimately I had an emergency c-section. Why do I prefer the original version and look forward to a generic version; I have difficulties swallowing pills, and would crush them and mix them in a drink. Yes my dr was aware and knew I was not abusing or misusing the meds. I'm drug tested bi-monthly when I see my dr. I have to melt the new one in OJ or warm soda for hours and drink it, making it much less effective. 2. Since the new version, I have had to literally triple my intake of medication. While many do misuse and abuse this medication; 3. there are more CPPs who actually rely and need the medicine and do not misuse or abuse it, many who like me cannot swallow pills. Maybe if there were stricter laws for dispensing this medication; there wouldn't be so much abuse. I know people who used Oxy for recreational use/abuse. A few who have begged and offered anything for a pill; one person offered me $130 for one pill. We no longer speak. I'm not a dealer, do not misuse or abuse my medication; the last I heard he had turned to using heroine and is homeless-SUX for him. If I had known how addicting this drug was I cannot say I would have ever taken it. Though I don't ever run out of my medication; I had once a few months after 1st being prescribed. My dr at the time just vanished apparently. I finally found a legitimate specialist to see regularly, who accepts my insurance and has really helped me with the pain I have. Many don't realize without the medication I take, I wouldn't be able to have a normal life. I wouldn't be able to do anything but stay in bed. It takes me hours just to get comfortable to go to sleep and every few hours I must change positions. Unfortunately, I am addicted and have been for years; it took no more than two months of being on the medication as prescribed to get addicted. Did not know this? I see the class-action suit that someone posted, but not for the US, something I may look into. For the time being, OxyContin had been a miracle drug for me. It really has. As a CPP don't knock us all because of a few addicts. What not many realize is the new "Neo" version is not as effective as the original version-fact! More ODs have occurred because of this. I should add its pretty sad that Purdue has decided to begin testing Oxy on children ages 6-16 to test the effectiveness in kids because clinical trials have never been done on children. Only to get its patent extended for an extra 6 months. These kids will take the medication for 4 weeks. Guess what.. Those poor souls will have to suffer with withdrawal symptoms because of a greedy pharmaceutical company. I can go on and on about this topic; I would NEVER allow any of my kids to take any kind of pain medication. My oldest is 19; had her tonsils removed at 16 and I was told she would need to receive the pain medicine around the clock-every 4 hours whether she needed it or not until her pain subsided. That killed me to give her that but it was only for a week. She was in a bad car accident at 17. Concussion, staples in her head, other injuries..she was a passenger in her friend's Beamer, the friend decided to race, causing the car to flip multiple times into a canal. She saw a dr for 8 months afterwards and was not given any type of opiode pain medicine. My kids are aware of the dangers of even prescription medicines.

Sineed

Rampant drug abuse results in pain patients being treated like criminals just for seeking the care they need.

But drug abuse is rampant. Fixing whatever is so profoundly broken in our culture that results in all this drug abuse is 'way beyond the scope of any one fix.

kropotkin1951

Seems to me that "drug abuse" is a very loaded term.  Drug use is either an addiction problem and is thus causing harm to the addict or the people around them and needs to be treated as a medical problem or it is recreational and therefore no bodies business but the person imbibing. When you criminalize the use of drugs and use pejorative terms like drug abuse it inflames the problem.  The temperance movement displayed the same kind of intolerance about the demon rum.  We don't arrest people for having a beer after work or tell them they have an alcohol abuse problem unless they are addicts when we arrive at the same societal view of drugs it will be a good thing.

Sineed

Kropotkin wrote:
Seems to me that "drug abuse" is a very loaded term.

"Drug abuse" is the term used to describe drug use that is harmful in a medical sense. It's from the DSM-IV, though the medical literature is increasingly using the term, "Substance Use Disorders," and DSM-V is combining the categories of "Substance Abuse" and "Substance Dependence" into "Substance Use Disorder."

Here in North America we use more opioids than the rest of the world combined. That's total use, including harmful use, but unless you think the rest of the world is woefully undermedicated, we are much too overmedicated here. People with pain are being written prescriptions instead of getting the root causes of their pain treated. A person with back pain might get Percocet here, but in the Netherlands, they might get a massage, or recommendation for physiotherapy.

I have worked in addiction treatment for quite a while, and it's a huge problem. We live in a quick-fix society where people like to pop pills and drug abuse/addiction is the consequence.

kropotkin1951

The DSM in every version has used pejorative terminology.  From homosexuality as a disorder to the use of the term mental retardation. I think that substance use disorder is a far better descriptor as it leaves out the moralizing implied in the term abuse. I agree that there is over prescribing but at the same time there seems to be under prescribing to certain groups especially the poor because many doctors view poor people with suspicion. They might prescribe a lawyer an opiate based medication in a situation that a person on welfare would not be given one. 

I agree that the solution is in a change in society.   I think many people have a deep underlying feeling that they have no control over their lives so they opt for the cop out. I would hope that empowering people would lead to a decrease in things like drug addiction. The question is how to empower people in a cutthroat capitalist system where greed and corruption are not only rewarded but celebrated in our "entertainment" industry.

Mikal Sergov

kropotkin1951 wrote:

The temperance movement displayed the same kind of intolerance about the demon rum.

 

Agree with everything K said. For the record, Sailor Jerry spiced rum and Coke Zero is a fantastic mix.

Sineed

kropotkin wrote:
I agree that there is over prescribing but at the same time there seems to be under prescribing to certain groups especially the poor because many doctors view poor people with suspicion. They might prescribe a lawyer an opiate based medication in a situation that a person on welfare would not be given one.

I don't think that's actually true at all, though I agree that there is discrimination. People on disability and social assistance get boat-loads of opioids from their doctors. The discrimination manifests in a different way: non-drug interventions for pain are frequently not covered by provincial health care systems. So the lawyer is likeley to have private coverage for shiatsu massage, custom orthotics, and more physiotherapy than the province pays for. But marginalized people get prescriptions instead because doctors get paid for every prescription they write, and most drugs for pain are covered by public drug plans. 

How doctors are reimbursed is a part of why we have so much drug addiction in North America. "Pain" clinics are a licence to print money for the physicians who run them.

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