Tag Archive: chronic pain


DOCTORS are writing thousands of suspect prescriptions for a pharmaceutical variation of heroin, much of it destined for the black market, forcing the federal government to investigate the actions of 50 medical practitioners.

More than 580,000 taxpayer-funded scripts were approved in NSW in the past two years for OxyContin and similar opiate painkillers, such as OxyNorm and MS-Contin, dubbed “hillbilly heroin“.

For every $34 script of OxyContin, users are obtaining a box of 20, 80 milligram tablets. Each tablet can then sell on the black market for as much as $50. With further subsidies to pensioners, the box can be bought for as little as $6 – and its contents might be sold on the street for $1000.

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While the medication has revolutionised care for chronic pain sufferers, it is leaking out of the health system to such an extent that police and health experts warn it could soon surpass street heroin and ice as the needle addict’s drug of choice.

The prescription opioids are obtained unlawfully by dealers and addicts who “doctor shop“ for multiple prescriptions. One patient visited 46 doctors in three months and obtained 119 scripts, primarily for OxyContin, the government has confirmed.

Sydney doctor Alan Saunders, who has been targeted by doctor shoppers, warned: „It’s not just OxyContin – it’s valium and all the other drugs. The government is subsidising the drug trade.“

Pharmacists say they are confronted with stolen and fake scripts, while legitimate pain sufferers are obtaining the drug and then selling it.

The government acknowledges the problem. Federal Minister for Human Services Tanya Plibersek confirmed to The Sun-Herald that Medicare had identified 50 doctors for “unusually high levels of prescription writing for drugs such as OxyContin and OxyNorm“.

„The misuse of prescription narcotics is a growing problem which destroys lives and tears communities apart. Doctors suspected of making these drugs available to patients who do not require them for clinical purposes will be put on notice.“

With a slow-release formula, OxyContin capsules are designed to work through the day. Illicit users, however, discard the other binding agents and extract the drug in its purest form so, when injected, it delivers an instant hit.

According to new state government statistics released to The Sun-Herald, more than $557 million worth of illegal drugs were seized in the state last year – more than double the street value of the previous year’s tally of $260 million. The haul included $185.2 million worth of cannabis, $126 million of cocaine, $195 million of amphetamines and $28 million of MDMA/ecstasy. NSW Police Minister Michael Daley said the figures showed police were doing “a fantastic job keeping our streets safe“, adding: “It’s millions of doses of deadly substances that have been kept out of the veins of would-be drug users.“

Significantly, NSW police also seized more than $25 million worth of heroin. At the same time, a taxpayer-funded version of the drug is infiltrating the black market. The commander of the NSW drug squad, Nick Bingham, said: “We’re talking pharmaceutical-grade heroin. It’s highly sought after in the drug-using community and, unfortunately, it is finding its way [onto the streets]. To be honest, police don’t particularly want to have to target prescription opiates when there are other important things to tackle, such as organised crime.“

Inspector Bingham is part of the recently formed National Pharmaceutical Misuse Strategy Committee and said prescription opiates were “high on the agenda … One of the discussion points is educating doctors in regards to prescriptions … there needs to be tighter scrutiny.“ The director of the Alcohol and Drug Service at St Vincent’s Hospital, Alex Wodak, agrees major reforms are needed to improve the way opiates are prescribed by the medical profession: “The process needs to be far more discriminating, more realistic, more careful.

“GPs do the bulk of this work. They’re under tremendous pressure and could do with better assistance from the whole system, whether it be from medicine doctors, psychiatrists, pain doctors or better guidelines tailored to them.“

Dr Wodak also referred to the “long overdue“ national real-time database which, if implemented, could alert authorities when “runners“ try to use multiple scripts at different chemists, at different locations.

“The Commonwealth seems interested in trying to get all the states to adopt a similar live system,“ he said. “If we are serious about this issue, we have to form a national response.“

But Richard Mattick, from the National Drug and Alcohol Research Centre, fears a crackdown could hit genuine pain sufferers.

“Let’s not forget these medications are terribly important to the community,“ he said. “If you have a loved one affected by cancer or serious pain, you want them to receive the best possible care and these medications are much better, much safer than anything previously available. The community is better served and, in a way, that has allowed prescribing to be more generous.

“The danger here is that we see the bad side but don’t balance that against the need.“

Gideon Warhaft, of the NSW Users & AIDS Association, argues: “There will always be people who inject drugs and there will always be people with narcotics dependencies. The positive advantage with OxyContin is that users know exactly what they’re getting, whereas with heroin, they don’t. Many now prefer OxyContin because it’s clean and it’s safer.“

Patients ’sell drugs to help families‘

"Better than heroin" ... Stephen buys Oxycontin from people who are terminally ill.„Better than heroin“ … Stephen buys Oxycontin from people who are terminally ill. Photo: Jacky Ghossein

FORMER heroin user Stephen* has been using Oxycontin for six years but has a better alternative than doctor shopping. He buys the drug from terminally ill people who use the funds as a legacy for their families.

“I got introduced to Oxycontin by a sick friend who was being prescribed it. They were receiving roughly 30 per cent more than they needed so I took it off their hands.

“There are a lot of terminally ill people out there who get so much of this stuff, they’re selling it and making a fortune. It’s their legacy, for their kids … it’s a far better option than doctor shopping, taking risks and ending up in jail. They’re helping you and you feel as though you’re helping them.“

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He said the Oxycontin rush wasn’t as intense as heroin and it wore off more quickly but the feeling was “extremely similar“ to heroin and many users preferred it.

“Heroin can be dangerous, particularly if you don’t know where it’s come from … I have overdosed twice. But with Oxycontin, you know exactly what dose you’re getting and at $30-$40 for an 80 milligram tablet, it’s far better value for money.“

He said if politicians came down on Oxycontin, users would “revert … to heroin – which can mean stealing, armed robberies and doing absolutely anything to fund it“.

source: http://www.smh.com.au/nsw/legal-heroin-sold-to-addicts-20110305-1bipy.html

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Experts are concerned with a finding that suggests chronic pain patients with a history of depression are much more likely to receive prescriptions of opioid medications.

Opioid medication include drugs such as Vicodin, OxyContin, Percodan, and Percocet.

Researchers discovered chronic pain patients with a history of depression are three times more likely to receive a prescription for this class of drug as compared to pain patients who do not suffer from depression.

The study, published in the November-December issue of the journal General Hospital Psychiatry, analyzed the medical records of tens of thousands of patients enrolled in the Kaiser Permanente and Group Health plans between 1997 and 2005.

Together, the insurers cover about 1 percent of the U.S. population. Long-term opioid use was defined as a patient receiving a prescription for 90 days or longer.

“It’s very widespread,” said Mark Sullivan, M.D., a study co-author and professor of psychiatry at the University of Washington.

“It’s a cause for concern because depressed patients are excluded from virtually all controlled trials of opioids as a high risk group [for addiction], so the database on which clinical practice rests doesn’t include depressed patients.”

Sullivan said most clinical trials exclude people with more than one disorder, but noted the problem is more worrisome here because depression affects so many — about 10 percent to 20 percent of the population.

The connection between pain and depression is complicated. First, no one really knows how often chronic pain and depression co-occur: 46 percent of patients seeing primary care doctors for ongoing pain have a history of depression and the vast majority of those seeing pain specialists have suffered both disorders, according to the authors.

“If you study depressed people, they tend to have lot of pain complaints that are poorly responsive to a lot of things so it’s not surprising that they end up on opioids,” Sullivan said.

Being depressed might make pain hurt more. “Emotional and physical pain aren’t all that different,” Sullivan added. “The same brain zones light up [in imaging studies].”

“Depression is mediated in some significant part by the brain’s opioid receptor systems; these things run together at every level that you look at them,” said Alex DeLuca, M.D., a consultant on pain and addiction and former chief of the Smithers Addiction Research and Treatment Center. He has no affiliation with the new study.

Consequently, it is impossible to tell whether pain is causing or exacerbating depression — or vice versa. To Sullivan, the bottom line is that “it is very important that opioid treatment for chronic pain does not replace or distract from treating mental disorders. ‘Both’ works better than ‘either/or.’”

source:http://psychcentral.com/news/2009/11/19/opioid-use-among-those-with-depression/9650.html