STATS ARTICLES 2003

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Media Coverage Hurts Chronic Pain Sufferers
May 27, 2003
Maia Szalavitz
They're worried about medication abuse

Newsweek's cover package on pain treatment claimed to offer "bold new insights into the nature and dynamics of pain" and a look at the future of pain treatment.

But the magazine didn't mention the main reason why pain remains under-treated, something which has nothing to do with lack of effective medications and everything to with misguided and media-fed fears about addiction.

For example, the opiate pain medication Oxycontin, introduced in 1995, has generated more headlines related to misuse by addicts than it has for its dramatic impact on pain treatment. Tagged as "hill billy heroin" and "the new crack," the media have failed to balance tales of misuse with stories of patients who were once bedridden and have now gone back to work thanks to the drug.

Oxycontin is not a new drug itself: it's a longer acting form of oxycodone, which has been used for decades to treat dental pain. Its strength is comparable to that of morphine, but as doctors and patients fear morphine because of its association with addiction, Oxycontin was more readily prescribed.

This should have been a great thing, given that researchers estimate that morphine is dramatically under-utilized: 50 to 70 percent of dying cancer patients don't receive adequate pain relief, according to experts and patient advocates.

For the dying, fear of addiction is simply ludicrous; nonetheless, these people are made to suffer. And people whose pain is chronic but not life-threatening are even less likely to receive appropriate medications.

But when reports began coming in related to Oxycontin misuse and overdose, the media went crazy. A search of "Oxycontin" and "addiction" in the past two years is stopped on Nexis because it will return more than 1000 documents.

Most accounts describe how the tablets could be ground up and snorted to defeat the time-release mechanism. They essentially, and very effectively, advertised the drug to new users.

And though The New York Times Magazine (7/21/01) and others described such users as "just" pot-smokers and binge drinkers who didn't know the dangers of opiates, they didn't emphasize what these recreational drug users weren't: patients in desperate need of medication.

The narrative - despite a lack of appropriate anecdotes - turned into one of evil doctors, fed by greedy pharmaceutical companies, hooking innocent people with conditions like minor back pain on powerful narcotics.

But when you look at the government survey data on the drug, a different picture appears: 75% had previously used heroin, cocaine and/or methamphetamine and at least two other prescription painkillers. Doctors weren't creating drug addicts; drug addicts were simply seeking the latest, new, hot drug from physicians, friends or pharmacists.

According to a review published in Clinical Journal of Pain, between 3.2 and 18.9% of pain patients become drug addicts - figures similar to those for the general population but variable because of different populations (younger people in general, for example, are more likely to be addicts than older groups). In other words, being prescribed pain medication doesn't make you any more likely to become a drug addict than anyone else.

But that's not what the media and the public believes, which is why pain continues to be a tremendous problem even though Oxycontin is an excellent and effective medication. Though new drugs with fewer side effects are always welcome, the real problem with pain treatment is not the lack of effective treatments but the lack of will and support for using them.

 


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