STATS ARTICLES 2008

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New Study on Drug Addiction Exposes Media’s Misrepresentation of OxyContin “Plague”
Trevor Butterworth, January 25, 2008
The media, DEA, created a myth of widespread accidental addiction new data on drug addicts shows

Of the many bywords for the evils of big pharma, OxyContin is one of the most powerful. The slow-release opioid painkiller has launched investigations in the Orlando Sentinel, and the New York Times (the latest of which probed Rudy Giuliani’s consultancy work the drug’s manufacturer, Purdue Pharma), the Drug Enforcement Agency (which deployed hundreds of investigators to monitor doctor prescriptions, and backed several high-profile prosecutions), and a five-year investigation by the office of U.S. Attorney John Brownlee in the Western District of Virginia and a subsequent widely-reported trial.

The consensus of all of these sources was, broadly, that Purdue had knowingly pushed a dangerously addictive product, and that thousands of people – most famously Rush Limbaugh – had become accidental addicts and hundreds had died, often through careless prescribing by doctors. As Geraldo Rivera raged on Fox news, Purdue’s “corporate vultures”

“…are the most insidious drug pushers, forcing their addictive junk on millions of unsuspecting victims, with the same disregard for their health and wellbeing as any demon doper."

There was only one problem with all of this: the consensus, the moral outrage, the muck-raking investigative journalism wasn’t supported by reliable evidence.

The Orlando Sentinel ended up issuing an apology and repudiating the data that had driven its investigation. The Food and Drug Administration rebuked the DEA for shoddy methodology in its widely touted study claiming a dramatic increase in OxyContin-related deaths (which New York Times investigative reporter Barry Meier noted in his book about OxyContin, “Painkiller,” but failed to mention in any of his numerous stories for the Times; likewise he also failed to report the General Accounting Office’s criticism of the DEA’s data).

And Brownlee, after a five-year investigation that examined millions of documents, talked up a storm about indictments but managed only to secure a misdemeanor charge of misbranding – there wasn’t enough evidence to convince a jury that Purdue executives should go to jail, he was forced to admit, even though he was quick, in interviews with the press, to counter that that was where they really belonged.

Now, a new, randomly selected study of 27,816 drug addicts attending 157 treatment centers across the United States, which was published in the November 2007 issue of the peer-reviewed American Journal of Psychiatry, provides the strongest evidence yet that, contrary to what the media reported and many, not least Brownlee, believed, there was no epidemic of accidental addiction to OxyContin. As the authors of the study “Prescription OxyContin Abuse Among Patients Entering Addiction Treatment” write:

“Media reports have often portrayed people who receive OxyContin and develop substance abuse problems as “drug naive” individuals or as individuals with “accidental” addiction and in turn they have brought about the speculation that this opioid has unique properties that make it more likely to induce or prompt abuse and dependence among the general population. Although some reporters have rescinded their reports or noted that OxyContin abuse may have been overstated , this is the only prescription medication, to our knowledge, that has been compared with ‘a plague’ or ‘nuclear bomb’ by the media.

In fact, prior research studies of OxyContin use or abuse among the general population and among those receiving the medication for pain management in specialty clinics have not supported such media claims. These studies have reported that while the rates of OxyContin use have increased since 2000, the proportion of those individuals who are prescribed OxyContin and have shown signs of abuse or dependence are quite low (less than 2%).”

In other words the chances of accidental addiction from being prescribed OxyContin are very low and have remained so despite greater overall use of the drug. The significance of this study is that it provides a powerful, random sample of drug addicts in the U.S. and finds that just 5% reported ever using OxyContin.

Among this group of 1,425 addicts, only 22% reported receiving OxyContin by way of prescription for a medical problem. But 86% reported using OxyContin, whether prescribed or not, to get high. Only eight (0.5%) used OxyContin exclusively. What this  means is that the overwhelming majority of those abusing OxyContin were abusing other drugs as well (specifically, heroin, cocaine, methamphetamines and sedatives). The authors observe that:

“One main finding of this study was that most of the OxyContin use reported in the sample of individuals seeking addiction treatment did not originate from physician prescriptions, but rather from illicit sources, such as family, friends, or other illegitimate sources. Clearly, the pharmaceutical opioid problems of the individuals in this sample were part of a larger pattern of alcohol and other drug use—the problems were not “accidental,” secondary to prescribed use for pain or other medical problems. These results also suggest that those who suffer from OxyContin abuse or dependence share many characteristics with those who are dependent on other classes of drugs.”

The study also found that among those who abused OxyContin, 51% had experienced symptoms of depression in the past 30 days, and 36% had chronic medical problems. The study suggests that psychiatric problems is one of the strongest predictors of OxyContin abuse.

There are, of course, limitations to the study that the authors carefully note. As the sample is based on those attending adult addiction centers, and not a sample of the general population, it “likely represents those persons with the most severe and complex substance abuse problems,” say the authors. It doesn’t address, for example, “the tendencies of abuse among adolescents presenting for treatment.” It may also, due to the way urban and suburban treatment centers were weighted in the sample,  not fully capture abuse rates in rural areas.

In the seven years that the OxyContin epidemic has been the subject of intense media coverage, there has been, for most of that time, significant data available to the press – from the FDA, the GAO, the Journal of Analytical Toxicology, the Drug Abuse Warning Network, The National Institute on Drug Abuse – that contradicted the anecdotal evidence which drove most of this coverage. These sources, unfortunately, were stubbornly ignored. (To be fair to the New York Times, after having done so much to create OxyContin’s accidental addiction meme it eventually published a de facto corrective in its magazine, from contributor Tina Rosenberg, “When Is a Pain Doctor a Drug Pusher?”)

This latest study adds another valuable corrective to a deeply misconstrued media-driven narrative about pain medication and addiction that has created havoc for doctors trying to deal with acute pain in the U.S. – something that afflicts 75 million people (Foundations of Opioid Risk Management, Katz et al, Clinical Journal of Pain, February 2007). But so far, it has received no media coverage whatsoever.

Finally, there is one other noteworthy factor revealed in the data, but one whose significance is not commented on by the authors: as with meth, that other bogus drug epidemic pushed by the media, those who abuse OxyContin are overwhelmingly white.


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