OxyContin settlement: Many doctors steer clear anyway
By Peter Reuell/Daily News staff
Tuesday, May 15, 2007


The manufacturer of OxyContin last week agreed to pay millions to settle a lawsuit claiming the company encouraged over-prescribing of the painkiller, but Milford area and MetroWest doctors say the decision is moot since many doctors are reluctant to prescribe the drug.

Faced with the controversy that has swirled around the powerful painkiller, and the ease of abusing the drug, many doctors have simply opted not to write prescriptions for OxyContin.

Although he still prescribes the drug, Michael Constantine, a medical oncologist and director of Community Cancer Care at Milford Regional Hospital, said it is used sparingly.

"We are aware that medication is something that drug addicts try to get...and we're very aware of those kind of things and watching for that," he said. "Even before all this, we have been aware it's a medication you don't take lightly."

But despite its high potential for abuse, Constantine said, the drug remains medically useful.

While there are other long-lasting pain medications, "some work on some people and others don't," he said. "It's good to have those options available."

But in some cases, Constantine admitted, the very name OxyContin is enough to drive patients away.

"Especially in the older population, they'll be like, 'I'm going to get addicted to this."' he said. "If a patient is very anxious about taking the medication you're not going to force them to."

"It definitely made most physicians very leery," Dr. Will Hynes, director of the pain program at MetroWest Medical Center, said yesterday of OxyContin's negative publicity. "And there's good reason for it.

"If you look across the country, the number of overdoses and ER visits for OxyContin, specifically interactions or abuse, was just off the charts."

Spurred in part by those statistics, 26 states sued Purdue Pharma L.P., the manufacturer of the drug, claiming the company encouraged doctors to prescribe the drug to be taken every eight hours, not the 12-hour dose recommended by federal officials.

In a settlement announced last week, the company agreed to pay $19.5 million to the states, including $949,500 to Massachusetts.

Although typically prescribed to help control pain over a long period of time, OxyContin abusers would crush the pills, then snort the drug, giving them a heroin-like high.

"I think it did catch us off guard," Hynes said. "I think all of us were surprised at how quickly the abuse exploded.

"The drug itself, when used properly, is a good agent. It's when it's misused - I think the issue is that it's fairly easy to abuse it. (And) with the numbers we were seeing, a lot of us did get away from using OxyContin."

The apparent decline in the number of doctors prescribing OxyContin seems to have also put a kink in the drug's illegal supply.

"I think it's fallen off significantly," Milford Police Chief Tom O'Loughlin said. "Most pharmacies don't carry it. If you got in with a prescription, it's, 'Come back in a couple days.' Or if they do carry it, they carry it in small quantities."

Other area police departments say the drug can still be found on the street, but they agree its incidence has dropped.

"It's still discussed," Natick Police spokesman Lt. Brian Grassey said. "I wouldn't find it to be an abnormal occurrence to make an arrest in the near future that had OxyContin mentioned. It's still out there and it's still abused."

Why the drop?

Among other factors, police say, is the cost.

At its height, the drug was sold for as much as $1 per milligram, meaning a 100-milligram tablet sold for $100. Abusers quickly found a substitute in heroin, which offered a similar high at a fraction of the price.

"Once a drug surfaces, and finds its way onto the streets, it's pretty much there forever," Framingham Police spokesman Lt. Paul Shastany said. "If there's a limited supply, and there's a demand for the stuff, people will find another substance to fill the gap."

Yet despite the risk of abuse and OxyContin's status as a street drug, doctors like Constantine say the medication will continue to have a place in at least some medicine cabinets.

"I don't see a change in that, but I do see a change, which is wonderful, in the pharmacists and the nurses, that they're more keen and aware (of problems)," he said. "As the physician, I still try to look at what's best for my patient, and what might be best for their pain. From my perspective, it's not going to change the way I'm prescribing."

(Peter Reuell can be reached at 508-626-4428, or at preuell@cnc.com.)

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