Wednesday, August 22, 2007

A nation in pain

This article in The Age reports on an explosion of addictive painkiller use in the US. It fails to mention that a significant degree of this abuse is due to prescription and illegally-diverted prescription use by those addicted to these drugs. Oxycodone is the drug most responsible for the increased use of painkillers – it is an opiate with similar effects to heroin.

According to The Age:

AMERICANS took more than 90,000 kilograms of painkillers in 2005, with sales of five major painkillers almost doubling between 1997 and 2005.

The dramatic increase has been attributed to the ageing population and aggressive marketing by pharmaceutical companies. (my bold)

According to analysis by the Associated Press of figures from the Drug Enforcement Administration, more than 91,000 kilo-grams of codeine, morphine, oxycodone, hydrocodone, and meperidine were purchased in 2005, the most recent year of the data. This equates to 300 milligrams of painkillers for every person in the country.
The main increase was in the sale of oxycodone, the chemical used in OxyContin, which increased sixfold…….

AP found that the reason for the increases was that the population of the US was getting older, with the number of Americans aged over 65 expected to reach 65 million by 2020 — almost double the 35 million over-65s in 2000.

But it also said that drug manufacturers had embarked on unprecedented marketing campaigns, with spending on drug marketing almost trebling from $11
billion in 1997 to nearly $30 billion in 2005.

Big pharma (a clone of big tobacco) is cashing in on the legal opiate addiction business for killing pain just as they are with methadone and buprenorphine that are used as ‘maintenance drugs’ for heroin addicts. In fact the effects of all these drugs are pharmacologically similar - they are all opiates.

These drugs are ideal products to market. Just like nicotine once you are addicted to any of them it is something you do for life – providing a lifelong stream of income to those supplying them. Indeed in many cases you can get the taxpayer to subsidise the cost of providing these drugs on the grounds that you are treating pain or treating heroin addiction among 'disadvantaged' groups.

Many in the medical profession promote methadone and buprenorphine as ways of practising harm minimisation with respect to heroin users. This is assisted by professional medical groups such as APSAD (Australian Professional Society on Alcohol and Other Drugs) who hold staged promotional sessions for drugs such as buprenorphine at their annual conference meetings. I have attended the last two myself.

Dare to question the case for substituting dependence on one addictive opiate for another and you will get a blasting. Addictive drug use is purely a medical issue and other views are not tolerated.

By the way how are so many drug users gaining access to prescription painkillers which they abuse are prescribed these painkillers by doctors? My assumption is that most are. In this sense the problem of painkiller abuse is a medical problem. It stems from selfish, inept and perhaps lazy doctors who do not do their proper duty with respect to those they are supposed to exercise a duty of care toward.

I'll try to get some data together on the extent of the painkiller issue in Australia. I know it is bad here but not quite as bad as for the US.


Anonymous said...

From time to time I take OxyNorm (oxycodone). It works well. (In fact in a fit of perversity I once wrote a post on drug addiction here whilst full of it.)With me it avoids an overnight or more stay in hospital dosed up on pethedine or morphine. It save at least one bednight for someone who needs it and enables me lead a normal(ish) productive life for the week I need it. I'm not addicted and not likely to be.

I'm inclined to think that a fair bit of the rise in it's use is due to ageing and the rejection of the stoic approach to pain. From my knowledge I think if you delve you'll find that it's mostly prescribed for severe cancer pain or severe pain due to degenerative spine or bone conditions. Many of those using it are in fact dying.

I'm sure there are some idiot doctors prescribing it for lower back pain 90% of which is benign and resolves withing 3 months. And I'm sure there are "hillbillies" buying it off Uncle Billy Joe who is getting it from Dr Shonk for a "bad back" - but just as one Vice Chancellor getting caught Tickling Peter doesn't make all academics criminal tax eaters neither does a bunch of rednecks swallowing an opiod make all uses of it medically unethical,

hc said...

fxh, A sixfold increase in use in 8 years. I cannot believe that reflects 'population aging' or an decreased tolerance for pain.

I do think community attitudes to pain management have improved.

If you have severe pain then a more than occasional blast is OK. But that is not what is happening here.

In my view it is big pharmas taking their share of what was previously an illicit drug market. It is what has happened with buprenorphine as well which has substantially cut into heroin demands.

It is analogous to the activities of big tobacco.

Anonymous said...

harry - I haven't had time to search around but I'd still be inclined to the view that most increase was legit and driven by enlightened attitudes to palliative care and long term severe pain.

I'm not denying the big pharma will push their product - thats a given - I'm not sure what evidence their is that they push oxycodone any more than anything else.

At least in OZ the hurdles a GP has to jump to write a script for oxycodone are difficult enough to slow most down and the checks by PBS on prescribing rates are pretty ruthless. Combine this with a general prejudice amongst the population and GPs/ Specialists/Health care workers that pain is somehow good for the soul and you have a situation where pain mitigation for severe and chronic pain is not all that easy to come by.

hc said...

fxh, I'll try to get some stuff together and post on this. I have heard quite a few verbal presentations that suggest a major Australian problem but the documentation is lax.

Its an important area in my view.