Same Day Multiple Prescriptions
 Why is Our Government Pursuing a War on Doctors?

Free Electronic Newsletter

OxyContin and the Need for Perspective
Stephen J. Ziegler, JD and Nicholas P. Lovrich, Jr., PhD
Washington State University
January 2002

If citizens were to take at face value what is most often heard from contemporary politicians and the broadcast media, they would probably think that OxyContin constitutes one of the most significant current health threats to our nation, and believe further that the drug should either be much more strictly controlled or taken out of circulation entirely. However, as a matter of actual fact the danger posed by the availability of this drug is not nearly so great as it is made out to be. If we look beyond the media sensationalism and the demagogic politics associated with the drug, we would find that OxyContin is likely the newest target in an on-going, multi-faceted war on drugs; this war is rather unusual in that it represents a national campaign that is being waged primarily against its own citizens. Although we fully recognize that the abuse of OxyContin has led to indisputable harm, it is also the case that other, far less strictly regulated substances pose a substantially greater risk without attracting anywhere near the same attention. In the following essay we examine some of the state and national politics involved in the war against OxyContin, and we argue that not only should the drug be put in proper perspective, Congress should follow its very own advice.

First, there should be little doubt that OxyContin serves as a very convenient target in the war on drugs. The past four decades have witnessed numerous drug wars, most of which have been waged on our own domestic soil. Drug wars have been initiated against heroin, LSD, cocaine, marijuana, methamphetamine, and most recently OxyContin. But is this declaration of intense and sustained public effort really aimed at drugs per se, or are there other policy objectives that are well served by maintaining a "war on drugs" of some kind? According to Joseph Miranda this war is not being waged against drugs, but is rather being directed against some groups of people and "society in general" (1). In fact, Miranda goes so far as to argue that the actual goal in this war "is not to suppress drugs, but to carry out some unstated political agenda" (1, 2). There is likely some support for this contention inasmuch as drugs and politics would seem to be tailor-made for each other; few public figures can argue against public efforts to prevent drug addiction or to prosecute drug violators, so fighting the war on drugs is often a very attractive political issue at both the state and federal level (3, 4).

For example, as sensationalized media reports fueled the OxyContin controversy, Connecticut Attorney General Richard Blumenthal felt compelled to enter the fray by offering his own suggestions concerning the dispensing and marketing of the drug. In a letter addressed to the president of Purdue Pharma, the manufacturer of OxyContin, Attorney General Blumenthal called for the centralization of distribution and the reduction in the number of pharmacies which could dispense the drug (5). Moreover, Attorney General Blumenthal also suggested that Purdue Pharma "voluntarily limit the distribution of OxyContin only to physicians who have extensive experience or training in pain management" (5). These recommendations raise serious questions and concerns. What is to be done about patients who cannot travel to a centralized pharmacy or who are not under the care of a physician who is specifically trained to use this drug? Reducing the number of pharmacies that can dispense the drug or limiting the number of physicians that can prescribe may help fight the war on drugs to a very limited degree, but it does so at the expense of patients who need the drug to manage pain. Although we think these recommendations would amount to bad policy if adopted, Attorney General Blumenthal is not alone in making recommendations concerning OxyContin; Congress has also jumped on the OxyContin band-wagon.

On December 11, 2001, a congressional subcommittee hearing was held on the use and abuse of OxyContin (6). Over the course of six hours, testimony was heard from five panels of witnesses, most of whom represented the law enforcement or addiction treatment community and took up a substantial portion of the hearing. Although the chair of the subcommittee, Representative Frank Wolf (R-VA.), appeared to be legitimately concerned about the need to balance patient care against regulation and prevention of abuse, several comments by other subcommittee members represented demagogic politics as usual (e.g., one stated that OxyContin abuse represented the worst scourge in the drug wars, that it wreaked havoc on adolescents and was linked to a rise in prostitution). In addition to the issuing of politically charged statements, more than one member of Congress raised the possibility that a ban could be placed on the drug. In fact, near the close of Dr. Goldenheim's testimony (Purdue Pharma), Representative Jose Serrano (D-NY) offered the drug company the following unsolicited advice: "It really won't matter how many people are being helped [by your drug], the focus will be on how many lives are being lost" (6). Not only is this statement an interesting recognition of the value of the drug as a medical tool in pain management, but it serves to set the OxyContin controversy in its proper politicized perspective.

For instance, much has been made of the allegation that the availability of OxyContin has lead to several hundred deaths and/or cases of addiction. Although the improper use of OxyContin has undoubtedly led to some deaths, the risk of death or harm is certainly not limited to OxyContin. For example, 16,500-20,000 deaths per year have been attributed to the use of non-steroidal anti-inflammatory drugs (NSAIDs) (7-9). Moreover, some patients who are already on prescription NSAIDs supplement their drug regimen with over-the-counter (OTC) NSAIDs that may increase "the risk of experiencing an NSAID-related gastrointestinal hemorrhage" (7). Granted, NSAIDs are not scheduled drugs, nor are they addictive, but if the focus is not how many people are helped but on the number of lives being lost, where are the press coverage and the congressional hearings on NSAIDs? If we are indeed focusing our societal attention on the number of deaths associated with the misuse of controlled substances, what should be done about the risk posed by the habitual use of tobacco? Albeit tobacco is subject to some level of regulation, unlike OxyContin it can be purchased legally without a prescription by anyone of legal age in any state. Moreover, unlike the hundreds of deaths attributed to OxyContin, the Center for Disease Control (CDC) reports that a staggering 430,000 deaths per year are attributable to the abuse of tobacco (smoking) (10). Consequently, do the number of lives lost really determine whether Congress will ban a substance or procedure? Whereas OxyContin has no doubt helped a great number of patients, how many people are "being helped" by tobacco?

In conclusion, as the testimony of Dr. Simmons and other witnesses on the medical panel indicated, preventing pharmaceutical diversion while ensuring opioid availability is an extremely complex problem deserving of careful study and tempered judgment (6, 11-12). The underlying problem is drug abuse; the problems associated with OxyContin are merely symptoms of a greater disease. This is a matter of societal pathology that will not be cured by passing tougher drug laws, arresting more people, or using OxyContin as a popular political issue to spice up the news or to promote reelection prospects. What is needed is an informed and civil policy debate; such a debate would likely require the making of some tough choices, choices that may even require a partial departure from the war on drugs. We are inclined to believe that Congressman Serrano's advice is basically sound - that is, the focus of our attention in public policy should be on the number of lives lost. However, if Congress followed its own advice, we doubt that the focus of its attention would remain on OxyContin.

References

1. Miranda, Joseph (1998). "War or Psuedo-war?" Social Justice, 25:2:65-84.

2. Musto, David F. (1999). The American Disease: Origins of Narcotic Control, 3rd edition. New York: Oxford University Press.

3. Meier, Kenneth J. (1994). The Politics of Sin: Drugs, Alcohol, and Public Policy. New York: M.E. Sharpe, Inc.

4. Mooney, Christopher Z. (ed.) (2001). The Clash of Private Values: The Politics of Morality Policy. New York: Seven Bridges Press, LLC.

5. Blumenthal, Richard (2001). "Attorney General Calls for Major Changes in Marketing and Distribution of OxyContin," Connecticut Attorney General's Office (http://www.cslib.org/attygenl/mainlinks/tabindex6.htm), last accessed December 23, 2001.

6. "Use of Painkiller OxyContin, House Appropriations Subcommittee," Testimony before the House Committee on Appropriations, Subcommitee on Commerce-Justice-State and Judiciary (CJS) (http://video.c-span.org:8080/ramgen/edrive/e121101_oxycontin.rm), last accessed December 31, 2001.

7. Setter, Stephen M. (1999). "Tailored Intervention Promoting Safe NSAID Use in Elders," U.S. Department of Health and Human Services Grant Application (funded, Stephen M. Setter Principal Investigator), 20-21, 31.

8. Bidaut-Russell, Michelle and Sherine E. Gabriel (2001). "Adverse Gastrointestinal Effects of NSAIDs: Consequences and Costs." Best Practice & Research Clinical Gastroenterology, 15:5:739-753.

9. Chevlen, Eric (2001). "A Bad Prescription from the DEA," The Weekly Standard, 6:36:16-20.

10. National Center for Chronic Disease Prevention and Health Promotion, Comparative Cause of Annual Deaths - United States (www.cdc.gov/tobacco/research_data/health_consequences/andths.htm), last accessed December 23, 2001.

11. "Promoting Pain Relief and Preventing Abuse of Pain Medications: A Critical Balancing Act, A Joint Statement from 21 Health Care Organizations and the Drug Enforcement Administration,"
(http://www.ampainsoc.org/advocacy/promoting.htm), last accessed December 31, 2001.

12. Wilford, Bonnie B., James Finch, Dorynne J. Czechowicz, and David Warren (1994). "An Overview of Prescription Drug Misuse and Abuse: Defining the Problem and Seeking Solutions." Journal of Law, Medicine, and Ethics, 22:3:197-203.