A Good Drug

By JEFF STIER, Mr. Stier is an associate director of the American Council on Science and Health.
May 23, 2007

There is a lot of bad news these days about a good drug: the painkiller OxyContin.

Not only has OxyContin become synonymous with drug abuse — but its manufacturer, Purdue Pharma, has confessed to criminally misrepresenting the addictive risks of the drug, and is paying a hefty fine.

Just last week, Manhattan and Long Island internist, Dr. Richard Morgan, was charged with supplying OxyContin to a drug ring. He could face up to 20 years in prison.

The Drug Enforcement Administration's online overview of New York State lists OxyContin as "among the most commonly abused and diverted pharmaceuticals in New York."

True, the powerful and effective painkiller is subject to dependence and abuse, as are all opiate type drugs. But the controversy over this drug is about abuse — not proper use.

In the context of all this negativism, it is easy to overlook the reality that Oxy-Contin is a uniquely effective drug for those in severe pain. I fear, on behalf of pain-sufferers, that efforts to ban the drug will now be revitalized.

We should not allow the misdeeds of bad actors, and there are many, to harm the true victims: severe pain sufferers for whom OxyContin is a godsend.

Calls to ban this morphine-like medicine go back several years. Two years ago, Boston area congressman, Stephen Lynch, introduced a bill to have the Food and Drug Administration approval of OxyContin withdrawn. He and those who supported his effort must be chomping at the bit. The growing ranks of activists who seize any opportunity to paint the entire pharmaceutical industry as villains will be delighted — hating drug companies is becoming the new opiate of the masses.

But OxyContin needs to be evaluated in perspective. The quality that led some people to abuse OxyContin was a valuable attribute that made it superior to other painkillers in its class: released gradually over twelve hours, OxyContin gives patients a more steady dose and thus better, steadier relief.

Older drugs like Vicodin must be taken every three to four hours, leading to peaks and valleys in their efficacy.

Like many powerful drugs, Oxycontin can lead to dependency. But when properly prescribed by doctors, and properly used by pain-sufferers who taper their dosage as pain becomes less severe, dependence is not a problem.

Cancer patients and others in severe pain, by and large, are not the ones abusing OxyContin. Instead, the product got its moniker, "Hillbilly Heroin," because addicts with a history of other forms of abuse were crushing the pills to void the time release effect. This gave them a powerful, immediate, super-addictive and sometimes fatal hit. Even the ethically-challenged manufacturers oppose this type of abuse.

In today's anti-Big Pharma atmosphere, this dual abuse couldn't have come at a worse time. As addiction expert and American Enterprise Institute scholar, Dr. Sally Satel, warned, "Pharmaceutical development of improved, slow-acting opiate medications may be derailed by fresh paranoia." An exaggeration? No. Just look at the demise of research into the promising anti-cancer effects of drugs like Vioxx, which was withdrawn amid controversy. We may never know whether such so-called Cox-2 inhibitors are effective against prostate and other cancers — who now would fund such risky and liability-inducing research?

Economists have long warned that the FDA, by being hyper-cautious about approving drugs, might in some cases kill more people than it saves, by keeping safe drugs off the market and out of the reach of seriously ill patients.

The FDA itself is slowly becoming aware of the problem, but now, thanks to the press and activists who think solely of the risks and unexpected side effects of medication without weighing the drugs' benefits, the general public is starting to think about drugs in the zerotolerance, no-risk way that the FDA did at its worst. This is an unrealistic and unwise standard.

Only the day before yesterday, it seems, we understood that health care is not and cannot be risk-free but that some treatments are worth the risks. Are we now to adopt the position that not only must drugs have no unanticipated side effects, but are not even fit for some people to use properly if other people abuse them?

The real wrongdoers must be punished. And the real victims and pain-sufferers must be protected from over-zealous and misplaced reaction to the Oxy-Contin abuse that has nothing to do with them.

A Good Drug

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