On Oxycontin

Hillbilly Heroin
What has been a very successful product for the treatment of cancer pain and for the treatment of severe intractable chronic pain as been a disaster for the Drug Abuse Prevention Community of Eastern Kentucky. Science based Drug Abuse Prevention is based on two pillars.
1. Environmental prevention.
2. Recognition of true peer attitudes and wise decision-making.
Environmental prevention is based on making drugs of abuse hard to secure. The State of Kentucky spends hundreds of thousands of dollars each year keeping tobacco out the hands of citizens below the age of 18 and alcohol away from citizen below the age of 21.
The state does this because:
1. The earlier in life an adolescent uses drugs, the greater the chance of abuse patterns developing – followed by addiction.
2. The greater the amounts and frequency of adolescent drug use, the greater the chance of abuse patterns developing – followed by addiction.
The federal government spends millions of dollars to limit the amount of heroin, cocaine and marijuana brought into this country each year. The thought is the less drugs available the less the frequency of use and the volume of drug use. The less the frequency/volume of drug use the less likely hood of addiction.
How are we doing with our environmental prevention in Eastern Kentucky?

A recent KIP Student Survey of the Pike County Schools in KY shows that when asked how many students had taken prescription drugs or narcotics without a doctor telling them to in the past 30 days: 10% of the 8th graders, 20% of the 10th graders and 26% of the 12th graders reported using. 2% of the 6th graders, 6% of the 8th graders, 9% of the 10th graders and 11% of the 12th graders reported they thought they had a drinking or drug problem.

I would summit that the environment of Eastern Kentucky is, at the present time, polluted with legally manufactured synthetic opioids. The drug of choice is clearly OxyContin, a time-release formulation of oxycodone. The problem has been caused by a multitude factors among which are:
Problem One:
The way in which adolescents and laypersons view OxyContin. OxyContin’s use and abuse has been widely covered by the news media. This drug is perceived as the badest of the bad, the real thing, the highest of highs. Youth in open rebellion or drug seeking individuals fine the press coverage titillating and act by seeking out this drug and paying top dollar for it.

Problem Two:
The false idea that this narcotic is truly a “safe” agent for the control of moderate chronic pain. It is true, that if used as directed, OxyContin has a lower addiction potential than other opioids because of the formulation but this drug is no magic bullet. Other effective drugs, such as amphetamine inhalers and Talwin, were safe and effective if used as directed but when misused were considered a threat to public health and therefore were pulled from the market or modified. The idea that OxyContin is a safe and effective pain killer with no down side has been sold to the physicians and pharmacists all over this country and has lead to mass over prescribing of this agent. The downside of this narcotic is its abuse potential when misused. Sales of OxyContin have increased from 55 million dollars in 1996 to 1.14 billion dollars in 2000. This represents a 21-fold increase in the number of tablets sold. This in turn has led to the overwhelming amount of the drug being diverted for street use. The question is: has the amount of cancer pain and severe intractable chronic pain increased 21 fold in this country in the last 5 years? It is plain that an increased amount of the drug on the street is directly related to the increased number poor judgment prescriptions being written.
Problem Three:
Most of Eastern Kentucky is located in the geo -economic area known as the Distressed Counties of Appalachia. 1/3 of the population lives below the poverty level. This makes drug diversion a real problem. A 30-day supply of OxyContin (60 mg, 1 every 12 hours) makes a one-month OxyContin prescription worth $4800 on the street. This is real money for someone who lives below the poverty line and adds to the diversion potential for this drug in our area.
The OxyContin environmental pollution of Eastern Kentucky must be stopped. The amount of OxyContin on the street must be reduced. This can only come about with stricter control and less substance available.

The individuals who become addicted to narcotics because of this pollution must be helped. We have no adolescent treatment beds available in our area and state wide there are waiting lists. The war on drugs is the only war in which we send the victims to jail. There will be far-reaching environmental impacts from this substance long after the drug is gone or has been reformulated.