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There Is Help

For Ray, jail was the turning point. "There's something about those metal bars slamming shut behind you that makes it all very real," she says. A drug program in prison helped her beat addiction and taught her to cope with the triggers or life stressors that pushed her down the path to drug abuse.

"If you find yourself not following your doctor's orders, buying drugs off the street, or doctor-shopping, know that there is effective treatment and you can get help," Clark says. "If there is a treatment center within 100 miles of you, we can help you find it." (See "Treatment Centers".) Addiction is a brain disease typically treated with behavioral intervention, drug treatment, or often a combination.

Some treatments need to alleviate both withdrawal symptoms and the psychological addiction to drugs. Detoxification, the process by which the body recovers from tolerance and dependence, is considered a first stage in the sense that it purges drugs from the body. "It doesn't constitute a treatment," Young says. "Treatment has to address stopping future use."

Methadone, a synthetic opioid, has been used for more than 30 years to treat some opioid addictions. Levo-alpha-acety/methadol (LAAM) is another opioid treatment.

With methadone treatment, the patient receives both behavioral intervention and an oral, daily dose that maintains the physical dependence. When people abuse drugs, they commonly use fast routes of administration such as injection or inhalation, which basically slam the drugs into the brain. Methadone treatment delivers the narcotic orally so that it is slowly released in the body. The intent is to lessen the chance that the patient will use illegal opioids, Young explains. Among the goals is to decrease cravings for the "rush" created when opioids are taken by fast routes, and to prevent the occurrence of withdrawal signs by maintaining a steady level of opiate in the body. "It's a maintenance therapy over a long period of time, just like maintenance for diabetes, asthma, or any other chronic problem."

Striking a Balance

Prescription drugs commonly are diverted through fraudulent prescriptions, doctor-shopping, over-prescribing, and pharmacy theft. Clark says that dealing with diversion requires the involvement of patients, physicians, and pharmacists, and that there are many variables linking these three groups.

"Sometimes it's a matter of patients and physicians without adequate information about drug abuse," Clark says. "Sometimes overworked pharmacies don't notice when a patient is doubling up on a medication."

But as pharmacists look out for false or altered prescription forms and doctors look out for suspicious complaints, patients with legitimate medical problems still need fair treatment, Clark says. "We don't want to wind up punishing people in need."

Ellen Stovall, president of the National Coalition of Cancer Survivorship, says some cancer patients have been frustrated with the lack of appreciation for assessment of their own pain. The last thing patients need is a setback to pain management, Stovall says. "We have all the important laws around the abuse of narcotics, but we need legislation and support to protect people who are experiencing real, honest suffering."

FDA Strengthens Warnings for OxyContin

Because of continuing reports of abuse, the FDA has strengthened the warnings and precautions sections in the labeling of OxyContin controlled-release tablets, a narcotic drug approved for the treatment of moderate to severe pain. Some of these reported cases have been associated with serious consequences, including death.

OxyContin contains oxycodone HCl, an opioid agonist with addiction potential similar to that of morphine. Opioid agonists act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. When these drugs attach to certain opioid receptors in the brain and spinal cord, they can effectively block the transmission of pain messages to the brain.

OxyContin is a controlled substance in Schedule II of the Controlled Substances Act (CSA), which is administered by the Drug Enforcement Administration (DEA). Schedule II provides the maximum amount of control possible under the CSA for approved drug products.

To educate health-care providers about the risks of OxyContin, Purdue Pharma of Stamford, Conn., manufacturer of the product, has issued a warning in the form of a "Dear Health Care Professional" letter, which will be distributed to physicians, pharmacists, and other health-care professionals. The letter highlights the problems associated with OxyContin abuse and explains the changes to the labeling, including proper prescribing information.

OxyContin, like morphine, has a high potential for abuse. It is supplied in a controlled-release dosage form and is intended to provide up to 12 hours of relief from moderate to severe pain. The tablet must be taken whole and only by mouth. When the tablet is crushed and its contents are injected intravenously or snorted into the nostrils, the controlled release mechanism is defeated and a potentially lethal dose of oxycodone is released immediately.

Tags: Medicine

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www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.