Widespread abuse of a potent painkiller is making some Kenai Peninsula physicians reluctant to prescribe it.
"For my patients, I've told them that unless you have cancer, I'm not going to give OxyContin," said Soldotna physician Nels Anderson. "It's too much of a problem. There are other drugs that are less abusable. If I give OxyContin, it will be short term or for cancer, not for something like chronic back pain."
That concerns OxyContin manufacturer Purdue Pharma.
"We feel that OxyContin is both safe and effective when used appropriately," said Jim Heins, Purdue Pharma assistant director of public relations. "It's setting pain management back years because doctors are afraid to aggressively treat pain using opioid analgesics."
Anderson said the death of 25-year-old Meghan McCord of Kenai, daughter of surgeon Byron McCord, was one of three central peninsula deaths attributed to OxyContin abuse this year. At the suggestion of an emergency room physician, her father last summer made OxyContin abuse the topic for one of the weekly meetings held by local doctors.
"We were trying to decide, 'How do you learn from a catastrophe?'" McCord said.
After the meeting, the doctors agreed on measures to control OxyContin abuse.
OxyContin is the patented, 12-hour, time-release version of oxycodone, a potent narcotic derived from opium. Abusers find ways to bypass the time-release system and get the whole dose at once, such as by chewing the tablets or extracting and injecting the oxycodone.
McCord said he believes his daughter obtained the drug by prescription after she complained of back pain. But prescribing the long-term use of narcotics, except for dying patients, is controversial, he said.
"You develop a tolerance, so you need more of the drug to get the same effect," he said. "A dependency develops, and that becomes part of the doctor-patient relationship."
OxyContin abuse has been a significant problem on the peninsula for a couple of years, said Kenai Police Lt. Jeff Kohler. He said the Kenai Fire Department has responded to at least 69 calls this year involving OxyContin overdose, ingestion or reaction.
"Frequently, we hear that burglars are active and using the proceeds to buy the drug," he said. "People are script (prescription) shopping, going from physician to physician to get as many scripts as they can."
Soldotna Police Detective Sgt. Tod McGillivray said people have reported their pills as stolen.
"Either people were taking them all at once, or they were selling them, and they needed a police report so their doctor would refill the prescription," he said.
Abusers bone up on symptoms to trick physicians into signing prescriptions.
"It's very difficult to tell if someone is lying to you," Anderson said. "I had one patient I thought had legitimate pain. I'd been giving him medication for some time. Then I heard from another patient he was selling them in the parking lot at Fred Meyer."
A urine sample produced no sign that the patient had been taking the pills himself, he said.
Medicaid pays for three-quarters of the OxyContin prescribed on the central peninsula, said Anderson. OxyContin, which comes in pills of 20 to 160 milligrams apiece, can sell on the street for $1 per milligram.
"With his OxyContin alone, say he had 90 80-milligram pills per month, he'd have $7,200 per month off pills paid for by the state," he said.
Soldotna physician Gonzalo Araoz-Fraser said many doctors have long asked chronic pain patients to sign contracts. For example, his pain patients must agree to see only one physician for chronic pain and to fill prescriptions at a single pharmacy.
After McCord's death, though, central peninsula doctors agreed that patients with pain contracts also should agree to allow their doctors to provide their names to pharmacists and other doctors. That way, doctors can distribute lists to keep patients from obtaining narcotic prescriptions from multiple physicians.
Araoz-Fraser said he will accept no new patients for chronic pain management. For short-term pain, such as after surgery or broken bones, he will prescribe pain-killers other than OxyContin, he said.
For his present chronic pain patients, he said, he will no longer refill prescriptions early, even for those who claim their pills were lost or stolen.
His pain patients also must agree to random urine tests to determine whether they are taking their prescriptions and to detect other drugs.
Still, there is no statewide registry where pharmacists can check whether patients are filling multiple prescriptions. In addition, some patients use multiple aliases.
"One thing we know is happening is that people are going to the doctor in Anchorage and then down here," Kohler said.
Kenai physician Michael Merrick said he simply does not prescribe OxyContin.
"I prefer to prescribe methadone if I have to use a long-acting narcotic," he said. "Methadone is not easily abused, because it doesn't produce the euphoria OxyContin does."
Pharmacies sell generic methadone for about 33 cents per pill and OxyContin for about $1.33 per pill, he said.
Heins said Purdue Pharma takes abuse seriously. It holds forums to teach physicians, pharmacists and health workers proper assessment of pain and to teach police to recognize and prevent abuse.
"Some states are looking at statewide prescription monitoring systems, so that a pharmacist can look at a registry and see the last time a patient had a prescription filled," he said.
Tom Hodel, owner of Soldotna Professional Pharmacy, said he has begun requiring identification to fill prescriptions for controlled substances.
Anderson said he has asked legislators about creating a statewide registry of Alaska prescriptions.
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