No One Needs To Suffer
Here is a cogent article written by MAGNUM addressing the national problems with proper access to effective pain management
President George W. Bush named two highly-qualified doctors to head key public health offices. Dr. Richard H. Carmona, a trauma surgeon from Arizona, was named to head the office of the Surgeon General, and Dr. Elias A. Zerhouni, Executive Vice Dean of the prestigious Johns Hopkins University School of Medicine in Baltimore, Maryland, was named Director of the National Institutes of Health (NIH). We are pleased to see the President echoing his position on pain issues as noted in a White House policy letter for IHC & MAGNUM and read to thousands of physicians and pain experts at the10th Congress of the International Headache Society in New York City last summer.
We are also pleased to see certain areas of our government perusing good public health policy. However, MAGNUM has been following the current OxyContin® controversy which demonstrates an area of health policy that could have long-term ramifications on all patients in pain. In the past few months alone, there have been nearly a half-dozen hearings on the OxyContin drug abuse problem. MAGNUM staff has attended these public health hearings. As health advocates, MAGNUM is deeply concerned about the quality of life of ALL pain patients, regards of disease.
Many groups have been following the OxyContin issue due to the serious long-term public policy issues that could result from Congress' reaction. Time-released moderate to severe pain medication is not a front-line treatment protocol for Migraine, but for those sensitive to ergot or triptan treatments, it may be used as an ancillary treatment or a rescue treatment. Therefore, any doctor treating a patient for Migraine should be afforded this treatment option.
MAGNUMs concern over the OxyContin issue is shared by other pain advocacy NGOs like the American Pain Foundation and the Oncology Nursing Society. The OxyContin issue has produced an aggressive public health policy that would limit access to those in pain from receiving appropriate pain management. Furthermore, discussions at recent hearings could lead to very tight control over what pain medications doctors may prescribe in general. Doctors may chose not to treat those in debilitating pain for fear of being profiled and/or targeted by law enforcement or other monitoring state or federal agencies.
Whether you saw it on TV or read about it in the national press, OxyContin has been vary newsworthy and alarming to us all. The Wall Street Journal ran an article entitled "Drug Crackdown" on February 20, 2002, and Newsweek ran an article entitled "How One Town Got Hooked" in April 2001. Concern has resulted in many government hearings and public forums being held in the recent few months.
Both chambers of the U.S. Congress have held hearings. The first hearing was held on December 11, 2001 by Congressman Frank Wolf (R-VA), Chairman of the House subcommittee with jurisdiction over the funding for the Drug Enforcement Administration (DEA). His hearing was held on what he termed "the illegal use of the highly addictive painkiller OxyContin." Rep. Wolf invited the following to testify: The DEA, law enforcement officials from Virginia and Kentucky, Purdue Pharma (the manufacturer of OxyContin), individuals recovering from addiction to OxyContin, the American Cancer Society, the American Pain Society, and Johns Hopkins Pain Medicine Department.
The Senate also held a hearing. Virginia Senator John Warner (R-VA), as a member of the Health and Education Committee (HELP), was the first member of the Senate to call for a hearing on February 12, 2002, to examine the risks and benefits of OxyContin. At the request of Senator Warner and Senator Collins (R-ME), the Committee, chaired by Senator Gregg (R-NH) and under the watchful eye of Senator Kennedy (D-MA), heard testimony from two Virginians. Dr. Art VanZee of the St. Charles Clinic in St. Charles, Virginia, testified on problems associated with OxyContin abuse in southwest Virginia. First Sergeant William R. Bess of the Virginia State Police Drug Enforcement Division testified on the abuse of OxyContin and Virginia law enforcement efforts related to the problem. Other Witnesses included Dr. John Jenkins, Director, Office of New Drugs, Food and Drug Administration; Dr. Paul Goldenheim, Vice President for Research, Purdue Pharma L.P; and several others.
MAGNUM monitored both Capitol Hill hearings and observed a possible dangerous trend. Both hearings heard anecdotal testimony from people who knew those that illegally obtained OxyContin for recreational use and suffered medical consequences. The hearings also heard testimony from medical experts expressing compassion for those abusing illegally-obtained pain medications. Lawmakers unfortunately reacted to his testimony by expressing limitations to the drug to those who are prescribed the drug legally, leaving those in pain with less access to appropriate pain management and a good quality of life.
However, the good news is that MAGNUM has had the privilege to work with Senator Warner on pain issues for more than six years, as he has been a champion on Migraine disease and pain matters. To that fact, Senator Warner released a statement on February 12 stating that "OxyContin serves an Important function for many Americans who are suffering from chronic pain." He goes on to say, "After today's hearing, I imagine that some of us on this Committee will sit down and determine how the federal government can be more helpful in efforts to stem OxyContin abuse. I look forward to working on this issue with my colleagues."
Another important hearing was held recently by the FDA Advisory Committee on January 30-31, 2002. On both days, the committee discussed the medical use of opiate analgesics in various patient populations, including pediatric patients and patients with chronic nonmalignant pain, as well as the risk-to-benefit ratio of extending opiate treatment into these populations. The FDA addressed concerns regarding the abuse potential, diversion, and increasing incidence of addiction to opiate analgesics, especially to the modified release opiate analgesics like OxyContin.
The National Consumers League (NCL) held a Second Symposium on Risk and the Media: Communicating Consumer Health and Safety Risk, at the National Press Club on January 24, 2002. The symposium was used as a vehicle to evaluate how consumers perceive risks to their own health and safety. The panel focused on the OxyContin issue which was moderated by former Chief Medical Correspondent for ABC News George Strait. Panelists examined news reports and features about the OxyContin problem from several perspectives. Panelists included Charles Cichon, President of the National Association of Drug Diversion Investigators; Dr. Howard Heit, Assistant Clinical Professor of Medicine with Georgetown University and a well-known expert pain and addition; and pain sufferer Mary Vargas, a patient advocate. The NCL held a valuable discussion on how media play a critical role in the public perception of major public health issues.
One of the most interesting hearings was held by the American Enterprise Institute (AEI) of Public Policy Research on February 7, 2002, entitled "The OxyContin "Crisis"Whos To Blame?" Panelists included John E. Calfee, AEI; James K. Glassman,Washington Post syndicated columnist; Dr. J. David Haddox, Perdue Pharma L.P.; Erika King, attorney, Covington & Burling; Dr. Sally Satel, former Yale professor of Psychiatry, and AEI; Greg Stone, Reporter for the Charleston Gazette; and moderator James K. Glassman, AEI. Some of the best statements and observations to date on this issue where presented at this hearing, including some compelling statements from audience members, including Laura R. Griffith, Federal Director of the Law Enforcement Alliance of America.
It was the AEI event that added some clarity on the OxyContin national debate. Where many would want us to believe that OxyContin represents a case of over-treating pain in this country, it was a statement from LEAA Federal Director Laura Griffith that put things into focus. Ms. Griffith stated to the panel "What we really need to do is to focus the debate on law enforcement in terms of detention, investigation, apprehension, and punishment for crimes associated with obtaining drugs illegally. The bottom line is that obtaining OxyContin or any other controlled drug illegally, is a crime." MAGNUM could not agree with her more. The OxyContin issue is a crime policy issue, not a public health care issue. Ms. Griffith went on to say that "To use drugs that are not prescribed for you, crushing them, selling them, is a criminal enterprise." Wise words from the only non-medical NGO in the room!
After the AEI hearing, MAGNUM followed up with several subsequent interviews with people who had made some of the most poignant statements. According to MAGNUMs Executive Vice President Ms. Terri Miller Burchfield, "Two things became clear: this is a law enforcement problem, and new public policies or laws that will handicap physicians could lead to even more Americans suffering from poor pain management."
In one subsequent interview, the Oncology Nursing Societys Executive Director, Ms. Bridgett Culhane, informed us that her organization submitted reports to both Congressional Committees. She told us that "cancer pain is still under-treated in this country." In a cogently written letter from her NGO to Chairman Wolf and Ranking Member Jose Serrano, she stated that "ONS believes that the inadequate treatment of pain is a significant public health problem in the United States and requires the necessary public health response." The letter goes on to say " if continuous release oxycodone (OxyContin) were regulated strictly, this could pose a major problem not only for people with cancer, but for a multitude of patients with nonmalignant pain who are enjoying an improved quality-of-life because of OxyContin." She stated that pain should be viewed as the 5th vital sign! That refers to the vital signs checked by doctors and nurses, which include temperature, pulse, respiration, blood pressure, and now pain assessment.
But not every medical professional holds the proper treatment of pain patients as a top priority. Dr. Katherine Hamic, for example, addressed the panel at AEI by asking "Is there a crisis?" This physician then expressed "The simple point is that there would be no prescribing of this pain medication (OxyContin) if it where not for licensed physicians writing that prescription." She goes on to intonate that American doctors are over treating pain. To illustrate her point she notes that hospitals all over the country have signs on the bathroom walls for the nurse to see stating "Be a Hero, Reduce Pain to Zero!" She notes "There are legislative panels that prescribe the use of these narcotic medications for benign-pain .(and these) pain management doctors profit greatly from this sort of orientation." It is statements like this that could lead the concern over OxyContin to create dangerous public healthcare policy that could leave millions of American in agony.
In the words of LEAAs Federal Director "Its not that complicated." Ms. Griffith went on to tell us " there is a drug problem in this country, but we need to be careful to focus on the right issues here. Its not hard." And we agree, we need to separate the law enforcement problem from the health care problem associated with OxyContin and other drugs to protect patients rights to reasonable pain management regardless of the disease driving the pain. MAGNUM will continue to follow this issue closely and will report the concerns of pain patients to the Congress and media with the hope that patients with Migraine, or those who are otherwise debilitated by pain, can feel confident that no new government health policies will be created to lower even further their quality of life.
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