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Dealers, Family Biggest Sources of Illegal Prescription Painkillers

Study refutes notion Internet is major supplier of Oxycontin, other opiods

FRIDAY, Feb. 9, 2007 (HealthDay News) -- Despite media reports of addicts getting prescription painkillers such as Oxycontin from the Internet, most of them are actually getting these drugs from family, friends or dealers, a new study finds.

A second study, which looked at the abuse of these drugs in the general population, found that more teenagers are getting their hands on these powerful medications.

"Illegal prescription pain medication use is a very complex, multi-faceted problem with many different sources," said Dr. J. David Haddox, who co-authored both studies.

A dentist and a physician, Haddox serves as vice president of Risk Management and Health Policy for Purdue Pharma. The Stamford, Conn.-based company makes OxyContin, a popular narcotic prescribed for the treatment of moderate to severe pain.

Other Purdue Pharma employees were involved in the two studies, which were presented Thursday at the American Academy of Pain Medicine in New Orleans.

In the first study, Haddox' team focused on more than 5,800 clinically diagnosed drug addicts whose primary drug of abuse was identified as an opioid analgesic.

All the patients were enrolled in a methadone treatment program at one of 69 centers in 33 states during 2005. Over 95 percent of the men and women were non-Hispanic white, and almost 57 percent were employed during the study period.

Questionnaires were administered to identify all drug source options accessed by the patients.

According to the researchers, almost 82 percent of the patients said they illegally obtained their prescription medications from a drug dealer. Just over 50 percent said friends or relatives were also a source, although no information was gathered regarding where those contacts originally got the drugs.

A little more than 30 percent said a doctor had prescribed them their opiates, although it was not clear if such prescriptions were obtained through trickery or collusion.

Emergency room visits were a source of the drugs for just under 14 percent, while theft constituted about 6 percent and faked prescriptions just under 3 percent.

Internet purchases were reported to be a source of drugs for just 2.4 percent of the patients, the study found.

Haddox said the findings, while striking, should be interpreted with caution.

"This is the first time we've looked at this particular population in this magnitude and in this depth, and that's important," he said. "But I would not want the results of this particular survey to be seen as generalizable to all drug abuse patients, because this is a very distinct subset who is so far along in their disease of addiction that they are seeking methadone maintenance treatment -- people at the far end of the spectrum."

"So, for example, I don't want to say that the Internet is not a problem at all for drug sourcing among any drug abusers, because the (U.S.) Drug Enforcement Administration certainly thinks it is," added Haddox. "It's not showing up in this work, however, so we just need to do a lot more research to solve the puzzle."

In the second study, the team conducted 258 phone interviews with law enforcement officers, physicians, pharmacists and drug abuse treatment staff located across 40 states.

The researchers identified hydrocodone, oxycodone and OxyContin (which contains oxycodone) as the most frequently abused prescription analgesics, with their use rising among teens.

As well, abuse of these drugs was found to be equally common in rural, semi-urban, and urban areas -- countering a popular assumption that the problem is more widespread in rural areas than elsewhere.

The survey also revealed that individuals often abused prescription antidepressants to counter some unwanted side effects of methamphetamines.

"This study really showed the value of looking beyond numbers to get at the source of the problems, which varies from community to community," said Haddox. "I think this gives us an opportunity to better educate the public about dangerous misperceptions and behaviors."

Dr. Adam Bisaga, an associate professor of psychiatry at Columbia University and an addiction psychiatrist at the New York State Psychiatric Institute in New York City, expressed surprise at the marginal role the Internet is playing as a source of illegal prescription painkillers.

"This might not be the right group of people to look at to see if the Internet is a real problem," he cautioned. "My impression is that patients -- especially younger, computer-savvy patients -- do cite the Internet as one of their big sources, but methadone clinics typically have older patients with established networks for getting drugs, so they might not be the ones most likely to turn to the Internet."

Another expert wasn't surprised by the findings, however.

Dr. H. Westley Clark is director of the U.S. government's Center for Substance Abuse Treatment, part of the Substance Abuse and Mental Health Services Administration (SAMHSA). He said that the 2 percent figure for those sourcing drugs off the Internet "is not zero, so the Internet is a source, but it's not a major source for these drugs. We look at a general population rather than hard-core users to see where people are illegally getting their drugs, and what we find is that just 1 percent is buying it off the Internet."

"About 60 percent are getting their drugs from friends and family for free, while another 15 percent go and buy them from friends," Clark said in reference to numbers from SAMHSA's 2005 national survey of drug use, which also confirmed that opioid analgesic use is on the rise among teens. "So, in the case of a general population, drug dealers aren't the biggest problem either, although it's certainly no surprise that hard-core addicts are getting it that way," he said.

"Of course, we can anticipate the possibility of a growing Internet problem, particularly among young people, and we need to have some controls," Clark added. "Things change, so you can't lose vigilance. But we also do not want to exaggerate the magnitude of the current situation, and we certainly do not want to deny people with real health problems their medications."

Haddox agreed. "I'm a pain doctor by training, and I've talked to many patients who said their treatment has literally saved their life," he said. "And yet you've got these other folks out there abusing them. So the public policy question is how you balance these two issues. I don't have the answer."

More information

There's more on Oxycontin abuse at Substance Abuse and Mental Health Services Administration.

SOURCES: David Haddox, DDS, M.D., dentist and physician, and vice president, Risk Management and Health Policy, Purdue Pharma L.P., Stamford, Conn.; Adam Bisaga, M.D., associate professor, psychiatry, Columbia University, and addiction psychiatrist, New York State Psychiatric Institute, New York City; H. Westley Clark, M.D., J.D., M.P.H., director, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, Md.; Feb. 8, 2007, presentations, American Academy of Pain Medicine annual meeting, New Orleans
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