OxyContin Abusers Strain ERs

Aug. 20, 2001 -- Thwarted at pharmacies and doctors' offices, addicts and others who want the powerful painkiller OxyContin are straining already strapped emergency rooms in their hunt for the narcotic, doctors and other experts say.

And, they say, some of the drug abusers go to extraordinary lengths to convince doctors they are legitimate patients in need of the drug, sometimes even endangering those doctors, and ultimately even keeping legitimate patients from getting it.

"We're seeing a lot more patients coming in to the ER actually asking for OxyContin, and many times demanding it," says Dr. Larry Alexander, medical director of the emergency department at Central Florida Regional Hospital in Sanford, Fla., near Orlando. "We're beginning to see it more routinely because they can't get it on the street or the pharmacy."

In just six years on the market, OxyContin has become the No.1 selling brand-name prescription painkiller, and has a reputation for being easily and frequently abused. Federal officials say no prescription drug in the last 20 years has been so widely abused so soon after its release.

OxyContin, often known as "Oxy," is the latest in a long line of "hot" drugs illegitimate users have sought through the ER. Vicodin was the drug du jour a few years ago, and before that it was methadone.

While no hard figures are available on the degree of abuse, ER doctors in urban, suburban and more rural locales all told ABCNEWS in private e-mails and in interviews of a sense of siege, and said the demand for OxyContin was having a significant impact on their work.

Nationwide, a rash of thefts (see related stories) has prompted several drug-store chains and pain centers to stop selling the drug and post "no Oxy" signs in windows. The Drug Enforcement Agency has asked the drug's manufacturer to limit the drug's availability to pain specialists only.

What Makes OxyContin So Appealing TUESDAY: The Case For OxyContin: Patients' Advocates Speak Out

Growing in Popularity

Dr. Charlotte Yeh, chair of the American College of Emergency Physicians, and a practicing physician for more than 20 years, explains that a hospital's emergency department, known as the "ED," is a window on society.

"For those of us 'longtimers,' we could always predict when illicit narcotic supplies are low in the field, because we would get increased number of drug seekers in the ED desperate for a fix. The tightening up of OxyContin supplies is part of the reason for seeing increased drug seekers in the ED."

Dr. Richard O'Brien, a spokesperson for the American College of Emergency Physicians who practices in Scranton, Pa., says that spillover into the ER is "inevitable."

"Oxy was not such a popular drug a year ago," says O'Brien. "I have noticed more people asking for it, both hard-core addicts and pain sufferers who are tolerant."

And while addicts who seek Oxy from the ER are likely to have a very hard time getting their hands on it — the drug is very rarely prescribed there because it is slow-acting — ER doctors can nevertheless be tempted to prescribe it when patients say they've lost their prescriptions or are on vacation and can't reach their regular doctors.

Those excuses can force the already overloaded ER physician to have to painstakingly check on records and verify claims.

How They Do It

Remarkably, say doctors, the opiate-dependent person will always tend to "run out" of his or her medication at 5 p.m. on Friday, when their alleged doctors can't be reached for a few days.

Abusers will go to great lengths to pose as legitimate patients, too.

Yeh says she has witnessed patients tape rocks to their backs to simulate kidney stones on X-rays. Others deliberately cut themselves to contaminate urine samples with blood to feign a kidney stone.

"People will let you do amazing things to them," says O'Brien, "CAT scans, MRI, physical therapy, spinal taps; they will let you mutilate their bodies to get narcotics."

"Hard-core addicts and the occasional young male who likes oral narcotics and who has come up with an amazing array of allergies and medical problems for which there is no other medical answer other than OxyContin" is typical, he says.

Doctors Face Bodily, Professional Harm

Not all narcotic seekers leave in peace when their requests are denied. Yeh was nearly assaulted by a woman seeking a narcotic in the ER after the woman realized that her story was being verified.

"They're tough people to manage," says Yeh, who also witnessed a man claiming to be in pain use his crutches as a weapon when he was denied narcotics.

Alexander notes that his hospital was reported to state authorities for alleged malpractice for refusing to prescribe OxyContin. The case was eventually dropped.

The time required to do a work-up, check medical records, notify the primary care physician and investigate a substance abuse program, says doctors, can be significant, especially when there is a room full of patients in need waiting. And once the doctor realizes that the medical claim is fraudulent, they don't just leave it there.

"We don't just blow it off," says Alexander, "it takes time to sit down with them and explain why we're not going to give them their drug."

But such experiences have an even deeper impact on the practice of medicine, according to some physicians.

Dr. Donald Yealy, professor and vice chair of emergency medicine at the University of Pittsburgh, says that abuses of OxyContin instill a fear in physicians of prescribing the medication, possibly causing some physicians to hold it back.

"In the long run," says Yealy, "there will be more harm to those people who really need it."

Which is precisely what Penny Cowan, founder and director of the American Chronic Pain Association, does not want to see happen.

"It just adds insult to injury," says Cowan. "Imagine the worst headache, the worst pain, and you go to the ER for help and are only questioned. It can be very frustrating. Sometimes they're leaving without medications or with just enough for the moment."

Reason for Hope

O'Brien, however, believes that ERs are getting better at managing narcotics fraud.

"They're getting better at checking photo IDs. They will dispense only the adequate milligrams and number of pills and then refer the person to a primary care physician. Paper prescriptions now are multi-colored and do not photocopy well.

"We call in narcotics to the pharmacies which have pretty thorough systems for keeping medical information. The technology has also improved. CAT scans tell us with 97 percent accuracy in 10 minutes whether someone really has a kidney stone."

Still, doctors like Larry Alexander hope that the efforts of the manufacturer of OxyContin, Purdue Pharma, will help the situation.

Earlier this month, Purdue Pharma said it was working to develop a painkiller like OxyContin that would also contain an ingredient to prevent abuse.

Though the formulation would probably take three to five years to develop and be tested, doctors faced with narcotic seeking in the ER will likely be relieved when it's released.

"You feel angry many times," says Alexander. "You're put in a position where someone is seeking your help and you can't give it. It's a tough situation to be in."

TUESDAY: The Case For OxyContin: Patients' Advocates Speak Out