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If Heroin is Illegal, Why Is OxyContin Legal?
On May 5, 2009, the FDA invited me to provide testimony for a second time before a special FDA committee that was investigating what Risk Evaluation Mitigation Strategies (“REMS”) to impose on dangerous prescription narcotics like OxyContin. (See February 16, 2009 Novus newsletter about the REMS process.)
During my testimony, I stated that this is known about heroin and OxyContin:
- Heroin was initially advertised as being less addictive than morphine and widely promoted in the United States for the treatment of pain and respiratory problems;
- Because of its addictive qualities, heroin was made illegal in 1914;
- OxyContin was released to the public in 1995;
- Purdue Pharma, maker of Oxycontin, pled guilty to lying to the FDA, doctors and the public in 2007;
- Purdue Pharma’s influential friends saw to it that OxyContin stayed on the market even though equal application of the law required that Purdue Pharma not be allowed to do business with the government (see Different Justice For A Drug Dealer);
- Heroin and OxyContin are molecularly almost identical;
- Heroin and OxyContin operate in the same manner in the body;
- Heroin and OxyContin are interchangeable and addicts regularly use the one that is available;
- OxyContin is easily obtained from a number of doctors who prescribe it for any excuse as long as the patient can pay for the office visit;
- According to the studies cited in the March 2008 issue of Pain Physician, use of narcotics like OxyContin in the treatment of non-cancer pain patients has little benefit and many side effects.
My question was, “One of our patients, a former heroin addict who used OxyContin when he couldn’t get heroin and heroin when he couldn’t get OxyContin, but preferred OxyContin even though it was more expensive because it was safer, asked, ‘Why is heroin illegal and OxyContin legal?’” There was silence from the panel and, unfortunately, there was no way that they could be compelled to answer.
The reaction was much different when I was asked to testify before Massachusetts State Senator Steven Tolman’s panel on OxyContin and heroin abuse on May 15, 2009. Senator Tolman is not your typical politician. He is a tall, straight talking man who lists his home phone number on his business card. Senator Tolman doesn’t sit in a plush office and read about the “statistics” of death caused by heroin and OxyContin—legal heroin.
His OxyContin and Heroin Commission is appropriately named. The Senator understands that it is just “drug company speak” to imply that OxyContin is not interchangeable with heroin.
When he spoke to me after I testified, he was proudest of his ability to help some kids get off OxyContin and heroin, not by getting on methadone, but by getting treatment and being off all drugs.
Senator Tolman feels so strongly about how these drugs are destroying the lives of so many of the young people in Massachusetts that he is on a mission to make sure that the state of Massachusetts actually provides real help—not just words. He tells people that it is not just something nice to do but, in addition to saving lives, really having a solution to these drug problems will save the taxpayers of Massachusetts hundreds of millions of dollars a year.
Senator Tolman wrote the following article that appeared in the Boston Globe May 11, 2009. We want to share this eloquent and forceful article with you.
The deadly epidemic no one’s addressing
MASSACHUSETTS taxpayers are being robbed. Families are having their loved ones stolen from them and taxpayer dollars are lost in a system wrought with inefficiencies and gaps in care. This epidemic is silent because of the stigma, shame, and heartache that the disease of addiction places on families. OxyContin and heroin addiction continues to be a devastating issue, but there is a lack of outrage over this decade-long tragedy.
Since there are promising alternatives that will save both lives and hundreds of millions of state dollars, now is the time to break the silence and make reforms to Massachusetts drug policy.
There are numerous pathways to addiction. Some citizens receive prescriptions for OxyContin for pain after an injury, while adolescents and others experiment with pain medications from medicine cabinets. Synthetic or natural opioids are heavily addictive; the long-term neurobiological changes opioid dependency exacts on the brain are profound and make the disease difficult to treat with an outdated infrastructure.
Since 2003, overdoses, primarily from OxyContin and heroin, have exceeded motor vehicle deaths as the leading cause of injury-related death in Massachusetts. Between 2002 and 2007, the state lost 78 soldiers in Afghanistan and Iraq. In the same time period, 3,265 residents died of opiate-related overdoses. We are losing citizens at home at a rate 42 times greater than we are losing our soldiers in war. Yet, these gut-wrenching stories rarely make headlines, and little is being done to examine the problem and implement solutions.
Private insurers have drastically reduced payments for substance abuse treatment; taxpayers contribute more than 75 percent of the dollars spent on substance abuse services in Massachusetts. In fact, private insurance payments for substance abuse treatment decreased 1.1 percent annually from 1991 to 2001, while public payments increased by 6.8 percent each year. As shocking as these statistics are, they cannot portray the heartache, frustration, and despair in the thousands of households around the Commonwealth.
In 2007, 1,300 people received five or more acute treatment services or "detoxes" through MassHealth. I believe that long-term treatment programs and diversion from jail are essential to remaking our treatment infrastructure. Targeted investment, efficiencies in the system, and changes in policy will save hundreds of millions of dollars in direct and associated costs on state and municipal governments. For example, 18,000 individuals were treated in emergency rooms for opioid-related overdoses in 2005. These hospital stays alone cost the state nearly $200 million.
Recently, the OxyContin and Heroin Commission, established during the 2007-2008 legislative session, held the second in a series of public hearings throughout the state. The commission’s purpose is to investigate the levels of addiction to OxyContin and heroin, study the laws regarding treatment, gauge the epidemic’s cost on state services, and offer solutions. We’ve heard from parents who have emptied bank accounts or remortgaged homes paying for private treatment because insurance won’t cover long-term care. Families have described reviving their dying children with Narcan, or having them arrested for felony drug charges to get them off the streets. Otherwise good people appear in our courtrooms, end up in jail or the ER, or spend a lifetime on harm-reduction medication because there is no clear path to recovery.
This problem will not be fully addressed overnight; policy recommendations must be comprehensive solutions to the overall campaign against addiction. The commission’s objective is to find the proper treatment outcomes, efficiently spend taxpayer money, and return addicted loved ones to their families. Substance abuse is a national problem, demand for illicit drugs in the United States continues to rise, and the connection with foreign policy makes this problem all the more urgent. National and state leaders must work together to implement effective treatment measures. With all of the efforts to fix economic systems, repair roads and bridges, and revamp the healthcare system, addiction treatment cannot be left out of the equation.
Sometimes it seems almost naïve to think that ordinary citizens can effectively take on a corrupt drug company that has hundreds of millions of dollars to use to make political donations and pay lobbyists. Sometimes in the middle of this struggle it is difficult to take seriously the words of Thomas Jefferson, “A majority is one man with courage.”
However, all of us can take heart when we see that there are men and women in public life who are not interested in the drug company money but care more about the well-being of their citizens. Senator Tolman is a man with courage, and he is making a difference by not ignoring this plague but by speaking out. If you also value his courage and commitment it would be great if you sent him an email and let him know.
Senator Tolman is planning to join many of us at the next series of FDA hearings on May 27th and May 28th. His powerful voice will add more strength to our cause.
Novus Medical Detox Center is proud that we are helping people safely and more comfortably withdraw from OxyContin, Vicodin, methadone, heroin, alcohol, Xanax and other opioids and psychoactive drugs. If you know of someone that needs assistance getting free of an unnecessary and unneeded substance, please contact us.
NOTE: This information is provided for general educational purposes only and is not intended to constitute (i) medical advice or counseling, (ii) the practice of medicine, health care diagnosis or treatment, or (iii) the creation of a physician patient or clinical relationship. If you have or suspect that you have a medical problem or that this information may be useful to you or others, please consult with your health care provider before applying any information from our articles to your personal situation or to the personal situation of others.
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