The truth about OxyContin (poem)

by Alexander DeLuca, M.D., FASAM – 2001-08-08; latest minor revisions: 2006-06-02. Source.

================

1) it is just another long acting opioid.

2) long acting opioids are good for a lot of reasons including that they are far less abuse-able if used properly.

3) if you lock yourself in a refrigerator, you will suffocate. This is an example of the improper use of a technology.

4) there is no significant difference between MS-contin, Kadian, OxyContin and methadone as far as the brain is concerned.

5) if you spill hot mcdonalds coffee on your hand under the sign that says, “watch out, hot coffee,” you will get burned. This is an example of the improper use of a technology.

6) we need short, quick-acting opiates, and slow, long-acting opiates. One size does not fit all. We have both endoscopic surgery for gallbladder disease, and open laparotomy for gallbladder disease. We need both.

7) if you park on a hill, leave the car in neutral, and fail to engage the parking brake, the car will run randomly down the hill and perhaps run a small child over. This is an example of the misuse of a technology.

8) it does not make any medical sense to punish the millions of pain patients to prevent what is, really, a comparatively trivial problem of prescription drug diversion. This is a media, police feeding frenzy. It is senseless. They will regret that they behaved this way.

9) all God’s children hurt or will hurt; nobody gets out alive.

10) they will regret they behaved this way.

11) it is possible to get 95% of all people with chronic pain down to pain levels of 0-3 using all the technologies we have, one of which is opioid medications. We should not rest until this is accomplished.

12) if you stick a small metal object into an electrical wall outlet, you will get a shock. This is an example of the misuse of a technology.

13) you cannot treat chronic pain in cancer patients without treating chronic non-cancer pain. This is a medical truth.

14) drug addiction can be treated. It is a minor problem, from a public health point of view, compared to chronic, untreated or under-treated, pain in this society.

15) you or your brother or your parents or your children or your nieces or nephews will get seriously injured, or develop a chronic painful illness, or will get cancer.

17) making sick people jump through hoops is damaging to the souls of those who hold up the hoops.

18) opiate medications are our friends. We need them.

19) they will regret they behaved this way.

20) we all need to show up and get back to work now.

[END]

17 Comments »

  1. Comment by:
    liz arce

    I’m on desperate need of a Dr that will prescribe my stable dose of methadone that I’ve been on for 2 plus yrs. My Dr abruptly retired and gave me a month and now I’m orphaned and terrified because I’ve only been able to find weak and scared drs who wont take me on as a pati,ent. Thus Med saved my life – I’ve had 2back surgeries and now suffer from failed surgery syndrome, herniated and bulging discs and ddd. I live in Chicopee MA and desperately need a Dr fast-please help. Email me at darkprincess121071[*at*]yahoo(-dot-)com

  2. Comment by:
    Kimo

    Am a pain patient, after 10 years of having cluster migrains, and back pain, after ten years of being prescribed opiate pain killers, i went to get a shot, [which my doctor told me to do] and a nurse [a neophite] gave me a hard time, and i am now havibng to fight for my right to pain reliefe, I have read much on it, and all i care about is pain relief, my doctor is standing behind me, and gave me another schipt of oxi, but I had to write a letter to admin, and am taking this nurse before the board, because she wrote “drug seeking behavior” on my jacket which clearly showes over 10 years of being phescibed pain meds. I am havibng to fight for my right to pain reliefe.I know i am but one of thousands running into this. it is madening. Just wanted to add my two cents. I have had to be my own doctor half the time, have had to learn medicine on my own. Am a male, with an IQ of over 170. I have a hard time believing the stupidity of some in the so called medical proffesion. A witch hunt is all it is. If niot for the pain meds i would be dead, plain and simple i would have taken my own life. The pain meds are the only thing that make my life livable. i am a disabled vet, who is pissed off. And, who can blame me? do you have any links to help for me? respectfully.Kimo

  3. Comment by:
    Alexander DeLuca

    Hello all,

    To Diana K. who left comments here regarding what the differences really are between, say, Oxycontin and MS Contin. I have deleted those Comments at her request, but I think the question is a good one.

    Here are two important concepts everyone interested in opioid analgesic medications should get, I think:

    1)There is tremendous variation between how different people respond to opioids – that is two different people with apparently the same underlying condition and who seem to be in the same amount of pain – these two very similar appearing people may require dramatically different doses to achieve good pain relief; and,

    2) An individual may response relatively well to one opioid and relatively poorly to another. That is, codiene may not work at all for you, but morphine will. Or morphine may work, but relatively higher doses are required and you get side effects like the itch’ies – but oxycodone gives you even better pain relief at relatively lower doses without any side effects at all.

    So, yes, opioids are different at the level of individuals doing better on one versus another. And they differ by potency, side effect profiles, onset and duration of action, etc. But THIS IS A POEM so, for once, I don’t have to be rigorously accurate. -smile-

    To Kimo: yes Sir, I can recommend a very good link for you – to a community that includes pain patients (quite a few of whom are vets), a few docs, a few quick-ass legal types, and experienced pain advocates. You will find good support, excellent information, and no double talk. I am referring to the:

    Chronic Pain Forums of the Pain Relief Network (PRN).

    Highly recommended.

    Sincerely,

    ..alex… Alexander DeLuca, M.D., MPH

  4. Comment by:
    Oceanbaby

    … I think I love you, Dr DeLuca.

  5. Comment by:
    docalex

    Wow. I am so flattered.

    I know poets – and I am way not a poet. Still, I like this one, too.

    Thank you for your very kind words, Oceanbaby. You made my day. -smile-

    ..alex…

  6. Comment by:
    Mike

    I am new to this but a person who lives in chronic pain. Being on 400mgs of oxycontin daily 5(80) a day and 4(75) Lyrica daily along with Xanac as needed. Going on 6 years of usage it finally caused terrible thoughts including suicide. I deemed necessary to rid myself of them completely but that was a terrible experience, went down on the oxycontin, eliminated the Lyrica completely and started with methadone, ridding the Lyrica took away thoughts, methadone was terrible am now usin only 3 oxycontin a day instead of 5 and although still in pain I am at best in 6 years and set goal to drop to 2 pills per day of oxycontin 80's knowing I will be on these rest of life but am at least functioning, the methadone was prescribed by a pain clinic doctor in which after 3 visits became the 2nd worse medical experience since my disability by what I think poor surgery. A person needs to trust the physician and all the degrees and knowledge mean nothing if distrust is present, the only person who knows the degree of pain is one experiencing it although pain clinic doctors seem to think they know it all I am preparing a total story in hopes Dateline will pick up and expose the facility.

  7. Comment by:
    Susan

    Hi My name is Susan.I am a longtime opiate user. I have been told by 2 surgeons that back surgery is necessary.I live in Massachusetts, so I am fortunate to have some of the finest Dr.’s around. I have just been diagnosed w/breast cancer.We’ve come so far that I know I will be a survivor.But get this the last back surgeon I seen ,although said it wasn’t my fault” for being on so much medication” I felt awful leaving his office that when I spoke to my oncologist, I lied about what and how much medicine I was taking because I am almost embarssed, because its SO socially criticized.

  8. Comment by:
    chiropractor plano

    if you spill hot mcdonalds coffee on your hand under the sign that says, “watch out, hot coffee,” you will get burned.

    But you can still sue mcdonalds and win millions. This is an example of the improper use of a legal system :)

  9. Comment by:
    Fed Up

    I pray to GOD I never need opiates long-term, as I develop tolerance very quickly in just a few days. This is a real problem! NO doctor would prescribe an increase in dose to cover an individual with this problem! Hope you have no ancestors from Turkey or other historical opium-producing lands!

    Because the DEA and state agencies record and monitor with great suspicion every narcotic pill doctors prescribe, doctors niggardly dole out opiate pain relief, if at all. My husband's pain contract threatens that his pain medicine will be discontinued if the opiate isn't working!

  10. Comment by:
    Justin

    I truly understand the hero (veteran) with a IQ of 170. I havé a IQ of 150 so I have the chance to be able to learn medecine by myself. I got Algodystrophy, the doctors are not very good, my doctor works for a pain clinic, he thinks pain killers kill the pain, they do mask pain only. I guess he does not care at all. Good luck everyone. P.S. Do you think pain killers reduce IQ ( Lyrica, Oxycodone, Elavil), I think that is the case…

  11. Comment by:
    kathleen

    Part of the problem I am having with the 30mg oxycodone, now having been on them for a few years, is the increased tolerance necessitating more doses (which is a known side effect even listed on pharmacy insert). I gave Suboxone six months, which of course got me through the withdrawals, but after two months I was back in bed with excruciating pain. having lost just about everything, the ER nurse said, well, if you can work, function, etc. on oxy, just stay addicted to the oxy! Starting back, was perfect — tolerance within "legal limits", but now here I am again, a year later, tolerance up. I've read where "pleasure addicts" ( I mean no disrespect, to each their own) do this thing called spin dry. I asked my Subox doc why couldn't we work a system where every so often we cleaned the receptors off and started again. the only thing he said was that it would take longer and longer to clean receptors. I've digested that but still don't understand. Do you know of a reason this wouldn't work? I just recently took two weeks with the Subutex, and at six a day, I could walk, but I would not be able to return to work as a stenographer ( in that positioning.) I will look into those trials you listed. I just wish both could be used without throwing you into withdrawal. thank you in advance. I just found your site.

  12. Comment by:
    kathleen

    Hi, Dr.,

    Kathleen again. So more specifically, if you or anyone else knows of a discipline that uses both forms or opiates (subox, etc. and oxy) for longtime users to have a quality of life, I would appreciate any info. Seems doctors are either/or. Could you maybe explain the "science" behind prescribing methadone with oxys, etc. and why that works so that I can try to figure out how to maybe formulate a system for me that doesn't include the downtime between the last oxy and the first subox and then the wasted first day on the subox? The scheduling of such a routine is lost on employers!!! thanks.

  13. Comment by:
    docalex

    Tolerance is rarely a problem in ADEQUATELY treated chronic pain patients. That is, once an effective dose is found by titration to analgesic effect, then dose stability over years, not chronic dose escalation, is the rule not the exception. And need for dose escalation, in a stabilized patient, over years is usually the result of disease progression.

    I believe inadequate titrations commonly produce what we call "tolerance." That is, patients get small dose increases that are not enough to 'close the pain gates' in the spinal cords. The patient does not much improve, and the doc gets frustrated. The basic problem is that everyone is trying to use the least amount of medication possible, rather than the amount that would provide relief, and allow healing to begin.

    In other words, doubling an ineffective dose of, say morphine, from 100 to 200 mg a day would more likely produce significant pain relief and dose stability over a year, than would giving 25mg increases 4 times over a year. Both patients would end up on 200mg a day, but the former will have less pain and greater functioning, and the latter will have experienced neither relief from pain or functional improvement in the world.

    21. This is an example of a medical treatment distorted by law enforcement imperatives (catch addicts above all else or else!) placed on physicians. :-)

    Please understand, docs have no medical reason for caring one bit whether a patient is stabilized on 100mg or 300mg of whatever opioid – it makes no medical difference. If the patient feels better, gets stronger, and becomes more pleasant to live with, everyone involved will feel very good about the medical care, and no one will care how many milligrams it took. It is a shame this outcome is so hard to get.

    love,

    ..alex… Alex DeLuca, M.D. doctordeluca@gmail.com

  14. Comment by:
    Gianna

    I am in Massachusetts. Does anyone know of a compassionate doctor who will treat me like a human? I have legitimate pain problems with enough records to back me up. Im so sick of being undertreated and labeled. That chronic pain forum is no longer available. I have searched and searched for a doctor and I cant find one!

  15. Comment by:
    Alexander DeLuca

    Very sorry, Kathleen, to be so long in replying. I reply to very few Comments – I am no longer very actively maintaining this website, but keep it going as an information resource and allow Comments so people can vent and share info; but this isn’t a Forum. But I was reading through the Comments on this page and saw your Comment and wanted to clear up one thing.

    You wrote: “I just wish both could be used without throwing you into withdrawal.”

    This is a very common area of confusion. First of all, this business about Subutex (buprenorphine withOUT naloxone) throwing people into withdrawal if they are already on opioids is mostly spouted by American docs who have never once seen this happen. In Europe where buprenorphine is the #1 med for chronic pain, they do not describe this happening.

    Nevertheless, the theoretical problem is when a patient on chronic opioids starts buprenorphine. Adding a pure mu agonist opioid (morphine, oxycodone, methadone, fentanyl, hydrocodone, hydromorphone, etc) to a patient on daily buprenorphine is NOT a problem – the patient will not (even theoretically) go into withdrawal.

    ..alex…

  16. Comment by:
    Cranky Pain Patient

    Southern New Mexico has lost another pain management practice thanks to yet another witch hunt Dr. Jain in Las Cruces will no longer provide pain management services as of June 1. I suspected that would be the case when a television news crew from a local station got its hands on a list of doctors and how many prescriptions for pain medication he was prescribing each year.. This news station did not exercise any concern for the patients who will now have to find new doctors and begin the whole process of establishing rapport with said new doctor and staff. Such compassion for these patients makes me feel all warm and fuzzy inside. Not.

  17. Comment by:
    Dudley Stamps

    I agree 100% that Oxycotin is a very good Pain medicine! I have had to take it in the past and never became addited to it or had any other problems whatsoever! I took it as prescribed! I did not crush it and sniff it up my nose to burn my brain out! To Hell with all those fools that do such Stupid things! If it kills them then that is just too bad, they would have done it with something else later on anyway! To say Oxycotin caused it is like saying knives are too sharp and will cut you! If they are made more dull then you complain because they do not cut well! The Media and Lawyers are the Two most Low Life groups of Sorry Useless Scum Bags in the World! Every breath they take is a waste fo perfectly good Oxygen! Why make those in servere unbearable pain suffer because of a small prencentage of Idots that misuse a perfecly good drug! To Hell with those people, they do not need to be alive anyway if they are that Stupid and that includes you Sorry Bastad News people and Damn Lawyers that make up a story if there is not one there! Research your facts and then Report on them in a fair and responsobile way instead of telling all these Lies!! You sorry Scum should be held accontable for your actions!

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