Focus 580; Painkiller: A Wonder Drugs Trail of Addiction and Death

When the prescription painkiller Oxycontin was first introduced back in 1906 it brought relief to a lot of people who were suffering with chronic pain and it had a special feature that made it very useful it was designed with a time release feature so people who were suffering with cancer or suffering pain after surgery for example could take that one pill and that it would allow them to get a good night's sleep. However this drug also had a dark side it was potentially highly addictive and it wasn't very long before abusers discovered that by simply crushing the pill they could get around this time release function and they could get the full dose of the drug all at once and very quickly it became a serious problem and in fact while marijuana remains the nation's most abuse drug according to government and private studies narcotic pain relievers like oxycontin along with some other prescription medications have now overtaken. Amphetamines to rank number two this morning in this part of focus 580 We will talk about some of the troubling issues raised by

the painkiller OxyContin and our guest for the program is Barry Meyer. He's a investigative reporter for The New York Times. He's been nominated for the Pulitzer Prize for his work in 2002. He was a recipient of a George Polk Award for outstanding journalism. He's written quite a bit on the subject of oxycontin and also now is the author of a book length treatment of the issue. The book is titled painkiller that's as two words the subtitle A wonder drugs trail of addiction and death and it's published by Rodale. It's out now. Questions are certainly welcome from people who are listening. If you're here in Champaign-Urbana where we are 3 3 3 9 4 5 5. We do also have a toll free line and that is good anywhere that you can hear us. And that's eight hundred to 2 2 9 4 5 5 3 3 3 W I L L and toll free 800 1:58. W while Mr. Meyer. Hello. Good morning David are you. I'm fine thanks and yourself. Very good thank you I'm out.

Well we appreciate you giving us some of your time. The the active ingredient in the drug and Oxycontin was something that that had been around. It was in other medications and different kind of formulations. And in fact the manufacture of Oxycontin did have another kind of drug that was that was similar that used the same active ingredient. What what was different a box about Oxycontin when it came on the market. Well two things are essentially different about Oxycontin was the drug in terms of the formulation of the drug. You're absolutely right. The active narcotic a drug called oxy Co don't that's been used in other painkillers that are known under brand names like Percocet for Gadahn Tylox but oxy frontin was unique in that it had very high levels of this particular drug. This narcotic because it was intended as you said earlier to last for 12 hours so these other drugs were short after short acting drugs so that made it unique which also made it unique is that it got a special label from the

FDA the FDA and the manufacturer thought that because it was a longer acting drug it would be less attractive to people who abuse drugs because people tend to like a quick hit from a drug so they got a label that said it might be less prone to abuse. This abuse appeal than traditional narcotics because it was a long acting drug. But what also made this drug different was that it was introduced at a time when there was a real sea change taking place in medicine and in our perception of the risks of narcotics and also because it was promoted far more aggressively and far more widely by its manufacturer than any other previous long acting narcotic of its power. Well let's talk about those two things and the first being that or as you say around the time that it was introduced there was a small number of physicians but a number that did grow over time. Doctors who were looking at the way

pain was treated and who were saying that there are people who are suffering needlessly and that we should be more aggressive about our treatment of pain perhaps we shouldn't worry quite so much about the kind of medications that are available particularly for their addictive properties. Essentially they're saying look people are suffering and that's just that does not need to happen. Well you know it's throughout the really throughout the whole past 100 years I tried to trace this. The situation in the book you know our country has gone through a kind of love hate relationship with this particular class of drugs narcotics. We can do it. There is times to look at them as completely dark. Drugs anyone will take them will become addicted to them and then more recently we tended to look at them as totally in reaction to that is kind of white drugs where they really didn't hold any risks. Now it's a set kind of things into time into time context back in the 1980s was kind of a period where we're looking at these as Doc drugs were very concerned about their risks and as a result lots of people with serious pain cancer patients etc were being denied

access to these drugs or warrant being given sufficient quantities of them to deal with their pain. That's a a movement was born that became known as the pain management movement that began to advocate for a more you main and broader use of these drugs. But to kind of get that message of cross they kind of had to show the addictive side or the potentially addictive side of narcotics into a black box and kind of set that off the stage. And so you kind of then came into an era where the real risks of these drugs and there are real risks were downplayed in order to make them more acceptable. It is true though that there were studies done that showed that for example people who were suffering with cancer or people who were have other kinds of very severe pain that for those people if you gave them these narcotic drugs that they they did not become addicted. Well I mean there certainly were studies that show that people. At the risk of addiction

it was it was small. I'm not aware of any studies that really show that people did not become addicted. I mean cancer patients it's sort of I don't think you can look at all pain patients as a kind of single universe pain is a very multifaceted type of health problem. It can accompany problems like Count counts or it can come out of chronic muscle injuries it can have psychological components to it so you really can't you know people tended to generalize from the experience of cancer patients which was very positive positive to the general community of pain patients and in making that leap. There was really no it. It's to support what was going to be the impact here in more general pain patients. Well and that does get at the criticism that people that many people physicians and people in government and people in law enforcement and people in the community that try to help folks who have substance abuse problems all of those people was one of the

criticisms they have leveled at the manufacture of Oxycontin is that the company in the interest of making money aggressively promoted the drug to physicians and went and went beyond the initial kind of groups that might have seen to be good cat or good potential users for the medicine that is cancer patients and people extreme pain and enlarge that in large that universe and started suggesting that people with other kinds of pain were also appropriate that also would be appropriate medication to treat them to. Well I mean there's no question that that the company did that that was you know they were legally entitled to do that because of the way the government approved the drug but they had a lot of you know sort of cool facilitators and this is well it wasn't just the company. There were a lot of pain specialists who sort of believed in this were strong components of the use of this drug. And the real problem developed as far as I could see in that

broadening the use of these drugs also brought it into the hands of many many doctors who weren't really skilled in the use of these drugs nor were they particularly trained to kind of look at their patients and say you know this patient could be this or it could be a problem for this patient this is not really a suitable candidate for this type of drug. I could give it to this patient but not this other patient. And so basically you had what is essentially the most powerful drug available to treat pain being used to treat often moderate or less severe pain conditions and I think once you start increasing the availability and accessibility of this kind of powerful narcotics you're essentially asking for trouble and. Trouble quickly following are our guests let me introduce again I get our guest anybody who might just have tuned in Barry Meyer He's an investigative reporter for The New York Times and has authored a book on the subject here we're discussing some of the problems associated with the prescription painkiller OxyContin. His title book is titled Pain killer. The subtitle A wonder drugs trail of

addiction and death that's published by Rodale. Questions are welcome 3 3 3 9 4 5 5. Toll free 800 to 2 2 9 4 5 5. The manufacturer of this medication was not one of the big drug companies. What did it mean to Purdue Pharma the maker of the drug to be able to have this. Well the search for this company produced pharma this was a blockbuster I mean this drug quickly became a billion dollar drug. It quickly accounted for 70 to 80 percent of produce sales and it basically took it from the ranks of a kind of small family family owned company in Connecticut and set them on the path to becoming a major pharmaceutical manufacturer in fact they began giving speeches that this center was going to be our ticket this drug was going to be our ticket to the big time you know their sales ranks doubled. It was kind of a boom time for this for

this company and I guess where I also raise criticism of the company in my book is you know raising the questions about well how did they react when. I'm the one you know they were seeing this incredible explosion in sales and then reports starting to dribble then coming to their attention that this drug was being abused with the drug first became available in 1996 when was it that it started to be obvious that there were problems with abuse. Well you just said it to be a sort of a subjective word a Certainly the if it became reports of abuse began to build in 1999 and then sort of exploded at the end of 1999 into early 2000. But what's very significant was that in 1988 there was also a report in The Journal of the Canadian Medical Association which essentially undercut the theory that this drug was being marketed on that. That is the idea that these longer acting

narcotics were less appealing and have less so-called abuse potential or use liability than shorter necked acting narcotics in fact this study said that. Drug addicts and drug abusers would be drawn to these longer acting drugs because they had far more narcotics in them than the shorter acting drug. And you know they were the reports of the should sound a warning bell but in fact that Bell was never sounded to the doctors who were prescribing these drugs for as I could tell. Well do it obviously. ALL manufactures a prescription medications try to market their products. But now increasingly they're marketing to the general public but historically they have marketed to doctors and they have sales people and they drop in on doctors and they glad hand them and they give away stuff and they do everything they can to try to get the doctor to prescribe their medication including no doubt providing them information on them on what they the manufacturer thinks are the benefits of the drug. Did the people who are representing Purdue Pharma do

anything different than any other drug manufacturer. No I mean they basically did what every drug manufacturer does but the drug that they were doing it with thier was a very very high powered narcotic that had significant consequences in the in the general population usually when when there are problems with the drug they usually manifest itself in the patient. You know there's a side effect. You know there's liver damage. There's this kind of damage and and we read about problems with drugs and usually usually has to do with problems that occur in patients taking these drugs for medical purposes. Here the problem exploded in the greater community and that's what made this story particularly interesting to me as a reporter do you think it we started out. Talking about you started out talking about the pain management movement something that started at about the same time that this drug started to become available where some growing numbers of physicians particularly people who specialized in dealing with pain were saying to

to their fellow doctors saying look you know there are a lot of people in pain and perhaps in the past we've been too conservative in treating this and that was a mistake we didn't need to. People are suffering needlessly. And so there and there were a number of physicians that were very publicly speaking about that talking with other doctors in a sense trying to spread this word. And that's something that the manufacturer of the drug obviously saw and really tried to to take advantage of did it. Is there some way I don't know if it's too harsh to say that they that they co-opted in part to the very legitimate movement to get more aggressive treatment of pain and that they did that simply because they were interested in selling more OxyContin. Well I mean you can look. It cynically or you could look at the sort of more sympathetically I mean there's no question that this manufacturer in particular as well as others nurtured both sort of emotionally and financially the pain management movement pain management exercise will say look we have to take money from these companies because we weren't in

any research money from the government and in fact that's true. The federal government really wasn't supporting any research into pain treatment. And again bearing in mind that this this this is a management movement was a very legitimate valid medical movement. But you know at a certain point cooptation does take place. People do align themselves emotionally psychologically ideologically with a manufacturer potentially as as happened in this case because their interests their ideas their visions really were aligned here and you know one of the tragedies of this story is that many of these pain experts the people that were advocating for these changes did not stand up when they saw the abuse taking place because they were afraid that they were going to roll back the clock. The people that did stand up were small country doctors including you know a character who's a

central character in my book a small town doctor in very western Virginia. He was the guy who stood up and spoke out on behalf of his community it wasn't the pain management doctors that were doing it. The FDA has to approve medications for use and for specific uses although it is true that any doctor can prescribe bethink any medication for any you know they call it off label use and a doctor can do that but generally speaking you know medicines are proofs for specific kinds of abuse. And part of the the selling feature if you if you will for Oxycontin was that even though it had this very heavy load of narcotic it was packaged in this time release form and so then the manufacturer could say well now this this actually makes it less likely that this drug is going to be abused. So I guess I'm going back to how it is the FDA approached the approval for the drug and what they said this drug should be good for and whether you think in fact that also government

regulators really ignored what was a potential a very large problem at the at the outset. I think that you know that the government regulators blew it virtually all down the line here I mean they certainly blew that at the beginning because they did not require Purdue or if there had been any other manufacturer to making the same claim to actually. Run tests to determine this. There was not a single test that was wrong with this particular drug prior to its release to support the theory and it really was just the theory that this drug would be less prone to abuse. It was basically an idea theory that was extrapolated from a report or experiment reports about other drugs but this drug itself and this kind of narcotic had never been tested. And for the government the FDA to have approved this labeling on that basis I consider to be scandalous. Well is it when people are looking at potentially hazardous drugs particularly like this

is it common that they do testing looking at the ways in which people might use this drug. Other than the way that it's intended to try to determine whether indeed there is a potential problem because what happened here was formulated in a particular way and tested that someone is going to swallow it. Well certainly yes they certainly can do that thing. There are laboratories that specialize in that testing and some companies have done such testing to the best of my knowledge in the in this particular case. This testing was not done by the manufacturer. You know essentially they didn't take a bunch of drug addicts or drug abusers put him in a room and say OK guys are and ladies here let me pour some of these pills out on the table in front of you. What would you do. How would you get. You know how would you get your best time out of this drug that was never done to the best of my knowledge. When it became more and more people started noticing that there was a problem and in particular you pointed to the physician that you talked about it. Some people said well you know

there's one relatively easy thing that we could do simple thing we could do to stop this and that was to change the formulation of the drug and that it would be possible to change in a way so that person taking it in the appropriate way would still get the desired effect but that the abusers who had find that way around that could continue doing what they were doing but then it wouldn't work for them. Is that. And so how did the company respond to that suggestion that by changing the way that they meant manufacturer changing the formula then that would take care of this serious problem. Well I mean the problem being is that it wasn't simple quick fix. Or the purported quick fix wasn't quick or easy and the company has been working for several years to try to do what you know incorporate essentially what's known as an opiate blocker into the drug and has not succeeded. Other manufacturers recently have handed other versions of this drug that contain sort of the

safeguard if you will but they're really in the testing stage now and they haven't advanced to the marketplace so we don't know once they've gone on to go out onto the market whether they would be successful in in achieving that goal. So the other thing that I guess they would have been easier than Also the people who were concerned about this problem suggested is that the manufacturer should put the word out to all physicians to anybody who might think about prescribing the drug that it was that there was this potential problem and so that it ought to be it ought to be prescribed with great care and only in the situations where it was really needed and really appropriate How did the company respond to that. Well I didn't not until much later. Essentially you know I sketch out some scenes in the book where this particular physician whose name was our Dan Z you know approaches the company one of their scientists and other and said look I want you to send a letter out to every doctor in the country tell them what's going on you know warn them about this. Tell him about

this and you know he essentially gets blown off I mean what really sort of propelled I believe anywhere in the company to do it was newspaper coverage and in papers like The Times that that you know cast a spotlight on the dimensions of the problem the company was totally you know is characterizing this is isolated in a little few towns here and there you know. And it was not until July of 2001 after the company had extensive negotiations with the FDA that they sent a letter out to every doctor apprising them of this before they had simply asked their salesman to do so and to change some you know describe the drug a little differently but as far as a direct letter warning letter to the doctor did that to not happen until July of 2001. We are getting closer to the midpoint of the program I just like to introduce Again our guest Barry Meyer he is an investigative reporter for The New York Times he's been nominated for the Pulitzer

Prize for his work. In 2002 he received a George Polk Award for outstanding journalism he's written about Oxycontin. He wrote about it for the paper for the New York Times and now he has a book length treatment discussing a lot of the issues that we here have been talking about. The title of the book is pain killer and the subtitle of wonder drugs trail of addiction and death and it was published by Rodale. It is out now in bookstores if you would like to read the book and of course hear questions and comments are welcome. The number in Champaign-Urbana 3 3 3 9 4 5 5 we do also have a toll free line that's good anywhere that you can hear us and that is 800 to 2 2 9 4. 5:5 the company that makes OxyContin Purdue Pharma is privately held. So you don't have the access that you might to the decision making process to help people in the company think that you would if this was a publicly held company and they have been they have not been inclined to open

up to you and I'm sure not to other reporters. Do you have some sense or is there any way of saying how company management really thought about this and what sort of discussion there was about whether there was a problem and B what to do about it. Yeah I mean I wish I had some better insight into that I really don't I mean anything I would say at this point would be sheer speculation but it would be fascinating to know because here you have a company that you know one day or is you know is thinking it's on the top of the world it's got a drug that's going to you know you know pulling in a billion dollars a year from this drug and then suddenly Coke Luly you know it's starts getting a little. Dribs and drabs of information and then it starts become more of a steady stream and suddenly there's the flood. And you know I had hoped when I was working on the book to kind of document that in the book. But as you said the company declined to

be interviewed by me and and it really hasn't made itself available to any reporter or journalists. And you know you can kind of understand that when you're looking at maybe three or four hundred lawsuits which the company is looking at now. This is was and is a prescription medication so you have to go to a physician and you have they got a righteous script so you can go out and get the medicine. How is it that you know given the fact that there is that kind of control that this and apparently some other medications like it have become so widely abused and what really is the problem because someone's got to be writing prescriptions for these. Well you know David one of the fascinating things you know I think that I try to do within the book and because the book is about. Oxycontin but it's really talking about this whole new era of abuse that's taking place that we see unfolding around us now in the era of narcotic painkiller abuse as you mentioned in your opening this is now the second most abused drug in the country and one of the one areas of drugs that is growing in abuse

rather than declining. You know I think a lot of it has to do with you know it's the availability of these drugs in some part the increase prescription of these drugs in recent years but you know they make their way into you know out of the medical severe in various ways one is inappropriate prescribing to use over the Internet. You know I don't know whether you get bombarded as I do with internet advert advertisements for you know like in other types of painkillers. Some of it is smuggled into the country but we're basically awash in these drugs right now to the point where I think you may have mentioned in your opening that you know the federal government the White House has now pointed to prescription drug abuse and the most significant drug problem we face at the moment. How much of this is if we look at prescriptions that are written by physicians would be physicians who are writing carelessly who may

in fact be somehow benefiting. And in that sense and others that are just they're prescribing and they think they think that they're prescribing appropriately but that they're not thinking carefully enough about whether this is the right medicine for that particular patient. Well I mean I think the the doctors who are running so-called pill mills or script Mills who you can go to pay you know hundred dollars for a for a physical and the right to any prescription you want. Really. You know our tiny minority of physicians though the damage they can cause is you know inversely proportional to their numbers because you can just have huge floods of these drugs coming out of such offices. I mean these are the real criminals that somehow have managed to also get medical licenses. The other side is doctors who are honestly doing their jobs who are getting either scammed by

patients who are you know addicted to drugs out of these drugs or who. Lack the time or the inclination to be more discriminating in how they prescribe I mean you have general practitioners in many parts of the country. Who are you know seeing hundreds of patients a week. They have 5 to 10 minutes to spend with a patient and that's really not enough time to identify whether this is a patient that's prone that has an underlying substance abuse problem. If you prescribe them for circular pill a narcotic may end up abusing and becoming addicted to that drug. Well it seems that's the kind of thing that that you could address in a couple of ways. You put some responsibility on the manufacturer to say to physicians look this is a very serious drug and treat it with respect. Also the FDA could put out a message like that also physician organizations could do the same thing so it seems that the piece at

least a piece of this is educating physicians to make sure that they are aware of the potential for the medication so that they are prescribing it but one would hope in only the appropriate cases and saving that if they have somebody who comes in who has pain finding some other way to treat that and saving these most powerful drugs. As your last line of defense against extreme. Well I would like to think that that has that is what has been going on in the last year or two you know with with the intense you know scrutiny of Oxycontin in particular although Oxycontin really is more a representative drug rather than you know a particular drug in and of itself. I think as a result of the Oxycontin episode however there is this type of awareness and there is this type of education that's going on it's going to take a while but at least it's now heading in in an appropriate direction. We have a caller and would welcome others if you have questions. 3 3 3 9

4 5 5. We do also have a toll free line 800 to 2 2 9 4 5 5 color here in champagne on our line number one. And I'm a chronic pain sufferer. I was injured in several car accidents. I used to be a driver's license examiner actually and I was hurt on the job a number of times. Many back surgeries and. I just want to point out that that I never got oxy cotton. I got oxy code on a couple of times when the pain was super severe and I did like it in fairly routinely but even that is stopping and now because of all of this heightened scrutiny my doctor who has prescribed this stuff for me without really any problem in the past meaning the pain is there

and he knows it's there and know that there's so much more scrutiny. He he was just you know. Sometimes I have to be absolutely early on Bill leave oblique crippled by pain before you'll give me anything and I just think that that that the other side of this is that people don't understand that all of this this. Public city and all the scrutiny now is also making it very hard for people really aren't paying to actually receive the treatment that was once pretty fairly easy to get. I understand that that that that is a good thing that it be scrutinized. I really do. I don't think that it should be. I don't think the stuff should be out there it's very powerful stuff. But I do think there are many people myself that just occasionally need it and it gets to the point where I mean I have to literally be in a

fetal ball sometimes before I'll get in the stuff. Well that's I think that's a perfectly important point to make and also part of the story that I know that our guest you know deals with well what do you think about that. Well I mean I think there's no question the people that suffer from pain like the caller should have access to these types of drugs I mean unfortunately the way that this. Problem has been posited that it often is you know there's a kind of you know it's a trade off or it's sort of like you have drug abusers on one side in pain patients on the other side and you know you know we're denying one making stuff available to the other. I mean I think doctors need to act responsibly. Doctors acting responsibly means getting drugs to people who need them and keeping the drugs away from people who don't need them. And I don't think doctors need to be afraid about prescribing the drugs if the

pain their patients need. I know there's been a lot of publicity of late that there are some you know DEA war on doctors and you know the statistics really don't bear that out at the moment. I mean we don't have you know trucks going around sweeping up doctors. Doctors need to be responsible doctors got to say this guy's a pain patient. He gets the drugs. This person may be a pain patient but maybe I can treat him with a less significant drug and that's really the doctor's decision to me. Like I Do I agree with that. I disagree with is the I guess the way you're presenting it is the way I would like to hear it presented more often the way it's presented often on the news and in mainline media is. This is a horrible problem and we need to get rid of this drug. And unfortunately for someone who gets two or three hours of sleep between painkillers because the pain wakes him up. I would

love. I mean I dream of the day when I could have eight hours of sleep you know. Well I mean I you know in the book I certainly and I've never advocated in any newspaper article I write but certainly in the book I don't advocate having this or any other drug and any other pain medication withdrawn really from the market. I mean I don't think that solves anyone's problem. What I do feel very very strongly about is the need for doctors to use these this drug like any other drug or these two types of drugs like in the other types of drugs in the appropriate patients and to monitor their use appropriately and also to use drugs selectively in patients. I think it's best for the patient and best for the general population as well. Thank you all thank you.

For the CO I guess the caller was pointing out toward something and you were said in response to his comments that it was not the case that the DEA was going around sweeping up doctors but I guess the impression I got is that there are doctors that are concerned that someone might be monitoring their prescribing practices and so they might for that reason they might be less inclined to prescribe the drug or give less of it or and so that there might be patients like this one who really needs a medicine like this that's not getting it just because the doctor is kind of nervous that somebody's going to be looking over his or her shoulder and looking at how many prescriptions for medicines like this. They are there writing right and fact. One of the sort of battle cries of the Pain Management movement was that there was so quote phobia that that there was a phobic reaction by doctors to prescribe opiates like Oxycontin because a number of states had these prescription monitoring programs or had active

state level DA's that could tell when the doctor was prescribing these kinds of drugs and then would then come in and say Look. You know either you're like a reckless doctor or you're a drug dealer or you're blah blah blah blah blah. And that's it. It was a chilling effect within the larger medical community and doctors tended not to prescribe drugs to the point that that you've just made. You know that's possible. I mean that could be happening now to some degree as a result of all the coverage of the drug and the problems with this particular drug and these classes of drugs. Nonetheless you know doctors. Still need to prescribe patients these drugs and the doctor really has to make that decision. Him or her self I mean the government has said that they're not going to bust doctors who prescribe legitimately regardless of how much they prescribe.

Is that the case. Do you want to risk your medical license on that. I don't know but a doctor's principal responsibilities to their patient. And you know doctors have to fulfill that responsibility. Let's talk with someone else the next person is in Chicago. Line four. Hello. I tuned in late so maybe the. Continuing on from what though. The person who called. Talking about it and I feel for him and those who are suffering to the extent that he is or even the sort of stand and continuing on with your comments I read an article quite awhile ago which said in effect that as a general rule American doctors do not prescribe painkillers to the extent that I think killers are prescribed in Europe.

And part of that is that they claim that they don't want people to become addicted to some of the drugs that they would prescribe otherwise the painkillers and the sink in people who are on that death bed seven and in terrible pain. Which seems resolute. Well I think that may have been the case many years ago back in the 80s when there was no aggressive treatment of cancer pain in in Europe particularly in England and that there was not in this country unfortunately that can kind of pain began to be treated aggressively through the through the the activities of some doctors in this country and that has caught on and that's a very very good thing but as to the broader point I don't know of any evidence to suggest that pain killers in general are less prescribed in this country in fact you know the American appetite for pills be it you

know tranquilizers or painkillers or any other type of prescription medication it far exceeds those of most other countries in the volume of of these drugs being prescribed in the United States. That's not in any way to diminish the concerns that this current caller and the previous caller raised but again you know we've gone through these cycles and I try to trace them in the Book of you know reaction and counter-reaction reaction and counter-reaction you know there are two month to minute of these drugs being prescribed. Now people are suffering because too few of these drugs are being prescribed. And you know we really kind of have to find some middle ground where these same arguments and counter reactions are not recycled and recycled and recycled because you know on the one hand pain patients need to be getting these drugs on the secondhand these

drugs cannot be prescribed indiscriminately because there are significant public health consequences as a result. Just just one comment. The article that I read I read about five maybe eight years ago I put the figure so. Right it was describing a situation where there's been an explosion in the prescription of these drugs over really the last eight years or so really since the mid 1990s. And unfortunately there's been an explosion of public health consequences as well and that's the kind of dilemma that we find ourselves in now. Right. Our guest this morning in our focus 580 Barry Meyer is an investigative reporter for The New York Times he's written about Oxycontin for the newspaper and also in a book length treatment. The book is titled painkiller a wonder drugs trial of addiction and death and Rodale is the publisher. And next we'll go to someone on a cell phone this is

lie number two. Hello. Yeah I was going to sound like a broken record but as someone who was an accident and was on painkillers for a while and the only way I could possibly sleep more than two hours without waking up. I think that the drug warriors need to be very very very careful because there's a lot of legitimate uses. Anyway I really think that. I mean I'm going to ask you put this in the larger context of the drug war because I think. Given how draconian the drug war has become I can understand why a doctor would go to heck with it I'm not. You can ask me to give a you know run run the risk of this I mean maybe they're overestimating the risk that there very well might be but. You know it is a given given the under undermining of well. Given what's been done in the name of anti

drug in many other cases I can see a doctor might just say geez you're asking me to ruin my life and you know if I if if I have people looking over my shoulder and I I think the chilling effect is probably quite quite present and very strong. So he put this in the context of a larger drug war that happened listen. But well Mr. Wright I'm not quite I mean I don't know in particular what the caller means by the larger drug war I mean this is a very specific problem. This is a problem that deals with making drugs available to certain patients and trying to control the public health consequences of making these drugs too available. They're both legitimate issues. And what we need to do is find an appropriate balance

between them. What we're doing and I'm an observer to censor from the calls you know is is an issue that's kind of perceived from the extremes. And both people of both sides of the argument have legitimate arguments to perceive it from the extremes. But I truly believe that people of good faith can find ways of making these drugs available to people who need them while protecting the public interests at the same time something that we really haven't talked very much about it. And. And I wanted to do justice to that piece of the story is just how serious a problem. Abuse of this medicine and others like it. Just how serious a problem this is and that is also something you devote significant amounts of the book to. Maybe we can do it I should give you the opportunity to talk a bit more about them. Well it's a tremendously serious program I think you know that the abuse of prescription drugs is probably the leading problem that we're faced with in the United States right now. It's a problem

that cuts through every segment of our society I mean you know most vivid example recently involved Rush Limbaugh But more troubling really is that it's affecting a lot of young people a lot of teenagers I mean I trace the life of one particular girl in my book who becomes addicted to OxyContin and the tremendous havoc that causes in her life and that of her family. I mean we are now faced with a situation where a generation of kids are coming of age when I came of age many many years ago the leading drug of abuse was marijuana you could abuse that drug and then move on with the rest of your life and you know myself and most of my friends did. Do you have a generation of kids coming of age where the drug of abuse of choice is often a prescription narcotic and that drug is going to have far more severe consequences for those

teenagers than we really understand and imagine and it is a terrible terrible dilemma that we're facing right now. I'm sure there would have been a time when people a lot of people would have said that drug abuse was an urban problem and now it's seems no longer to respect that kind of division and certainly in rural areas we have seen significant problems with the amphetamine use and manufacture is in this particular case is it something the story that you focused on was indeed in a rural area was it right. But is this something that seems particularly to be more of a problem in in rural areas or is that just you just chose to play your silly games. Particularly drug kind of popped up there but as far as the broader story of prescription drug abuse is concerned it's certainly not a problem that's limited to rural areas I was just on a college campus

a while ago giving a talk about these subjects and about the book and you know kids are coming up to me and telling me about you know these parties they have where kids arrive with you know basically drugs that they get either on the street or from their parents and they have something called pharming ph a r m i n g where they kind of pour pour these through drugs into a bowl and kids kind of pop pills and drink a couple of beers and get high. And you know the tragedy is that you know teenagers are like overdosing teenagers are dying teenagers are getting addicted. Teenagers are engaging in activity that is going to have severe consequences for the rest of their lives. And these are the kids that we really need to be concerned about and and protecting. That doesn't mean that that these drugs shouldn't be made available. To Pain patients no one saying that. But there are many many steps that can be taken to reduce the public health consequences of

having these many drugs valuable to too many people. I mean there's no reason why these drugs should be available over the Internet. There's no reason why people should be able to get these drugs by filling out some form and sending it over the Internet where some doctor who's got a medical degree and is still allowed to continue to practice can then you know write a prescription for these drugs. I think pain patients should be the ones who should be up in arms about this because it is the the a valid delivery of these drugs and the abuse of the availability of these drugs is making making their lives difficult and making their access to these drugs difficult. They're the ones that really should be sort of in the forefront of leading the charge against this type of behavior. We have another caller in Chicago line for. Hello hello can you hear me. Yes.

Yeah. First thought the last last comment. Most of your people that are legitimately Oxycontin can lead a charge anywhere. They're having enough trouble just handling their lives and that is the one I wanted to call I believe there's that expression let 10 guilty men go rather than put one innocent person in jail and I think that applies here in this case. We're all we've always had crooked doctors. We've always had abusers and I think anything that we do that puts pressure or increases the possibility of someone who really. Need this medication from getting it is inhumane and I think we have to stop suing McDonald's for cheese burgers they get us that and we just we simply have to stop spending so much time and worry about people who want to be abusers. And in the

process of trying to legislate against these abusers we ultimately might hurt the people that need this medication the most. Well hang up now let's turn it around. Well I know that we really address this I think probably more than once and certainly you've said Mr. Meyer that you you think that it ought to be possible to make it so that people who need the medicine can get it and that the people who shouldn't can't you know always away. Why we can't satisfy both of those concerns. Yes and I think you know the this this last comment while understandable you know kind of reflects a denial. And it's it's a denial that does not benefit either the pain patient or the greater public health problem and I hope that you know that the people's consideration of this issue can move beyond that denial and gets into dealing with what you know what some

solutions these problems might be. I think we're at the point that we're going to have to stop because we've used up the time and I want to though again mention that if you're interested in reading more on the subject you should look for the book that we have been talking about here this morning it's titled Pain killer and that's two words painkiller a wonder drugs trail of addiction and death that's the subtitle. It's published by Rodale and came out actually last fall by our guest Barry Meyer he is an investigative reporter for The New York Times. And Mr. Meyer We just want to say to you thanks very much we're going to show you giving us some of your time.