Tuesday, March 13, 2012

Was CBC's the fifth estate attack on Oxycontin the whole story?

The Myth of Drug-Induced Addition. Source: Parliament of Canada
Sunday night the fifth estate looked into addiction problems associated with OxyContin, one of the most popular pain relief medications in Canada. The CBC program had a singular point of view: Oxycontin is a highly addictive, potentially deadly narcotic, over prescribed by doctors influenced by the drug manufacturer's erroneous claims of safety.

No big argument there, but is the fifth estate giving us the whole story? As a simple blogger writing from home, it is impossible for me to say. That said, I'm well into my 60s and worked for more than three decades in the media. I saw a lot of one sided stories and learned that many media stories making it into the top ten list had good hooks and played well at first, but had little staying power. A lot of drug related stories fall into this slot: Think of the crack babies scare.

W. Joseph Campbell writes: "As I note in my latest book, Getting It Wrong, the crack baby scare was a media-driven myth based more on anecdote than solid, sustained research." It turned out to be, as the New York Times put it in 2009, “the epidemic that wasn’t.' "

My years spent closely working with reporters have left me suspicious of one sided stories. Canadians, the CBC tells us, will ingest possibly 10 million grams oxycodone, the active ingredient in OxyContin, for pain relief in 2012. That's a lot of oxycodone. With numbers like these, surely there must be something good to be said.

On the growing Oxycontin problem, Campbell quotes the words of a lawyer-politician, the Florida attorney general, who said: "I’m scared to death this will become the crack-baby epidemic." Which, of course, proved to be mostly an epidemic of media hype.

A little more googling turned up this positive story from Karen L. Simon:

I suffered for 20 years with an arthritic hip while being miss-diagnosed with Fibromyalgia. I finally got a doctor who cared enough to order a plain hip x-ray and I was able to get hip replacement surgery.

After the operation, my surgeon said that the femur head was half gone. Without pain medication there is no way I could have had any, I repeat, any kind of life. I was on pain medication for 20 years and went off with no withdrawal symptoms.

Your continued reports on pain medicine abuse simply make it harder for chronic pain patients to get adequate pain medicine. Believe me that if you suffered from pain 24/7, you would require medication. Please, please report on some other better subject.

Ms. Simon is not alone in singing the praises of Oxycontin. Very little searching will turn up hundreds of positive testimonials. What I found very interesting in Simon's story was she claimed to have used pain medication for 20 years without suffering severe withdrawal. Is this possible? The short answer is: Yes.

Let me quote Richard Pacheco of the Harvard Law School, who as a third year law student he wrote a paper on the use and misuse of OxyContin.

"The physical dependence associated with some drugs can be treated by gradually reducing the dosages of the medication to the point where a patient is drug-free and has no withdrawal symptoms or craving"

You may believe Pacheco or not, but be aware that media scare stories to the contrary there are many who agree with Pacheco. And, of course, many who do not.

Still, there are areas of agreement, right? For instance, OxyContin is highly addictive. Some of my quoted sources claimed OxyContin pills when crushed and then snorted or swallowed resulted in  almost immediate addiction, much like heroin. Crush it, snort it, and be left immediately needing to do it again and again. Bing, bang, boom and the addictive boom engulfs the unsuspecting user.

I've read this claim before and alarm bells went off. Immediate addiction, an interesting concept seeing that addiction involves a recurrent failure of control and a continuation of a behaviour with significant destructive consequences. 

It is a lot like reporting something is the first annual. If something has only been done once, it cannot be annual. Many "annual" events fail to be held again and many folk taking "immediately addicting" drugs do not develop an ongoing pattern of abuse.

I can hear the protests to this line of reasoning already. Fine. But a reporter has an obligation to report the whole story and the whole story is that many do not believe in "immediate addiction."

Terms like addiction, dependence, withdrawal are not the neat, clear cut descriptive words many in the media would like us to believe. Read the following from the American Psychiatric Association (APA) discussion of an entry in the upcoming fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM).

"The term dependence is misleading, because people confuse it with addiction, when in fact the tolerance and withdrawal patients experience are very normal responses to prescribed medications that affect the central nervous system," said Charles O’Brien, M.D., Ph.D., chair of the Substance-Related Disorders Work Group. “On the other hand, addiction is compulsive drug seeking behavior which is quite different. We hope that this new classification will help end this wide-spread misunderstanding."

I don't think the media understand that there is a large group of people who would argue that dependence, tolerance and withdrawal are all very normal responses to oxycodone based pain relievers.

One person, claiming to be a legal user of OxyContin, wrote on the Net:

"To keep this within limits I will not get detailed on the benefits of Oxycontin. As you can read on the other forums it works. I take 80mg 3x a day and it works great. Been on it for 5 years now and liver test done last month was excellent.

I am tired of the bad rap this medicine gets though. There are even sites devoted to its removal by people who have lost loved ones who abused the drug. While I feel for these people, no one told anyone abuse this wonderful drug. When taken properly this medicine works excellent with little to no side effects.

It is said that you become dependent on this medicine but it is meant for long term and a good doctor will bring you down properly. So withdrawals should be minimum. This is a true wonder drug."

Let's give the last words to W. Joseph Campbell writing one of his Media Myth Alert posts.

(There is) a tendency among journalists "to neglect or disregard the tentativeness that characterizes serious scientific and biomedical research, and to reach for certainty and definitiveness that are not often found in preliminary findings."
Journalists pushed too hard on thin, preliminary, and sketchy data, and extrapolated rather extravagantly from small numbers of anecdotes. It’s a pattern that tends to repeat itself, as journalists fail to take lessons from misreported drug scares of the past.

"What reporters need to do,” the inestimable media critic Jack Shafer has written, "is challenge their sources in criminal justice, medicine, drug treatment, legislatures, and the user community when they make assertions of fact."

Some years have passed since writing the above post. I was wrong. This story has legs. In February of this year, 2018, Reuters reported OxyContin maker Purdue Pharma LP slashed its sales force in half and would stop promoting opioids to physicians. This after widespread criticism of the ways that drug-makers marketed potentially addictive painkillers.

I still question the reporting on the opioid crisis but there does seem to be enough blame to go around. Producers, like Purdue, have been forced by the courts to accept some responsibility. Users have always had to shoulder some blame.

But the days of the media slipping by unscathed may be coming to an end. CBC Radio reported, "the media perpetuated the notion that Oxycontin was the problem, the (Canadian) government reacted, Oxycontin was pulled from the market, and the supply was throttled.

"But drug markets are complicated and the notion that a supply line can be simply cut off without something else emerging to take its place is naive." Hence, the appearance of fentanyl and carfentanil. According to Dan Werb, the role of the media is to provide context. The media must dig beneath the surface. Link: Media Coverage Is Making the Opioid Crisis Worse.

Think of Portugal and its unique approach to the universal drug problem. Read: Portugal’s radical drugs policy is working. Why hasn’t the world copied it? This is an in-depth report from The Guardian. We need more stories like this.

According to the article, one critical change was the shift in language. Junkies became known more broadly, more sympathetically, and more accurately, as "people who use drugs" or "people with addiction disorders". This was crucial. In North America we still brand folk as junkies. Maybe there's a story here for the fifth estate.


  1. I agree. I took oxycodon for about a year after I broke my ankle. Now that I have managed to make do with one Tylenol 3 each night, I find I cannot even get that. I moved back to London a year ago, had a Dr for a while who renewed my prescription for Tylenol, but now even that has ended.

    The walk-in clinic couldn’t give me a repeat on the Tylenol 3 as it is a narcotic. I could try other clinics, but she didn’t know which. The problem is not just journalists doing one-sided reporting, but the healthcare system too. See http://suemcpherson.blogspot.ca/2010/08/survey-can-canadian-baby-boomers.html

  2. Oxycontin is not the problem but first pharma for saying it is not highly addictive and second the doctors who prescribe it to easily and not trying other pain killers before giving oxycontin. As for the addictive part, people say i have been on this for years and im not addicted. Well try stopping it and then see how you feel. I was prescribed 80mg oxycontin for severe period cramps. yes you read that right. I took it for 7 months then stopped cold turkey. I had the worst withdrawl i could ever imagine but what people dont realize is its not just a week of severe flu symotoms then your fine. The sickness was gone in a week but the panic, deppression, suicidal feelings were there 2 months later. its been a year and im still not myself. My new doctor said oxycontin use can take months to years to repair the receptors in your brain. I dont want anyone to live in pain but i think oxycontin should be the last resort when all other drugs failed. Also i never shot or crushed pills but took them orally and still became addicted in such a short time. I never used drugs in my life and never had deppression. I got addicted as they gave me a energy i never felt and could work all day come home clean cook play with my kids and still have energy. I understand the media being down on this drug and i believe some people need this drug. We here stories of people on this drug that say it is great but where are the p[eople that were on it for years ans have came off of it with no problems. I dont hear any.

  3. As a recovering addict / alcoholic I have met many people addicted to Oxycodone. Most of those people started out with a regular doctors script and took the drug as per doctors orders for a long time.
    As use increases, the pain killing effects are lessened and more and more of the drug is ingested. It's usually after the stomach lining is burnt out and the person is still in a phydo-pain that their brain thinks is real pain that the real abuse starts. Many people turn to smoking / injecting the drug, not to get high - but to get relief from pain that doesn't really exist anywhere but in the addicts mind.
    Once the cycle of abuse starts it is a hard drug to stop.

    IMO, it's the over prescribing of the drug that starts the addiction cycle.