Apr 16, 2010
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Oxycontin is a long acting, powerful narcotic pain killer. It is often used to treat severe pain like that experienced by cancer patients or severe arthritis where other pain medications wont work. Unfortunately, oxycontin has a bad reputation. It has been called Hillbilly Heroin as it has become a popular drug of abuse. Because it has been abused, the Manitoba government is in the process of making it more difficult for patients to get oxycontin paid for by the Pharmacare program.
Why does oxycontin work so well as a pain killer and why has it become popular for abuse? Well it starts with opium and the opium poppy. There is evidence that people were growing opium poppies in Mesopotamis at least 5000 years ago. Opium poppies were traded into Egypt, Greece and Europe. Hippocrates, the father of medicine, would have been aware of opium in ancient Greece. Alexander the Great is credited with bringing opium to the far east. From the 1600s on opium became the main commodity the British traded with China. They even fight a few wars over it. In the early 1800s, Friedrich Serturner in Germany discovered how to extract morphine from opium.
Opium seems to have always had its problems with addiction. The extraction of morphine was thought to be a great break-thru as it made the opium like pain killing effects more reliable, longer lasting and safer. Morphine was even called Gods own medicine. Morphine is usually referred to as the original narcotic. All the modern narcotic pain killers, including the oxycodone in oxycontin, are derived from morphine. As good as morphine was and a safe as it was compared to opium, problems with addiction seem to have started early as well. Morphine was used during the American Civil War. In that war, there were reports of hundreds of thousands of cases of soldiers disease. Soldiers disease of the American Civil War is now interpreted as symptoms of morphine addiction.
All the modern derivative of morphine tried to create a safer, more effective pain killer. One of the most unfortunate examples was heroin. It was developed in the late 1800s and early 1900s by Heinrich Dreser in Germany for the Bayer company. Apparently heroin was originally marketed as a safe pain killer for children. Then it was marketed as a way to step down off of morphine in adult patients. Unfortunately, although heroin is a stronger pain killer than morphine, it is also much more addictive.
Oxycodone, the active ingredient in oxycontin, was also developed in Germany in the early 1900s. It is a stronger pain killer than morphine and has the potential to cause slightly fewer side effects. It has been in different pain killers over the years, including in Percocet. Oxycontin was marketed by Purdue in the 1990s. Its advantage is that is it very long acting. Most people can use just 2 pills a day 12 hours apart. Unfortunately, like other narcotics going back to opium, there have also been problems with addiction and abuse. Rightly or wrongly, oxycontin abuse seems to have received a large amount of media attention in the last few years. So the Manitoba government has decided to act. Although I understand the governments desire to reduce prescription medication abuse, I worry about patients who need the pain relief. Some of them may get caught in the new paperwork and not be able to afford their medication.
The new rules work through the Part 3 EDS system. EDS stands for Exceptional Drug Status and is an appeal process your doctor can do on your behalf. If you have never been on oxycontin before, and your doctor decides you need it, he or she can fill out forms to say why your pain is very severe, and why other drugs wont work for you. If Manitoba Health doesnt like the paperwork, they wont pay for it, even if you go over your pharmacare deductible.
If you are on oxycontin right now, you have a little time. The government has put in a grandfather clause until May 26, 2010. That means you have between now and May 26 to contact your doctor and ask them to fill in the Part 3 EDS paperwork. After May 26, all patients on oxycontin, new and existing, will require a Part 3 EDS to get coverage from Manitoba Health. If you get the letter from Manitoba Health saying you have a Part 3 EDS, remember your medication is still not necessarily free. You still have to spend your pharmacare deductible before Manitoba Health will pay.
Do I think these new oxycontin rules will fix the problems with abuse and addiction? Not to be a pessimist, but probably not. There are other medications to abuse if you have an addiction. And although Manitoba Health is well intentioned, we have been dancing with the fantastic benefits and dangerous pitfalls of the opium like drugs for over 5000 years and I dont think this will be the last song.
As always if you have any questions or concerns about these products, ask your pharmacist.