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Ohio doctors more cautious about drug

When OxyContin first came out on the market, Dr. Ravi Khanna said he prescribed the drug to some patients along with other pain-relieving medications.

But the Ohio physician said he decided to prescribe it less after OxyContin received so much negative publicity, especially associated with drug abuse.

"I became a little bit more cautious about its use," Khanna said.

The oncologist said he doesn't know how often he prescribed OxyContin a few years ago and how often he prescribes it now, but added that he now seldom tells a patient to use it.

His patients mostly get morphine, which Khanna said drug companies were claiming wouldn't be as effective as OxyContin.

"That has not been the case for me," he said.

Morphine, a pain-relief patch and a combination of other anti-cancer and pain drugs, Khanna said, usually work well for the 20 patients per day he sees on average.

Khanna said narcotics are regularly used by oncologists and that the drugs don't pose a problem for their patients.

Dr. Paul Andorfer, a pain specialist in Springfield, Ohio tells patients not to make OxyContin and other chronic pain drugs accessible to anyone — especially family or friends.

"With these kinds of medications, they're like a loaded gun," Andorfer said. "I insist patients keep them locked up, if possible, and not carry any quantities with them. I tell them I don't want to feel responsibility in any way, shape or form for anyone who gets a hold of these medications."

Andorfer said his patients are usually in severe pain. He said 80 percent of patients who say their medications have been stolen tell him the thief was a relative or friend.

The physician said OxyContin is a welcome addition to relieving pain, allowing patients to take two to three pills a day instead of taking them once every three to four hours. It also has a great potential for abuse.

"Anything can be abused," Andorfer said. "Any doctor who is unable to define addiction shouldn't be prescribing narcotics in the first place on a long-term basis for chronic pain. There are a lot of doctors who won't prescribe any narcotics, unfortunately, because they claim they cause addiction."

According to the American Academy of Pain Medicine, the American Pain Society and the American Society of Addiction Medicine, most specialists say patients usually develop a physical dependance and sometimes tolerance for medications but don't usually become addicted. Behaviors of addiction, the organizations say, include the inability to follow a prescription, isolating from family and friends and visiting different doctors to get drugs.

Andorfer said he has about 400 patients at any one time. Up to two-thirds of them, he said, have at least tried OxyContin for pain relief.

One was Brian Ward, a former patient who filed suit against Andorfer in Clark County, Ohio Common Pleas Court in June. In the lawsuit, Ward said the doctor negligently continued to prescribe OxyContin and other drugs to which the patient became addicted. Ward is now in the North Coast Correctional Treatment Facility in Grafton outside Cleveland, Ohio serving a year term for operating a motor vehicle while intoxicated.

Andorfer would not comment on the pending lawsuit, but he said abuse or suspicion of abuse of drugs was partly why he started random urine tests on patients a year and a half ago. Many doctors, he said, would be surprised about patients who don't take medications as instructed.

Andorfer said he does multiple urine tests to confirm if any abnormal results are consistent. His patients, he said, know they will be randomly tested, adding that he will no longer treat patients after attempts to get them to take medications as instructed fail.

Andorfer said sometimes information about a patient's misuse of drugs comes from family members, other doctors, pharmacies or anonymous callers.

While a physical exam and a medical history offer clues to how to treat a patient, the level of pain can't be measured by blood pressure or heart rate.

"You really have to believe what the patient tells us about the intensity of pain," said Dr. Costantino Benedetti of the James Cancer Hospital in Columbus, Ohio. "Many studies indicate (pain) thresholds people tolerate varies from person to person."

Relief from pain could require OxyContin, Tylenol or a combination of several drugs, said Benedetti, professor of clinical anesthesiology at Ohio State University. He is also the cancer hospital's director of pain and palliative medicine and treats patients from all over Ohio, including Clark County, Ohio.

Benedetti said OxyContin and other drugs should be used to control pain, not to cause a high. Since being introduced, the maximum dosage of OxyContin has been reduced from 160 mgs to 80 mgs in 2001, said Purdue Pharma spokesman James W. Heins.

Andorfer said people can develop a physical dependance on drugs without becoming addicted and also gradually can get off strong painkillers without becoming addicted, adding that a drug's effectiveness depends on how well it improves someone's life.

"A lot of times, it is easy to confirm," he said. "More restful sleep, reported reduction of pain and overall, a better quality of life for the patient."


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