How Fear of Narcotic Abuse Makes It Hard for Pain Patients to Get the Medicine They Need

Oxycodone became popular as a street drug, making it harder to get this opioid pain medication at the doctor's office.

If you're suffering from chronic pain and you've found little relief with over-the-counter painkillers, such as Advil or Aleve, you may ask your doctor for something stronger. You've probably heard about opioid drugs, such as Vicodin, Dilaudid, OxyContin, and Darvon.

There's a street demand for these prescription drugs, whether obtained from pharmacy theft, unethical doctors, or addicts who fake their pain to get legitimate prescriptions. And that means that it's become more complicated to get an opioid prescription, even for patients in real need.

The rise of prescription narcotic abuse

Prescription-narcotic misuse began to climb in the mid-1990s, fueled in part by oxycodone (the active ingredient in OxyContin and other drugs). Traditionally, opioids had been prescribed mostly by oncologists and pain doctors. But OxyContin was marketed by its makers, Purdue Pharma, to physicians as being less prone to abuse and less likely to cause addiction. (The company and three executives pleaded guilty in May 2007 to overselling the drug's safety and were fined more than $630 million.)

Although OxyContin had been designed as a slow-release drug, it was soon known that it could be crushed and snorted, giving a heroin-like high. The abuse became an epidemic in some areas. Concerns about addiction have made some doctors gun-shy about prescribing pain meds.

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In reacting to mounting concern over abuse, in 2001 the Drug Enforcement Administration intensified efforts to reign-in abuse and the diversion of OxyContin into the illicit drug trade.

But as the New York Times Magazine pointed out in a 2007 article, the uptick in arrests and investigations into the diversion of controlled substances (which include opioids), coupled with a lack of adequate training in pain management, can be a deterrent for legitimate prescribers. They may be fearful that investigations—even those that don't result in charges—could cost them their livelihoods. In 2007 the DEA arrested 82 doctors for crimes related to the diversion of controlled substances and opened cases into 896.

Narcotic fears come in cycles

The OxyContin crackdown tightened supply and raised awareness of prescription-drug abuse, but Roger Chou, MD, associate professor of medicine at Oregon Health and Science University, takes the long view. Narcotic use has swung back and forth over the decades.

"Twenty or thirty years ago nobody was prescribing opioids for noncancer pain … because there was such a fear of addiction. The pendulum really shifted after studies showed that most people who receive such medication don't get addicted." Then came OxyContin and other prescription drug abuse, which forced doctors to take a more conservative approach amid heightened awareness of the risks. Now Dr. Chou believes doctors are struggling to strike a balance.

Jan, a 45-year-old chronic pain sufferer from Boulder, Colo., agrees. "I think doctors have to be able to distinguish the people who can handle it and who can't—and help the people who can," she says.

For more information, read "When Your Doctor Won't Prescribe Narcotics: Tips for Getting the Pain Relief You Need."