Michael Jackson's death has prompted fears that pain medications could be tougher to come by and has raised the issue of prescription drug abuse, a growing public health concern.
The Canadian Pain Society (CPS) is concerned that the negative publicity surrounding Jackson’s alleged addiction to painkillers could result in people who take medication to treat chronic pain being stigmatized or made to feel like they might be doing something wrong.
Some patients may even fear that their doctors could be scared into stopping their pain-relieving medications altogether.
“Every time something happens in the world that leads to negative press around either addiction, abuse, or diversion, what ends up happening is the access that people can get to their agents can become more difficult,” says Mary Lynch, CPS president and professor of Anesthesia, Psychiatry, and Pharmacology at Dalhousie University.
“Michael Jackson’s untimely death is a really a tragic situation and we’re very sorry that it happened, but it is highlighting the importance of chronic pain and the need for access to treatment.”
Jackson’s long-running addiction to several prescription painkillers, including the powerful narcotics Diprivan and Oxycontin, is said to have contributed to his death on June 25 at the age of 50.
Lynch says “there is an escalating public health problem related to pain that needs to be grasped,” such as a wait list of over a year at one-third of Canada’s multidisciplinary pain centres.
“In Canada we have six million people suffering from chronic pain that is moderate to severe. We have a problem with under-servicing that population.”
Worldwide, narcotics regulations have led to a situation where in many developing countries, patients do not have access to oral morphine when they’re dying of diseases such as cancer, says Lynch.
“Internationally we have a huge problem getting access to these necessary agents to assist people with pain.”
But there is an equally huge problem with addiction to prescription painkillers.
Prescription drug abuse is a growing rapidly in Canada and the United States, with addiction to the painkiller Oxycontin, an oxycodone preparation, at epidemic proportions in many areas.
Hundreds of deaths have been associated with the drug, which also goes by the name of Hillbilly Heroin, coined because Oxycontin abuse is rampant throughout mainly poor and rural regions of the U.S.
Studies in both countries show that addiction to prescription opioids has surpassed that of street drugs such as heroin and cocaine.
“Well over 80 percent of the people who come to us are addicted to prescription opiates, mostly oxycodone preparations,” says Dr. John Craven.
Craven works at a large methadone prescribing clinic in London, Ontario, which, along with Atlantic Canada, has one of the highest rates of Oxycontin addiction in the country.
Approved by Health Canada about six years ago, Oxycontin was designed to be time-released. But if it is crushed or chewed and either inhaled or injected, it produces a euphoric heroin-like effect that makes the drug highly addictive.
Craven says Oxycontin addiction is an extremely difficult habit to kick even for seasoned drug users, adding that he sees increasingly more youth becoming addicted. Studies show that the potent painkiller has become the drug of choice for many teenagers.
“Every year that I’ve worked at our clinic the average age goes down…. We had a mother not too long ago begging us to take her two 15-year-old sons on in treatment. I mean, they do not have the capacity to get off these medications without intensive treatment.”
Although the package carries a warning, teenagers in particular may not realize how dangerous Oxycontin is when used inappropriately.
The U.S. Drug Enforcement Association predicts that before long, every community in America will be confronted with the issue of OxyContin abuse.
Contributing to the problem in the U.S. are the approximately 100 storefront pain clinics located in Florida which supply a black market in painkillers that extends across several states including Kentucky, West Virginia, and Massachusetts.
The Canadian Pain Society emphasizes that the vast majority of people prescribed opioids for pain do not become addicted, nor do they manifest behaviours such as taking more pain medicine than prescribed, seeing multiple doctors to obtain more medication, or buying the medication on the street.
“The main thing is not to let the issue of diversion and the fact that some people will lie and some people will do wrong things with their drugs prevent the majority of patients who are using these meds responsibly from getting access to the medications they need in order to cope and live with their pain,” says Lynch.
She points out that when prescribed appropriately and taken correctly, prescription opioids are safe and provide valuable relief of pain.
But as far as Craven is concerned, doctors are far too quick to prescribe these powerful painkillers.
“Many of the patients I see get offered these medications when they don’t even ask for them, after dental procedures or minor procedures or minor emergency visits,” he says.
“Obviously those who are addicted are pressuring their doctors for more, but I don’t see people who aren’t addicted pressuring them—they just get prescribed them very easily.”
A 2007 study published in the Canadian Medical Association Journal found that in most cases, prescription painkillers used by street drug abusers come from the medical system rather than from illicit production and distribution.
The study made a number of recommendations, including educating physicians, pharmacists and the public, reducing improper prescribing practices, expanding prescription drug monitoring programs, and developing non-opioid treatments for chronic pain.
However, Craven says the “big issue” with opioid medications is not that they treat pain per se—it’s “the other things that they do.”
“For people with anxiety disorders they relieve anxiety, for people with post traumatic stress disorder they relieve all sorts of emotional pain, for a person working ten hours at a factory they make the day float by.
“Doctors think they’re prescribing them for pain, but in fact people are going to get them for a lot of other reasons, and that’s how they get hooked. And once somebody’s brain is dependant on it, it’s a very hard, long-term process of ever getting back close to normal.”