'Cotton'-pickin down east

As OxyContin abuse soars in Atlantic Canada, experts say don't throw the baby out with the bathwater. Rush Limbaugh's keeping quiet

By Deana Stokes Sullivan

Sonya Harvey, a petite 20-year-old with wavy blond hair, has been dubbed by a provincial court judge as a "poster child" for OxyContin abuse in Newfoundland and Labrador. She's a stark contrast to the typical chronic pain sufferer OxyContin was developed to treat. After pleading guilty in December to 16 charges of double-doctoring to obtain multiple prescriptions, Ms Harvey was placed on probation on the condition that she spend the next six months in a rehabilitation centre. Her substance abuse began about seven years ago but they only learned that she had been using OxyContin about six months before her court appearance. She'd scam doctors and pharmacists � anything to obtain the drug. She almost had to have her arm amputated because of damage from injecting it.

The problem of OxyContin abuse in Newfoundland is being addressed in a collaborative partnership to make recommendations for the management of narcotics and prevention of abuse, with the manufacturer of OxyContin, Purdue Pharma, taking a leading role in the efforts. "Purdue Pharma takes great pride in educational programs for healthcare professionals and our participation in this task force is a perfect fit," says John Stewart, the drug manufacturer's executive vice-president and general manager. "We're confident that our support of current and future educational programs for doctors and pharmacists in Newfoundland and Labrador will improve pain assessment and treatment. These programs will also help doctors identify potential abusers, ensuring that only patients truly in need of OxyContin to relieve their pain will continue to receive it, while helping reduce diversion and abuse."

OxyContin � also known as cotton and hillbilly heroin � has been getting a lot of attention lately due to reports of skyrocketing abuse in eastern Canada. The bulk of abusers are young people who've never legitimately been prescribed the drug and are using it purely recreationally. The problem is so bad in Cape Breton that the area around Sydney, Glace Bay and North Sydney is known

to police and users alike as 'Cottonland.' In Newfoundland, a government-appointed task force announced in its interim findings in February that OxyContin abuse appears to be more widespread there than in any other province. The document says that in 2003, the Recovery Centre in St John's reported that 89 out of 934 admissions were for OxyContin abuse � an increase of 9.5% from the previous year. The street value for one pill can go as high as $80.

DON'T PUNISH THOSE IN PAIN
The issue has raised concerns that patients who genuinely need the drug won't get it because doctors and pharmacists will be overly cautious about drug abuse. Newfoundland Medical Board registrar Dr Robert Young recently issued a statement to doctors advising them that while drug abuse needs to be monitored, no physician should alter his or her prescribing practice and deny patients access to pain relief, provided best medical judgement is being exercised. "The medical board encourages physicians to view effective pain management as part of quality medical practice for all patients with pain, acute or chronic, and it is especially important for patients who experience pain as a result of terminal illness," says Dr Young. However, Dr Young cautions that patient-initiated demands for specific drugs require careful assessment, particularly if the patient is new or unknown to the physician.

Dr Gerard Farrell, a St John's physician who treats cancer patients, agrees that doctors shouldn't become so paranoid about drug abuse that they deny legitimate patients much-needed pain relief medications. He believes the solution lies in monitoring the "drug seekers," which can be achieved through a soon-to-be-established planned provincial pharmacy network that will give doctors and pharmacists shared access to patient files. "If a doctor knows you got a prescription at 10 am and you're looking for another at 11 am, it never gets written," he says.

Calls for a similar electronic prescription network in Nova Scotia are meeting resistance from government � mainly because of the $25 million price tag. Doctors there have been under fire from the press and police investigating a spate of OxyContin-related deaths in Cape Breton due to overprescribing the drug. Deputy health minister Dr Tom Ward has challenged the charge, saying addicts are getting the bulk of their drugs from street dealers, not doctors.