According to this Drugs.com report, there may be an alternative. Remoxy has been suggested by Pain Therapeutics Inc. as a safe alternative. The company claims Remoxy is more difficult to abuse, even among those with a history of abusing pain medications.

Remoxy was reported as less enjoyable than OxyContin by those with a history of prescription drug addiction and abuse. These individuals did not like the drug as quickly and claimed they could not chew the drug for any length of time due to its unpleasant texture and taste.

Research results such as these could help the company receive approval for Remoxy. Regulators request data proving that new drugs to treat chronic pain are less likely to be abused than OxyContin, made by Purdue Pharma LP.

A trial to test the effectiveness and abuse potential of Remoxy included 45 adults, each of whom had used opioid drugs at least five times in the past year to achieve a high. The study also focused on a comparison between Remoxy, OxyContin and a placebo. Reportedly, none of the participants were able to chew on the Remoxy tablet longer than 90 seconds.

The active ingredient in these painkillers is oxycodone, a substance one can access all at once by simple crushing or dissolving the pill. To make it harder to abuse OxyContin, Purdue Pharma has reformulated the drug, while competitors continue to seek approval for pain medications more resistant to abuse.

A report from the Substance Abuse and Mental Health Services Administration (SAMHSA) says that visits to hospital emergency rooms due to misuse of carisoprodol have more than doubled from 15,830 visits in 2004 to 31,763 visits in 2009 (the most recent year for which statistics are available).

The federal report went on to say that during the time of its investigation, people making ER visits for misuse of carisoprodol had often combined it with other drugs. In fact, 77 percent of such visits involved at least one more drug besides carisoprodol. The figures were as follows:

• 18 percent of ER visits were for misuse of carisoprodol only
• 25 percent of ER visits involving carisoprodol included misuse of a second medication
• 33 percent of visits involved misuse of two additional drugs
• 12 percent of visits included four or more drugs besides carisoprodol
• 12 percent of hospital visits related to carisoprodol also involved misuse of alcohol

Prescription painkillers were the drugs most often taken in combination with carisoprodol (55 percent of visits), followed by benzodiazepines which includes tranquilizing drugs such as Valium and Xanax (47 percent of visits). Furthermore, 35 percent of all ER visits relating to carisoprodol ended up in patients being hospitalized.

Though the SAMHSA report records that carisoprodol-related ER visits were made by people of all ages, the worst offenders were those over age 50 whose visits were three times as many (2,100 in 2004 vs. 7,100 in 2009) while patients ages 35 to 49 doubled their trips to the hospital (6,300 in 2004 vs. 12,000 visits in 2009).

It may not be surprising that the demographic being prescribed carisoprodol is most heavily represented by those over age 35, since muscles are more injury-prone as we age. Some have suggested that patients who experience muscle injury and take carisoprodol to treat pain find the medication provides unforeseen fringe benefits. Passing through the liver, carisoprodol is broken down into chemicals useful in reducing anxiety. It is therefore likely that patients enjoy the calmness and restful sleep produced by the drug and continue taking it beyond the range of its intended prescription.

The increase in hospital ER visits involving carisoprodol is another sign that the public is moving away from abuse of illicit drugs in favor of misuse of prescription medications. Prescription drugs may seem like "safe" drugs, but the emphasis should be on the word drugs rather than on the adjective safe. Drugs are a serious matter, even more so when taken in combination with alcohol or other drugs. The federal report has not named this an epidemic but does point out that the numbers of carisoprodol-involved hospital visits is a significant and increasing figure.

Federal agencies watching these trends have yet to make carisoprodol a controlled substance but are quick to point out that it is a drug and, as with all drugs, should be taken with careful attention to the parameters of its prescription use. Physician monitoring, proper storage and destruction of unused pills by patients, and warnings from ER staff regarding mixing medications are a few practical steps which can be taken to stem the tide of the drug’s misuse.

All too often, Americans are being prescribed highly potent opioid medications like Oxycontin or Vicodin for long-term treatment of non-cancer-related pain—most commonly for back pain—and end up becoming dependent upon their prescriptions. Some patients believe that these medications are the only solution to their chronic pain. Patients relying on prescription pain relievers for extended periods of time are at higher risk for opioid dependency, which can lead to prescription drug misuse, abuse, and addiction. This self-defeating cycle leaves millions of Americans impaired physically and mentally, all the while exacerbating their dependencies.

Recent national studies have shown an increase not only in prescription drug misuse but also in the proportion of prescription drug-related overdoses and deaths. Researcher Jennifer Brennan Braden, MD, and her colleagues from the University of Washington School of Medicine in Seattle conducted a study to investigate the relationships between opioid prescribing and the frequency of serious adverse effects of opioid use.

Using information from the medical records of adult patients who were registered under Arkansas’ Medicaid program or HealthCore program, the researchers identified patients who used prescription opioid medications for at least 90 continuous days within a six-month period between 2000 and 2005. The researchers identified almost 38,500 patients covered under the HealthCore program and 10,000 patients covered under the state Medicaid program who were administered long-term opioid therapy during this time frame. None of the study’s participants were prescribed opioid medication for cancer-related diagnoses, and the most prevalent reason for their prescriptions was chronic back pain. Then the researchers tracked the patients’ medical activity within the first year following their long-term opioid treatment to measure their frequencies in emergency department visits and alcohol- or drug-related incidents.

In their results, the researchers discovered that 24% of private insurance holders and 28% of the Medicaid patients had made visits to the emergency department within the first year following their long-term opioid treatment. Also, approximately 2% of private insurance holders and 3% of the Medicaid patients had required medical treatment for alcohol- or drug-related problems. Headaches, back pain, and preexisting substance abuse disorders were found to have a strong associations to patients’ likelihood of visiting the emergency department or having an alcohol- or drug-related problem. Private insurance holders who were diagnosed with a mental illness were significantly likely to later visit the emergency department, and both private insurance holders and Medicaid patients with a pre-diagnosed mental illness were more likely to later have a substance abuse problem.

Furthermore, the type of opioid prescription affected the patients’ risk of future emergency department visits or substance abuse problems. Taking over 120 mg of opioid medication (similar to morphine doses) on a day-to-day basis was related to a twofold risk of substance abuse problems. Being prescribed short-acting Schedule II opioids increased the likelihood of requiring a visit to the emergency department, while long-acting Schedule II opioids were related to a higher risk of future substance abuse problems compared to patients who were not prescribed Schedule II opioids.

The researchers also noticed that the group of individuals who were most likely to experience emergency department visits or alcohol- or drug-related problems, such as those younger than 60 years of age and those with a history of substance abuse disorders, were the most likely to be prescribed opioid medications, and were more likely to receive higher potency opioids, to be prescribed higher doses, and to be prescribed longer term opioid therapy. Those who were less likely to become addicted, such as those over the age of 60, were less likely to be prescribed the medications.

Overall, the researchers found that headache, back pain, Schedule II opioids, and preexisting substance abuse disorders were significantly associated with the long-term opioid-treated patients’ likelihood to make emergency department visits and have alcohol- or drug-related issues. The researchers advise that reducing the number of Schedule II opioid prescriptions among individuals with these high-risk factors could help improve their general health and safety.

Source: Reuters Health, Anne Harding,  Less-potent opiates may be safer for long-term use, September 13, 2010

The case brings up challenging questions about the proper method of conducting a patient exam to identify addictive or drug-seeking behavior, how and when to prescribe drugs for new and existing patients, and whether a doctor has a duty to ensure that a patient complies with dosage instructions. Unlike when apprehending a drug dealer on the streets, where evidence of criminal activity is relatively obvious, law enforcement officials encounter obstacles when trying to build a criminal case against a doctor for negligence or intentional wronging in writing prescriptions. Given that much of the information doctors rely on to determine the proper course of treatment is actually communicated directly by the patient, holding doctors liable for abuse and misuse of prescription drugs continues to be a gray area of the law.

Dr. Tseng, age forty, is a graduate of Michigan State University. She received an osteopathic degree from its College of Human Medicine in 1996. Despite claims that she is responsible for the deaths of several of her patients, Dr. Tseng’s license to practice medicine in the State of California remains active; she has had no malpractice judgments against her and has not yet been charged with any crimes.  However, officials now must determine whether Tseng is a medical professional or a prescription drug dealer, not such an easy task.

Unbeknownst to Dr. Tseng, the US Drug Enforcement Administration (DEA) embarked on a three-year investigation of her prescription-writing practices after receiving several complaints from pharmacists and loved ones of her patients. At the conclusion of the investigation, investigators determined that Dr. Tseng poses an imminent danger to public health and safety and they are in the process of initiating criminal proceedings against her. As a result, the DEA terminated her ability to prescribe addictive drugs, such as OxyContin, indefinitely.  After going public with Dr. Tseng’s case, law enforcement officials have received additional complaints from parents who claim that their kids overdosed on drugs prescribed by Dr. Tseng.

Tseng has been forthcoming about the way she practices medicine and claims that she receives complaints from parents of her patients daily. Tseng claims that these parents call her names, such as “drug doctor”. However, Tseng strongly defends herself and her prescription-writing practices, claiming that she prescribes meds based on what patients tell her their symptoms are and what she is able to discern from a physical exam. New patients pose particular difficulties, Tseng claims, as she has no way of knowing whether or not they are telling the truth.  Instead of acknowledging her role in the deaths of several young people under her care, Tseng blames the patients for not precisely following her dosing instructions.

Government officials, however, claim that Tseng is prescribing dangerous narcotics, such as OxyContin, without evidence that a patient has a bona fide need for the drug. Under the law, a physician can prescribe addictive painkillers, anti-anxiety drugs, and sleep aids after she has diagnosed the patient and determined that the drug will help alleviate the symptoms or the medical problem. The law does require, however, that the doctor conduct a physical evaluation and keep detailed medical records.

If carried out correctly, medical authorities claim that a physical and history-taking should help doctors identify addicts who are doctor shopping in order to obtain a new supply of drugs. Among the things that should warn the doctor that a patient is drug seeking are patients who are willing to travel a long way for a medical appointment; those who already know what they need and take it upon themselves to ask for a specific medication; and patients who claim that they “lost” their current bottle of pills. Another indictor of addiction, although not necessarily something a doctor would be aware of, is when a patient fills narcotic prescriptions at different pharmacies (in order to avoid detection).

Tseng readily admits that several of her patients drove long distances for an appointment with her but says that when she questioned them, they indicated that they had been referred by her other patients. Tseng believed that a personal referral was a plausible reason for someone to drive incredibly long distances to be seen for a bad back.

Although she suspected that some of the patients she was treating were using her to obtain prescription drugs that were not clinically indicated, the first real alarm started to sound when she became aware that pharmacies where questioning her prescriptions or even declining to fill her prescriptions. Combined with the public outcry surrounding the recent overdoses of high-profile celebrities such as Michael Jackson and Corey Haim in 2009, this negative feedback from pharmacies prompted Tseng to cease prescribing OxyContin. For her part, Tseng feels that her refusal to write prescriptions for OxyContin successfully deterred drug seekers from continuing to come to see her.

The Patients of Dr. Tseng and Their Stories

Sadly, for those with legitimate chronic or acute pain, the ease with which patients can transform from a legitimate user of prescription pain medication to a prescription drug addict is horrifyingly easy. These drugs are so powerful that those pre-disposed to compulsive or addictive behaviors need to be monitored closely in order to prevent addiction from taking hold. When allowed to progress unchecked, however, prescription drug addiction can turn deadly. Dr. Lisa Tseng has discovered this the hard way.

Tseng is a general practitioner in Los Angeles County whose patient roster inexplicably includes people from as far away as south Orange County, Palm Springs, and beyond. Many of her patients are young white males in their early 20’s.

In December 2009, twenty-one year old Arizona State University student Joey Rovera and a couple of friends from school drove from Arizona to Tseng’s medical clinic located in a mini-mall just off the 60 Freeway in Roland Heights; Tseng wrote several prescriptions for the men. Just over a week later, Rovera died of a drug overdose.

Rovera was not the first patient to die while under Dr. Tseng’s care. Since 2007, at least six young men have died of drug overdoses after visiting Dr. Tseng. Two additional young men died after obtaining prescription drugs from other patients of Dr. Tseng. Officials now believe that these “patients” were drug dealers. The victims were all athletic, had a history of playing sports from an early age and came from good homes and loving families. Unfortunately, these young men also had a history of experimental drug use. Some had become full-blown addicts, causing sporting injuries in order to obtain prescription-grade painkillers.

Dr. Tseng was known throughout the southwest for being a medical practitioner who did not inquire too deeply into the veracity of a patient’s claim of chronic or acute pain, anxiety, or sleep problems. She readily prescribed painkillers such as OxyContin and Vicodin, as well as muscle relaxers, anti-anxiety meds, and sleep aids such as Soma and Xanax. All of these medications are known for their addictive properties and are largely responsible for the recent increase in prescription drug-related addiction and overdoses in teen and young adults.

Another of Tseng’s patients, Matthew, was a dirt bike racer from San Clemente, California who started on the path to prescription drug addiction when he was just thirteen years old. After breaking his leg during a race, doctors in the hospital prescribed morphine for pain and he quickly become addicted. Throughout his teen and young adult years, Matthew entered various addiction treatment centers in an attempt to treat his painkiller addiction.  His parents often wondered whether he was intentionally injuring himself during bike races so that he could obtain more painkillers from medical professionals.

Then, a few years ago, things started looking up for Matthew. It seemed as if one of his various stints in rehab had worked; he managed to stay off prescription painkillers for ninety days and got engaged.  However, then his girlfriend fractured her cervical vertebrae and needed his help. Instead of continuing drug treatment, he dropped out and returned home to care for her. The 24-year-old lasted only about two weeks before relapsing; his mother found him dead on the bathroom floor surrounded by prescription drugs (maximum-strength OxyContin, Soma, and Xanax).

In a confusing twist for Matthew’s parents, the pills were traced back to an unfamiliar Dr. Tseng, who practiced roughly fifty miles from where Matthew lived. Tseng had prescribed OxyContin just 48 hours before Matthew died – only four pills remained in the bottle out of the original thirty. His parents had never even heard of Tseng and still have no idea how Matthew had come under her care.

Ryan Latham, a twenty-one year old man who died of a prescription drug overdose in 2008, is another young patient who traveled to see Tseng. Officials claim that Latham’s system contained Vicodin, Xanax, and Soma when he died, pills prescribed by Tseng just one week prior. Although he had a history of drug abuse, Ryan had been clean for at least six months before he started seeing Tseng. Sadly, before he died, Ryan informed his mother that Tseng would prescribe painkillers to a patient based solely on past history of a painful condition.
 

http://www.latimes.com/news/local/la-me-overdose-new-20100829,0,6188118,full.story