+ Health

THE

ADDICTS
A drug linked to the deaths of Heath Ledger and Michael Jackson and responsible for widespread addiction problems overseas is now this countrys most popular powerful painkiller. Why on earth didnt New Zealand heed the warnings from other countries about the risks of Hillbilly Heroin? Donna Chisholm investigates.

ACCIDENTaL
E
very so often, when talking about the death of her daughter, Denise Stephens face involuntarily freezes into a dreadful mask of grief. Its more than three years since she found 19-year-old Freya sitting slumped, blue and cold in her bed, but the memory seems to be on permanent replay in her brain. The absolute, ultimate horror of what I saw will stay in my mind forever, she says of that November morning. I stood at the door and screamed and screamed. I rang the ambulance. They asked who I wanted. I said I want police, ambulance, the whole lot. My daughter is dead. I think my daughter is dead.
DONNA CHISHOLM IS NORTH & SOUTH S EDITOR-AT-LARGE.
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Otago University student Freya Stephen, photographed here two months before she died, was addicted to OxyContin, an opioid drug originally prescribed for pain relief.

John and Denise Stephen have struggled to come to terms with the loss of their daughter, Freya, but say its brought them closer.

Freya Stephen, about two years before she died.

Freyas father John, a carpenter, was working in Balclutha when the copper from Dunedin called his cellphone just as he was about to start on his mutton pie for morning smoko. Are you John Stephen, of Walker Park Ave, Faireld? Yes, thats me. The sergeant introduced himself, then said: I regret to inform you, Mr Stephen, that your daughter is deceased. I said, I beg your pardon? I said, Youre joking. I was trying to work out what deceased meant. The police who came to the Stephen house in the quiet, leafy street that morning sussed out pretty quickly what had killed Freya when they saw the needle marks in her arms. But the story of Freya Stephen cannot be written off as the death of just another druggie. It is much bigger than that. It is the story of prescription drug addiction and how a canny pharmaceutical company and unquestioning doctors are potentially harming hundreds of unsuspecting patients. It is the story of oxycodone, marketed here under two main brands, OxyContin, the slow-release form, and OxyNorm, a quicker-acting capsule. It is a drug that was so abused among rural white males in the United States on its release there in the mid-1990s that it came

to be known internationally as Hillbilly Heroin. It was one of the medicines in the lethal cocktail swallowed by actor Heath Ledger in January 2008; singer Michael Jackson was said to be addicted to it before he died in mid-2009. And it was the drug that enslaved Freya Stephen before she died of a methadone overdose in November 2008. In 2010, the drug became New Zealands most prescribed opioid painkiller for severe pain, overtaking morphine for the rst time. And yet, sales of morphine have not reduced comparatively, meaning thousands of people who werent on strong painkillers before the introduction of oxycodone are now taking them. Thats because Mundipharma, the company which sells the drug in New Zealand and Australia, has succeeded in growing the market and doctors are now prescribing the high-powered drug for conditions which some believe do not require them. Oxycodone use has rocketed since 2005, when Pharmac decided the drug should be funded by taxpayers. After its registration four years before that, patients had to pay for it and the cost, about double that of morphine, severely limited the numbers of patients prescribed it. But in hospitals, where the drug could be dispensed at will, doctors embraced the little white pills, particularly in specialties

such as orthopaedics. On discharge, though, patients would be prescribed either morphine or a less-powerful alternative. That all changed with Pharmacs funding decision. And yet it took another four years before prescribing guidelines were issued saying there was no evidence to support the use of oxycodone ahead of morphine and pointing out the perils of the rapid increase in oxycodone use. Those guidelines, issued by the Best Practice Advisory Centre, were reiterated and expanded last year. But with more than 180,000 scripts written last year at a cost of $6 million and annual prescriptions quadrupling since 2007, the prescribers love affair with oxycodone is showing no signs of abating. Thousands of New Zealanders from young car-crash victims with sore backs to pensioners with shonky hips are now taking it every day. Some of them will be addicted to it. And they may not even know it. By the time Freya Stephen realised she was addicted to the drug, she had only a few months to live. She had already been taking OxyContin for about 18 months. Just weeks after her GP rst prescribed OxyContin in April 2007, in her nal year at Otago Girls High School, executives of Purdue Pharma, the company which dis-

tributed the drug in the US, were in the dock after admitting misleading the public about its safety and risk of addiction. They were ordered to pay $600 million in nes, $160 million to state health-care programmes and $130 million to resolve a raft of private lawsuits. It was, said the Los Angeles Times, one of the largest nancial penalties ever imposed on a drug company. In 2010, Purdue Pharma reformulated Oxy Contin in the US to prevent the misuse and abuse of the tablets, adding substances to prevent the tablets being ground up for a quicker high or to inject. Two of the four directors of Mundipharma NZ have high-powered roles with Purdue Pharma. One, Stuart Baker, of Florida, is executive vice-president and counsel to Purdues board of directors in the US and has been its general counsel since 1994. Another, Cornelia Hentzsch, is the president of Purdue Pharma in Canada. When North & South asked Mundipharma why New Zealand patients were still being supplied with the original, more easily abused version of OxyContin, its Australianbased quality use of medicines director Carolyn Winkler told us: As you would be aware, regulatory processes are very different in each country. When we asked her how Mundipharma

The sergeant introduced himself, then said: I regret to inform you, Mr Stephen, that your daughter is deceased. I said, I beg your pardon? I was trying to work out what deceased meant.

and Purdue Pharma were linked, she replied that Mundipharma was an independently privately owned company. In online company information, Mundi pharma is described as an independent associated company of Purdue. In written responses to North & Souths questions, Winkler said Mundipharma had been dedicated to providing strong analgesic medicines to help relieve severe debilitating pain and improve the quality of life of patients. She said the company recognised many prescription medicines could be, and were, increasingly abused, and this was of concern to the company. Fortunately, New Zealands regulatory environment and the strict prescribing
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ADRIAN MALLOCH

After Courtney Love overdosed on OxyContin in 2003, the US Department of Child and Family Services briefly took custody of her daughter. Top right: Heath Ledger may well have been an unwitting victim of OxyContin. Right: Michael Jackson is said to have been addicted to the drug before his death.

rules followed by healthcare professionals serve, as far as is possible, to largely restrict abuse, misuse and diversion of prescription products into the illicit market. She says the company distributes guidelines to help doctors manage the pain of genuine patients and to better identify those seeking medicines illegally.

n the rst few months after Freya Stephen hurt her back jumping over a creek on a family holiday in Nelson in December 2006, her GP tried to control her pain using the World Health Organisation analgesic ladder guidelines. Start with the simple stuff such as Paracetamol and if that doesnt work, move up to step two weak opioids including Tramadol and codeine. Its when those drugs still dont help that doctors are faced with the analgesic big guns, morphine and oxycodone. Despite being an emergency department nurse, Denise Stephen says she had no idea that the drug her daughter had been prescribed was anywhere near as strong as morphine. Indeed, North & South has been told by many concerned doctors that the name oxycodone and OxyContin led both
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prescribers and patients to believe the drug is more akin to the weaker codeine than the far more powerful morphine. Morphine, too, has long been associated with terminal cancer care and the connotations of this have deterred many patients from taking it. Not so OxyContin. And yet its stronger, about twice as expensive and potentially more addictive. I didnt give two thoughts about it, says Denise Stephen. It seemed to be just like prescribing Voltaren [a commonly used antiinammatory drug]. I never thought to ask why she was on OxyContin. There were so many questions I could have asked and didnt know I had to. We all know about morphine and methadone if it had been morphine I would have been on to it, but not OxyContin because I didnt know I had to be. The drug worked well, but made Freya drowsy and impaired her memory. In September 2007, she stopped taking it for a few weeks to improve her performance in end-of-year exams. She resumed OxyContin after the exams, and early in 2008, an x-ray revealed a broken bone in her back. Surgery, including a bone graft, was scheduled for May.

A US police officer displays OxyContin pills recovered from a drug bust in San Francisco in 2009. OxyContin was so abused among rural white males in the US on its release there in the mid-1990s that it came to be known internationally as Hillbilly Heroin.

On April 15, 29 days before the operation, she wrote in her diary: Every day, make yourself happy. Dont rely on other people. Surround yourself with friends. Talk to parents. Write a letter to friends. Right now, life feels 60% crap. The trick is, to treasure the other 40% SO much. Except that you still have so much to lose. To be scared means you still have something to lose. LOOK FORWARD TO YOUR FUTURE. Says Denise: What a bloody awful future she had to look forward to. I had no idea that what was being prescribed was leading her on the insidious road to addiction. She believes the OxyContin doses were increased after the operation. Though the surgeon declared the operation a success, Denise says Freya was in such hideous pain that she slept in a chair by her hospital bed to comfort and reassure her.

Around the middle of 2008, when she turned 19, Freya moved into a family-owned at. Though Denise says she saw her daughter three times a week and spoke to her every day on the phone, they couldnt keep such a close eye on her when she no longer lived at home. About August, Denise noticed Freya seemed restless and emotional. Her hair began to get dry and frizzy and despite being usually particular about her appearance, Freya didnt seem to care. She looked tired and dishevelled and Denise occasionally wondered if she was washing her clothes often enough. About this time, Freyas GP also had concerns about the continuing OxyContin regime, and reduced her prescription. The idea sent Freya into a panic, says an Otago University friend well call Mike. I remember her telling me how one day she decided not to take it because she didnt think shed need it and she went into terrible withdrawal. This was frightening for her, as it is for anyone: the realisation that you are now a drug addict. Mike had been taking over-the-counter codeine for a high since the age of 14 and bought his rst OxyContin on the street when he

was 16. I crushed and snorted it with my partner. She got very ill off it the rst time, but I felt amazing. I later found a regular supplier who had a script himself, and bought from others with scripts to sell at a prot. He says patients prescribed 20mg a day of OxyContin can sell that amount on the street for about $20 and manage their pain with $5 a day of cannabis. Its a very lucrative way of going about it. Mike soon moved from snorting OxyContin to injecting it. There were other opioids around morphine, codeine and methadone predominantly but OxyContin was my favourite. Morphine pills tended to glue up when mixed with water, but OxyContin was very easy to prepare. I found the high more speedy and happy. Mike soon became Freyas street supplier of OxyContin. When the GP reduced Freyas dose, Freya asked Mike to inject her. She felt too dependent to be coming off. I obliged on the grounds that she only did it this once. I saw her a few days later and she had been injecting it since that day. She never went back to eating it. No one really does after youve tried it IV.

In 2010, Purdue Pharma reformulated OxyContin in the US to prevent the misuse and abuse of the tablets, adding substances to prevent the tablets being ground up for a quicker high or to inject.

CORBIS

GETTY

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To Hell and Back

hey were magic for a while, those little white pills. For then 28-year-old telecommunications worker Jessie, OxyContin eased her pain and lifted her mood. Then it sent her to hell. Jessie is the rst person to go through a public health medical detoxication programme in Auckland for OxyContin addiction. They were the worst days of her life. As she lies on her bed in her Sandringham at recounting the experience, its hard to believe that just six months ago, withdrawing from the drug left her so psychotic doctors considered committing her to a psychiatric hospital. The rst time Jessie had heard of oxycodone was when she was prescribed it in Melbourne where she was working four years ago, to combat the crippling pain of chronic bladder problems. Fearing she might have cancer after suspicious ndings on an MRI scan, her GP told her the drug would at least allow her to get on a plane home to her parents in Hawkes Bay. She was home alone when she took the rst two 5mg pills. I remember being really scared. It was like, Whoa, Im utterly and absolutely hammered. I was petried. There was a knock at the front door and I remember trying to make it downstairs, holding on to the banister. It was my atmate who was training to be a nurse. She took one look at me and said, What are you on? Whats going on? When I showed her the pills she swore and said, Thats what you give people who are dying of cancer who gave you this? I was screwed. I was under the inuence of something I hadnt experienced before. But now Id found something that removed the pain, despite feeling extremely intoxicated, I had no plans to stop taking it. When she returned to New Zealand, her urologist asked her how the OxyContin was working. He said hed never used it before but because it was giving me pain relief, hed keep me on it. But she says if anyone had told her to take morphine, she would have said no. The name morphine just sounds really horrendous and I knew it was a very hard drug to come off because I knew someone whod used it recreationally. But knowing what I know now, I would have taken morphine over oxycodone. As the months passed, both her pain and the doses of OxyContin increased. Mood

Oxycodone is marketed here under two main brands, OxyContin, the slow-release form, and OxyNorm, a quicker-acting capsule.

I had about every withdrawal symptom you can have. I was absolutely freezing, my feet were extraordinarily painful. I was shufing around like an old person. I had diarrhoea and constipation.
stabilisers and antidepressants were added to the medicinal mix. By 2009, Jessie was taking around 200mg of OxyContin and OxyNorm a day. She rst realised she was hooked when she ran out of OxyContin on a camping trip with her boyfriend. In the middle of the night I just started kicking everything. I wanted to punch everything and I thought Oh my God, Im having some kind of t. When she went to a different pharmacist to ll her prescription the next day, he couldnt believe I didnt know what I was on. He said, Jessie, youre on narcotics, strong narcotics. From that point on I became a Google fanatic and I learnt what I was on that it was called Hillbilly Heroin, I learnt its street value, I learnt that you could burn it off and inject it if you wanted to. I learned it was a really intense drug I was on and no one knew much about it. I was petried. But I was scared of dropping off it because the pain I had been in was petrifying as well. But, she says, the only information she could nd was from the US there was no New Zealand-based research or help on how to come off the drug. By the time she decided to start weaning herself off in November 2010, following bladder surgery which helped her pain, Jessie had been on OxyContin for two and a half years. As she gradually reduced her doses, she was in a mild state of withdrawal for about nine months. I was slightly more irritable, and there were a lot of struggles, but I was really determined.

Last spring, when Jessie was down to about 40mg a day, she was accepted into the detox programme after going into more severe voluntary withdrawal. Doctors put her on a substitute opiate, Suboxone, to treat the symptoms of her withdrawal the irritability, the running nose, the shaking, the kicking legs, the buzzing in the head, the exhaustion and the vomiting. Then the Suboxone was withdrawn. I had about every withdrawal symptom you can have. I was absolutely freezing, my feet were extraordinarily painful. I was shufing around like an old person. I had diarrhoea and constipation. The physical effects she could tolerate but after seven days, the emotional reaction kicked in. I remember lying in a bath, sobbing, screaming and crying uncontrollably and thinking Im not going to make it. That Id rather die than have to do this. When the 14-day programme ended, Jessie was discharged home. She thought shed already reached the bottom but worse times were ahead. At 4am on her third day at home, she went into postwithdrawal psychosis. I had the urge to get a knife because I wanted to kill someone. Then another side of me said I needed to smash the mirror so I could carve my body into pieces and chop off my ngers so I wouldnt be able to hurt anyone. I was screaming. I woke my partner and said Get me the diazepam [Valium]. By 10am, when she had a sudden urge to crack the neck of her beloved cat Elvis, she was taken back to the detox centre, where she was given methadone. But within hours, she had an allergic reaction to that drug and her partner had to phone a mental health crisis assessment team who had her admitted to hospital. It was, she says, the worst 24 hours of her life. I was tripping. I was yelling Help me, help me, help me. From hospital, she was sent to a psychiatric respite facility where she was heavily sedated for a fortnight before she was well enough to be discharged home, where she was looked after by family and friends. It was December before Jessie nally began to mentally and physically return to normal. She hasnt taken OxyContin since September, but now has to wean herself off diazepam instead. She is about to undergo more bladder surgery and remains on an invalids benet. Despite her experiences, Jessie is not condemning the drug but the lack of knowledge about its appropriate use. If its given for the right amount of time for the right level of pain and its watched over, its a great painkiller. But if its not, its extremely dangerous.

He says he and Freya were part of a core group of student junkies who were all shooting OxyContin. When the obsession of addiction takes over, studying seems pretty trivial. Freya and I would hang out in the daytime, we would shoot up together then talk about how we were going to get clean. He was on a waiting list for a methadone programme, and says both he and Freya were interested in trying an experimental detox drug called ibogaine. This was the substance that saved my own life. I only wish Freya had access to it before it was too late. He says Freya was the rst person he knew who had died after becoming addicted to OxyContin. We just didnt know what we were playing with. We didnt see it coming.

n October 2008, Denise Stephen noticed for the rst time the reddened and infected lump on the inside of Freyas arm, right over the vein into which she was injecting OxyContin and possibly other drugs by this stage. Freya, whod been given lop-eared bunny George for her 19th birthday, explained the wound away as a rabbit bite. I said, Thats no rabbit bite, says Denise Stephen. I took her to the emergency department and my colleagues saw this nice, bright, intelligent girl and said, Oh yes, your rabbits bitten you, gosh. None of them thought that what she was doing at this stage was becoming this person that she abhorred. She had, in fact, become a drug addict. Denise Stephen may have taken matters further with Freya then had it not been for her own ill health. On October 28, she underwent a liver resection for biliary sepsis, a condition for which she was being regularly hospitalised with pain and fever. She was discharged from hospital with a 500ml bottle of liquid methadone, an oozing wound and a drug-addict daughter for a nurse. Freya had moved back home a couple of days earlier and had been unpacking her photos and hanging fairy lights around her bed. To welcome her mother home from hospital, shed taped a handwritten note to the kitchen range and left a bunch of owers beneath. Hey mum, I love you heaps. Youll understand how much your life means to me. These owers are for you for brightening up my life. Denise recalls Freya coming home about 10pm from what might have been a Guy

Denise and Freya Stephen, and the loving note that Freya left for her mum days before the teenager died.

Fawkes party on November 5, the night before she died. She was amped, Denise recalls, and puffing on a steroid asthma inhaler. I thought she was just excited, but in retrospect I think she was hyped up and manic. Freya asked if she could sleep with her mum that night. Denise, still in pain and with a bag of uid leaking from the site of her operation, said no. Its a decision she will always regret. I blame myself for not

Morphine pills tended to glue up when mixed with water, but OxyContin was very easy to prepare. I found the high more speedy and happy.

PAIN RELIEF: THE CHANGING DRUG Of CHOICE

Oxycodone prescribing has overtaken morphine but at what cost?

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ADRIAN MALLOCH

BEST PRACTICE ADVISORY CENTRE

the bottle on her bedside table before returning to bed to go to sleep for the last time.

For nearly a year, Whangarei GP and addiction specialist Alistair Dunn has been waging a oneman crusade to educate his colleagues about the risks of inappropriately prescribed oxycodone.

seeing that night that something was wrong, and putting something in place that might have saved her life. Every mother would blame herself, wouldnt she? It was my job as a mother to protect my child and I failed. And I failed miserably. Not only did I fail, I inadvertently caused her death by bringing that very thing into the house that caused it the methadone. My methadone was sitting there like a beacon to a young woman who was already struggling with addiction. She thinks she must have been asleep when Freya crept in and took a swig from

or nearly a year now, Whangarei GP and addiction specialist Alistair Dunn has been waging a one-man crusade to educate his colleagues about the risks of inappropriately prescribed oxycodone. He was alerted to its potential for abuse at an addiction conference in Australia last year and now wants to prevent the tsunami of problems that have occurred there and in the US, with a rapid rise in hospital admissions for oxycodone overdose and later addiction. We have these warning shots from other places, so I thought maybe we can avoid that. He says little is known about oxycodone overdoses here because regular opioid screening tests dont detect it a doctor would have to suspect and ask for a specic test to pick it up. Although oxycodone milligram for milligram is nearly twice as strong as morphine, it is no more effective in controlling pain, Dunn says. He acknowledges it is safer in patients with severe kidney problems, but he questions why Pharmac fully funded the drug here. Pharmacs medical director Dr Peter Moodie said it was the agencys policy to fully fund all newly listed medicines and the 2005 decision came after a positive recommendation from its analgesia sub-committee. He said the agreement to fund the drug did not include the agency getting a better deal for any other Mundipharma products a tactic thats often employed in the price negotiations. New products such as oxycodone tended to grow the market because they often had different or fewer side effects, which allowed them to be taken by more people. Dunn says that new market, in oxycodones case, seems to be 50 to 70-year-olds with osteoarthritis, a group targeted by Mundipharma in ads for the product in medical journals. Alcohol and drug specialist physician and chief medical ofcer at Capital and Coast District Health Board Dr Geoff Robinson said oxycodone had been a very successfully marketed drug despite having little if any clinical advantage over morphine. I dont know why its become avour of the month but it has. The health boards medicines committee had last year noted the prevalence of oxycodone prescribing in Wellington Hospital and issued guidelines that morphine was

the preferred option. Thats also the view of Otago professor of general practice Murray Tilyard, who heads the Best Practice group which issued the prescribing guidelines for GPs. After his group told doctors in June last year that oxycodone should only be used if morphine was not tolerated or unsuitable, several GPs wrote saying patients were often coming to them on oxycodone after a hospital admission and were reluctant to have a family doctor change what a specialist had given them. Tilyard said while a large proportion of oxycodone prescriptions were initiated in hospitals, all prescribers had to take responsibility. GPs are saying dont blame me, but its a joint responsibility primary care cant just blame secondary. He said patients often didnt realise they were on a morphine-like drug and when you tell them theyre often quite surprised and shocked. Those same people, asked if they would take morphine, would probably say no way. Hes only ever prescribed oxycodone once in his career, to an elderly patient with severe osteoporosis of her spine, where other options were discussed and rejected. He said oxycodone came in with a rip and a roar but was not a wonder drug. I dont believe it should be marketed as a potential rst-line drug for osteoarthritis pain. Personally, Ive never used narcotics [for this group]. I think the volume of oxycodone prescribing in New Zealand is a signicant issue. That will mean there are people who have been inappropriately prescribed it or continued on it and of those, a signicant proportion are most probably addicted to the medication but they may not know it. Dr Jeremy McMinn, consultant psychiatrist and addiction specialist at the Wellington Opioid Treatment Service, said of the patients hed seen recently, most have mentioned oxycodone among the drugs they were using to maintain their habit. His concern was that oxycodone could create a different group of addicts. The risk is people have a perception oxycodone isnt that dangerous, which is wholly unfounded. I think its the opposite some people have argued oxycodone is more addictive. It appears to have a surging onset. One of the things that gets you addicted is how quickly the drug starts to have an effect and thats made even worse by injecting it or putting it into a blood-rich area like up your nose. McMinn says doctors are waking up to the fact that chronic pain in a number of

New products such as oxycodone tended to grow the market because they often had dierent or fewer side eects, which allowed them to be taken by more people.

associated with a rise in overdose deaths from the drug. Coroners gures from New Zealand show OxyContin has contributed to the deaths of ve people in the past two years. In a further 14 deaths investigated, it was being taken but was not considered a factor in the death. Hardy says while Mundipharma reps seemed to have a responsible attitude when talking to doctors, theyre still marketing a product where they perhaps dont raise the issues about its abuse potential or its association with increased suicide risk. The overuse of opioids for pain relief is a relatively recent phenomenon. Twenty or 30 years ago doctors were very reluctant to prescribe drugs like morphine even in terminal care and it was not uncommon for patients to suffer agonising pain between doses. The hospice movement philosophy that terminally ill patients were entitled to proper and adequate analgesia led in turn to doctors with other patients in chronic or acute pain applying the same rationale surely were all entitled to adequate pain relief? The medical profession has got past its opioid phobia, says Geoff Robinson. ts difcult to believe that after all the evidence internationally of the problem oxycodone abuse and addiction has caused, New Zealand authorities didnt warn prescribers much earlier to take special care with the drug. The oxycodone problem was compounded by the 2010 withdrawal of two popular painkillers, Capadex and Paradex, for health reasons. Nearly 80,000 people were on those drugs at the time and its likely some doctors transferred their patients onto oxycodone, despite it being far more powerful. Medsafes medical director Dr Stewart Jessamine says much less was known about abuse problems in 2001 than subsequently, but that would not have changed the registration process for oxycodone. For any new opiate-type drug, theres a potential for diversion, abuse and addiction. We werent in the United States; we have a different practice of medicine and different monitoring systems in place. Mundipharma told North & South it had been urging New Zealand authorities to establish real-time electronic monitoring of the prescribing and dispensing of all opioids. Such a system has just been implemented in Australia. Jessamine says while New Zealand is about to roll out a pilot programme for electronic prescribing, real-time monitoring
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Osteoarthritis sufferers aged 50 to 70 have been targeted in ad campaigns by Mundipharma, which sells oxycodone in New Zealand.

cases may well be incorrectly treated with opioids. If your chronic pain lasts longer than six months, is going to grumble on but youre not going to die of it, theres increasing awareness that opioid drugs like morphine, like methadone, like oxycodone might not at all be very good for those pains. In fact they may make the situation worse. The best use of opioids was in severe acute pain. You cant just say, dont use them in chronic pain, but you can say they appear to have been overused in chronic pain. Were all anxious about whether this increasing use of oxycodone represents a tsunami of addiction that we are going to have to deal with. Wellington pain specialist Dr Paul Hardy, a British doctor who spent a year in Wisconsin in the mid-1990s when OxyContin abuse was a huge problem, says Australian and Canadian experience has shown that the rise in oxycodone prescriptions is

NICOLA EDMONDS

Theres been a lot of people doing and sending out educational material but I guess the unfortunate thing is its all a little bit late.
the regulatory and funding arms of the Health Ministry. This is designed to reduce the possibility for forgery or altering prescriptions and to assist monitoring of prescribing. Prescriptions are restricted to 28 days supply. Data sheet and consumer information contains details on the drugs safe use, risks and side effects. Of 1700 people registered here as being addicted to prescription medicines and under restriction orders, only ve or six are addicted to OxyContin. Jessamine says Medsafe wants to express its sympathy to Freya Stephens family. However every opioid carried the risk of addiction and harm. Dr Dave Woods, chief pharmacist at the Best Practice Advisory Centre, says better communication between agencies to encourage safe and rational prescribing for new medicines at the time they are registered or funded would be helpful. That would perhaps put an alternative point of view to the marketing. The medicine was made available for prescribing in primary care and I suspect the manufacturers went full bent into marketing they could get in rst before all the rational guidance came along [such as those issued by the Best Practice Advisory Centre]. [Now] theres been a lot of people doing and sending out educational material but I guess the unfortunate thing is its all a little bit late. The question is, whose responsibility is it? Pharmac will say their responsibility is to make the drugs available at good cost and Medsafes responsibility is to decide if its safe to be registered. Pharmacs line is that its an individual prescribers responsibility to decide on the appropriateness and safety of a medicines use. As part of her campaign to raise awareness of the risks of OxyContin abuse, Denise Stephen says she phoned around drug clinics asking what they knew of people whod become addicted. One CEO told me I was about two years too soon for this story. I told him, I think were about three years too late. +

For Denise and John Stephen, telling Freyas story comes more than three years too late for her but in time, they hope, to save others.

isnt part of that. At its best you might be able to pick up patients who are doctor shopping, using their own or multiple identities, but there are lots of issues with it. I dont think we have evidence theres a big enough problem yet to warrant going down that pathway. There would be issues around how to make it work and how to t it into existing legislation like privacy and human-rights laws. Because OxyContin is a controlled drug like morphine, prescriptions have to be written in triplicate, with one copy staying at the pharmacy and other copies sent to
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