#6: Define the Word “drug”

 Would you be able to define “drug” if someone asked you to? We are in the business of drug testing yet many would not be able to accurately define the word “drug.” A medicine or other substance which has a physiological effect/change in the body when inhaled, injected, smoked, consumed, absorbed via a patch or dissolved under the tongue is how Wikipedia defines it. Webster’s definition is similar, just shorter. In both definitions the words “other substance” stand out. The drug that kills the most people in the United States is an “other substance”. Over 40 million people use tobacco. There is more information regarding the dangers of this drug than any other drug out there. Tobacco claims more lives than any other drug, yet I would bet if you were asked, “What is the most abused drug in your clinic?”, the first thing that would come to your mind would not be tobacco. If someone wants to quit smoking, but is unable to, they are addicted. I attended a seminar back in the 90’s where a PhD was speaking to a room full of physicians. He asked us to name any disease and then he showed how smoking affected every disease mentioned, from obvious lung cancer to rheumatoid arthritis, bladder cancer, cataracts, diabetes, sexual dysfunction, and multiple others. It was an enlightening two hours. We test for Cotinine (Nicotine metabolite) for some clinics that offer smoking cessation for their patients.

The purpose of the lead paragraph was to stimulate you to consider how you classify the people being drug tested in your clinic. It is so easy to get caught up in the popular thought process that people going to pain clinics are all drug addicts. All they want are the drugs. Is that your thought process about your friend who smokes two or three packs of cigarettes a day. (By the way there are 20 cigarettes in a pack) Maybe you smoke? Do you look at the patients you test the same way you look at your smoking friend? My point is urine drug testing is just part of a treatment plan. It should never be done to be punitive. It should not be done to “catch a patient”. It definitely should not be done to shame a patient. I will admit it is so easy to become bitter and hardened and even cynical doing this job. The person who smokes did not come out of the womb saying I am going to start using a drug which causes all sort of diseases and will eventually kill me. I would bet most wish they never picked up a cigarette. The patients in substance abuse treatment or the pain patients you test most likely feel the same way about the drugs they test positive for. Urinary drug testing is an important tool that a clinician can use to document adherence to a treatment plan, diagnose abuse or addiction, uncover diversion and determine appropriate treatment protocols. If I have changed your attitude towards some of your patients in a positive direction my mission with this blog has been a success.

Have an awesome weekend. Get some exercise. Help someone do something. Love on your family. Live your life to the fullest. As always we very much thank you all for your business.

Lance Benedict

President/CEO Industry Lab Diagnostic Partners
03/22/2019

#5: Oxycontin: Perception and Reality

Harry Anslinger, the first commissioner of the US Treasury Department’s Federal Bureau of Narcotics once said, “I’ve made up my mind…don’t confuse me with the facts.” Harry’s words often flash before my eyes as I speak with clinics throughout the country. Purdue Pharma did such a criminally good job marketing Oxycontin in the late 90’s through the early 2,000’s many providers made up their minds, and refused to be confused by the facts. “When truth is blurred by lies and misinformation, perception becomes reality and all is lost.”

Let’s examine some facts. In 1972, Purdue Pharma, the makers of Hydromorphone, Oxycodone, Fentanyl, Codeine and Hydrocodone, developed Contin, a controlled drug release system. In 1996 Purdue Pharma introduced Oxycontin, a sustained-release oxycodone preparation. Purdue Pharma’s sales grew from $48 million in 1996 to almost $1.1 billion in 2000. By 2004 Oxycontin had become a leading drug of abuse in the US. How could this happen? Remember the last quote in the first paragraph regarding perception? From 1996 to 2001 Purdue Pharma conducted more than 40 national pain-management and speaker training seminars which were attended by more than 5000 healthcare providers. They started to bonus their sales reps based on the number of Oxycontin scripts providers wrote. In 2001 the average sales rep’s bonus above their annual salary was $71,500 with some bonuses reaching $240,000. Fueled by an unprecedented promotion and marketing campaign over 14 million prescriptions for Oxycontin were written in 2001 and 2002. By 2002, Oxycontin accounted for 68% of all Oxycodone sales. (Go to Youtube Purdue pharma oxycontin commercial done in 1998 by Dr Alan Spanos to get a feel for their sales pitch.) Purdue Pharma sold the perception that by releasing the Oxycodone over 12 hours it was not as addictive as the single Oxycodone pills and the providers bought into this. The fact is Oxycodone is approximately twice as potent as Morphine! In other words 10 mg of Oxycodone is equivalent to 15-20 mg of Morphine. Yet due to perception (there it is again) we have more fear of Morphine than Oxycodone. This blog doesn’t begin to give me the space to pontificate in the manner I would like, so I will leave you with a few more tidbits.

 In 2007 Purdue Pharma paid $600 million in a settlement after pleading guilty to misleading the public about Oxycontin’s risk of addiction. They paid West Virginia $10 million in 2004. They settled with the state of Kentucky in 2015 for $24 million. As of January 2019, 39 other states are suing Purdue Pharma and some have included the Sackler family who own Purdue Pharma. Although the perception is Purdue will be severely punished the reality is their earnings went from $31 billion in 2016 to $35 billion in 2017. Huh?

 Kiss your loved ones. Do something nice for someone today, and as a friend of mine recently said, “Life is short, don’t sip!” Thank you all for your business.

 Lance C Benedict
 President/CEO Industry Lab Diagnostic Partners
03/08/2019