DOCTORS are writing thousands of suspect prescriptions for a pharmaceutical variation of heroin, much of it destined for the black market, forcing the federal government to investigate the actions of 50 medical practitioners.
More than 580,000 taxpayer-funded scripts were approved in NSW in the past two years for OxyContin and similar opiate painkillers, such as OxyNorm and MS-Contin, dubbed ''hillbilly heroin''.
For every $34 script of OxyContin, users are obtaining a box of 20, 80 milligram tablets. Each tablet can then sell on the black market for as much as $50. With further subsidies to pensioners, the box can be bought for as little as $6 - and its contents might be sold on the street for $1000.
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While the medication has revolutionised care for chronic pain sufferers, it is leaking out of the health system to such an extent that police and health experts warn it could soon surpass street heroin and ice as the needle addict's drug of choice.
The prescription opioids are obtained unlawfully by dealers and addicts who ''doctor shop'' for multiple prescriptions. One patient visited 46 doctors in three months and obtained 119 scripts, primarily for OxyContin, the government has confirmed.
Sydney doctor Alan Saunders, who has been targeted by doctor shoppers, warned: "It's not just OxyContin - it's valium and all the other drugs. The government is subsidising the drug trade."
Pharmacists say they are confronted with stolen and fake scripts, while legitimate pain sufferers are obtaining the drug and then selling it.
The government acknowledges the problem. Federal Minister for Human Services Tanya Plibersek confirmed to The Sun-Herald that Medicare had identified 50 doctors for ''unusually high levels of prescription writing for drugs such as OxyContin and OxyNorm''.
"The misuse of prescription narcotics is a growing problem which destroys lives and tears communities apart. Doctors suspected of making these drugs available to patients who do not require them for clinical purposes will be put on notice."
With a slow-release formula, OxyContin capsules are designed to work through the day. Illicit users, however, discard the other binding agents and extract the drug in its purest form so, when injected, it delivers an instant hit.
According to new state government statistics released to The Sun-Herald, more than $557 million worth of illegal drugs were seized in the state last year - more than double the street value of the previous year's tally of $260 million. The haul included $185.2 million worth of cannabis, $126 million of cocaine, $195 million of amphetamines and $28 million of MDMA/ecstasy. NSW Police Minister Michael Daley said the figures showed police were doing ''a fantastic job keeping our streets safe'', adding: ''It's millions of doses of deadly substances that have been kept out of the veins of would-be drug users.''
Significantly, NSW police also seized more than $25 million worth of heroin. At the same time, a taxpayer-funded version of the drug is infiltrating the black market. The commander of the NSW drug squad, Nick Bingham, said: ''We're talking pharmaceutical-grade heroin. It's highly sought after in the drug-using community and, unfortunately, it is finding its way [onto the streets]. To be honest, police don't particularly want to have to target prescription opiates when there are other important things to tackle, such as organised crime.''
Inspector Bingham is part of the recently formed National Pharmaceutical Misuse Strategy Committee and said prescription opiates were ''high on the agenda … One of the discussion points is educating doctors in regards to prescriptions … there needs to be tighter scrutiny.'' The director of the Alcohol and Drug Service at St Vincent's Hospital, Alex Wodak, agrees major reforms are needed to improve the way opiates are prescribed by the medical profession: ''The process needs to be far more discriminating, more realistic, more careful.
''GPs do the bulk of this work. They're under tremendous pressure and could do with better assistance from the whole system, whether it be from medicine doctors, psychiatrists, pain doctors or better guidelines tailored to them.''
Dr Wodak also referred to the ''long overdue'' national real-time database which, if implemented, could alert authorities when ''runners'' try to use multiple scripts at different chemists, at different locations.
''The Commonwealth seems interested in trying to get all the states to adopt a similar live system,'' he said. ''If we are serious about this issue, we have to form a national response.''
But Richard Mattick, from the National Drug and Alcohol Research Centre, fears a crackdown could hit genuine pain sufferers.
''Let's not forget these medications are terribly important to the community,'' he said. ''If you have a loved one affected by cancer or serious pain, you want them to receive the best possible care and these medications are much better, much safer than anything previously available. The community is better served and, in a way, that has allowed prescribing to be more generous.
''The danger here is that we see the bad side but don't balance that against the need.''
Gideon Warhaft, of the NSW Users & AIDS Association, argues: ''There will always be people who inject drugs and there will always be people with narcotics dependencies. The positive advantage with OxyContin is that users know exactly what they're getting, whereas with heroin, they don't. Many now prefer OxyContin because it's clean and it's safer.''
Eamonn Duff and Daniel Lane
March 6, 2011
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