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Giving OxyContin to 11 Year-Olds

— September 8, 2015

The FDA recently issued guidelines for doctors to use in prescribing OxyContin (oxycodone) to pediatric patients as young as 11 years-old. As could be predicted, the Internet lost its collective mind. Doctors and senators are doing the Kermit arm flail and crying about how the FDA is plotting to turn innocent American youth into strung-out junkies. They’re so uninformed that they don’t even know that docs have been able to prescribe this, and other powerful pain medications, to pediatric patients for years. The FDA guidelines only serve to make such practice safer for all concerned.

The FDA recently approved OxyContin (oxycodone), an opioid pain medication, for use in patients as young as 11 years old. This move was in answer to children who need “daily, round-the-clock, long-term” pain relief that other medications don’t provide. Giving OxyContin to 11 year-olds has sparked a lot of arm flailing on the Internet, largely from those who have no idea what living with pain is really like. Buckle up nay-sayers, you’re about to be educated.

Take a look, if you will, at Amanda Brown. In 1999, she was diagnosed with brain cancer and had several surgeries, weeks of radiation, months of chemo and many blood transfusions. She was 16 at the time. Her care team gave her morphine (also a narcotic, but no one lost their minds over it!) for the incredible pain she endured. Eventually, the morphine stopped working; doctors switched to OxyContin.

Amanda’s mother Lynn said, “It made her treatments bearable. I knew it was a powerful drug. . . . But you have to weigh the circumstances. You have to deal with the situation you’re given.”

So, is Amanda a narcotics junky nowadays? Nope, not even close. Her care team weaned her off of OxyContin when it was no longer necessary. At 32, she survived brain cancer, graduated college and just got married. This is the face of a true pain patient on and after treatment with narcotic medication. This is the situation the FDA contemplated when it made its decision.

Of course, once the decision was announced, countless experts and nay-sayers jumped up, waved their arms and cried out, “What are you trying to do, turn our kids into addicts?” Sadly, some of these were actual doctors, such as Andrew Kolodny, New York psychiatrist and director of Physicians for Responsible Opioid Prescribing.

An example of what the FDA decision is NOT about.
An example of what the FDA decision is NOT about.

In Kolodny’s world, Amanda Brown and those like her are either anomalies or they just don’t exist. He insists that the risk of addiction is greater in younger, not-fully-developed brains. I can’t argue that point as I’m not a neuroscientist. However, I have quite a varied background (a reason I write for LegalReader) and part of that is as a chronic pain patient.

While I’m obviously not a child (those days are so far gone, they’re not even in the rearview mirror anymore), I have experience with pain medications. Fibromyalgia, a chronic condition with no cure, brings a whole host of “interesting” challenges to those who deal with it. The most obvious, and germane, is widespread chronic pain. My medications do not include opioids at this time. Instead, I use a drug called Tramadol (brand name, Ultram). It is, I’ve been told by docs, the last step prescription pain med before one needs opioids.

What qualifies me to write about this, then? Research. I am an inveterate researcher. I never leave a doctor’s office thinking, “Oh, I’m all set now.” I take the information given me and I research it until I am satisfied that the proposed course of treatment fits with my life. That includes researching opioids, just in case.

What I’ve found is that pain medications of all types, from the stronger, non-narcotics like Tramadol (an opioid agonist) to OxyContin, make life bearable for those who live with intractable pain. Those who take such medicines for pain become functional human beings. Those who are addicted, become non-functional after dosing.

In other words, if I take my meds, my pain eases and I get to go about my daily duties, such as writing. If an addict takes pain meds, they get “high” and aren’t able to go about their activities of daily living.

Does that mean that using pain meds cannot become addictive to those who really need them? No. However, I challenge the definition of addiction. Do these patients merely sit on the couch, staring at TV and drooling or, after dosing, are they up and at ’em, getting stuff done? True pain patients are the latter. I say that we may be “addicted” to our meds simply because our meds make us functional. Who wouldn’t want to be able to live a productive life? If that makes me an addict, so be it. Take the meds away from me and I will be a ball of pain, curled up on my sofa. Take them away from a true addict and, after withdrawal, they will be normal, functioning human beings again.

It’s not just doctors that have their knickers in a twist. Senator Joe Manchin III (D-W.Va.) is all riled up over the FDA’s decision. Granted, his state has been hit badly by prescription drug and heroin abuse, but see my argument above.

Sen. Manchin’s letter to the FDA reads, in part, that the agency “should be absolutely ashamed of itself for this reckless act.” He went on to say that the FDA decision could be “poisoning our children’s brains and setting them up for future drug abuse.” He also called for a Senate investigation into the issue.

This is a knee-jerk response by someone who is not entirely informed on the topic.

According to the FDA, this decision doesn’t encourage the use of opioids in pediatric patients, it merely gives prescribing doctors better guidelines on how to use OxyContin safely. This is a good thing, people. Doctors have always been able to prescribe OxyContin and other opioids to pediatric patients. That ability was not granted by the recent FDA decision, it’s been there for years!

Janet Woodcock, the director of the FDA’s Center for Drug Evaluation and Research, said, “We understand there is a terrible problem with opioid abuse and addiction. But this is about evidence-based medicine for children — seriously ill children who are suffering pain.”

It should be noted that Duragesic, a fentanyl releasing patch, is the only other time-release opioid approved by the FDA for children.

“I am a firm believer in relying on when and how to prescribe medications. I am a firm believer in relying on data to drive clinical practice,” said Gary Walco, the director of pain medicine at Seattle Children’s Hospital. Walco doesn’t think the FDA decision is either good or bad; it merely provides guidelines.

However, Walco is not blind to the challenges. “We have learned from the adult world that opioids are often prescribed inappropriately [emphasis added]. . . . It is critical that anyone prescribing this medication to children and adolescents be intimately familiar with the limitations of the data and the nuances of prescribing.”

Inappropriately prescribed medication sounds an awful lot like a lack of guidelines for the prescribing doctors to me. These are potent medications, to be sure. I am not advocating that everyone who experiences pain be given them. I am advocating for the option to have them if all other treatments fail. Despite the opinions of some, there is no dignity is suffering. Suffering is a useless, horrible state and allowing anyone, especially children, to suffer should be criminal.

Mattie Miracle Cancer Foundation co-founder, Peter Brown (no relation to Amanda) and his wife Victoria (the other co-founder) watched their little boy, Matthew battle bone cancer. Matthew lost his fight in 2009 at age 7, but not before enduring horrible pain from the cancer, the invasive surgeries to remove the disease from his lungs and limbs and the chemotherapy. Matthew’s care team gave him OxyContin, as well as other pain meds, to help him through these excruciating ordeals.

Peter Brown said, “I understand the controversy. Regulation is needed, and public safety is very important. . . . [But] when your child is in pain . . . it’s sort of a no-brainer to have this available.”

I could not agree more, Mr. Brown.

Bottom line: doctors have been able to prescribe OxyContin and other powerful pain medications to those who really need them for years. Those who don’t need them and are merely chasing a “high” go to great lengths to get them. The FDA decision only gives prescribing doctors better guidelines to help them serve the pediatric population.


Why the FDA approved OxyContin for kids as young as 11

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