Question 12: Is there a particular subset of patients which is more likely to abuse OxyContin?

Raymond Sinatra, MD: This is from one of our members who says is there a particular subset of patients which are known to be likely to abuse OxyContin? Based on our discussions I don't think it's patients who are truly in severe chronic pain are going to be the abusers, but ... anyone else who wants to comment on that question.

Commander John Burke: This is John Burke, I would just probably reiterate what we had talked about before, and that is that I think those who are most likely are going to be those people that have a significant history of substance abuse in the past, that's key.

Raymond Sinatra, MD: Right, it's nothing magic about the drug, it's just this history of getting the thrill or getting the rush, or as Jean said, just like sit in the corner and feel dysphoric effects. But these are the people who are going to do this day in, day out.

David Joranson, MSSW: I think it's important to note too that no major case has been made that it's patients who are diverting these medications, it's abusers who are not patients.

Raymond Sinatra, MD: Right, exactly. In light of the abuse potential of OxyContin if there is one, there rely ... at least the site that is commenting here is relying on methadone for patients who need long term medication. Its advantages include less abuse potential, it's much less expensive and it is less likely to cause tolerance. Methadone may have some NMDA receptor antagonist effects. And for neuropathic pain we also agree it seems to be a little bit more effective than traditional opioids, which do not have NMDA receptor activity to my knowledge. Anybody else use methadone in their practice or wants to comment on it? One other problem we have with methadone is the stigma associated with it. Many patients say well this is a drug that's used for detox and for addicts and I'm neither of those and I don't want to take this medication. We have to be fairly careful how we explain what methadone is and its history of being an analgesic way before it was used for detoxification. And as long as you handle those patients concerns well, patients will feel a little more comfortable with that as prescribed.