donna chisholm is north & South ’s editor-at-large.

+ Health

the AccidentAl addictsA drug linked to the deaths of Heath Ledger and Michael Jackson and responsible for widespread addiction problems overseas is now this country’s most popular powerful painkiller. Why on earth didn’t New Zealand heed the warnings from other countries about the risks of “Hillbilly Heroin”? Donna Chisholm investigates.

Otago University student Freya Stephen, photographed here two months before she died,

was addicted to OxyContin, an opioid drug originally prescribed for pain relief.

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Every so often, when talk-ing about the death of her daughter, Denise Ste-phen’s face involuntarily freezes into a dreadful mask of grief.

It’s more than three years since she found 19-year-old Freya sit-ting slumped, blue and cold in her bed, but the memory seems to be on permanent re-play in her brain. “The absolute, ultimate horror of what I saw will stay in my mind forever,” she says of that November morn-ing. “I stood at the door and screamed and screamed. I rang the ambulance. They asked who I wanted. I said ‘I want police, ambu-lance, the whole lot. My daughter is dead. I think my daughter is dead.’”

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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 en-slaved Freya Stephen before she died of a methadone overdose in November 2008.

In 2010, the drug became New Zealand’s most prescribed opioid painkiller for severe pain, overtaking morphine for the first time. And yet, sales of morphine have not reduced comparatively, meaning thousands of people who weren’t on strong painkillers before the introduction of oxycodone are now taking them. That’s because Mundipharma, the company which sells the drug in New Zea-land 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 pre-scribed 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 Pharmac’s 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 Prac-tice Advisory Centre, were reiterated and expanded last year.

But with more than 180,000 scripts writ-ten 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 vic-tims 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 first prescribed OxyContin in April 2007, in her final 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 fines, $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 financial 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 Purdue’s board of directors in the US and has been its general counsel since 1994. Another, Cornelia Hentzsch, is the presi-dent 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 Australian-based quality use of medicines director Carolyn Winkler told us: “As you would be aware, regulatory processes are very differ-ent in each country.”

When we asked her how Mundipharma

Freya Stephen, about two years before she died.

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.”

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

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Freya’s father John, a carpenter, was work-ing in Balclutha when the copper from Dun-edin 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, Fairfield?”

“Yes, that’s 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, ‘You’re joking.’ I was trying to work out what de-ceased 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 pre-scription 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

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 & South’s questions, Winkler said Mundipharma had been “dedicated to providing strong anal-gesic medicines to help relieve severe de-bilitating 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 Zealand’s regulatory environment and the strict prescribing

was 16. “I crushed and snorted it with my partner. She got very ill off it the first time, but I felt amazing. I later found a regular sup-plier who had a script himself, and bought from others with scripts to sell at a profit.”

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. “It’s a very lucra-tive way of going about it.”

Mike soon moved from snorting OxyCon-tin 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 Freya’s street supplier of OxyContin.

When the GP reduced Freya’s dose, Freya asked Mike to inject her. “She felt too de-pendent 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 in-jecting it since that day. She never went back to eating it. No one really does after you’ve tried it IV.”

Around the middle of 2008, when she turned 19, Freya moved into a family-owned flat. Though Denise says she saw her daugh-ter three times a week and spoke to her every day on the phone, they couldn’t 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 be-ing usually particular about her appearance, Freya didn’t seem to care. She looked tired and dishevelled and Denise occasionally wondered if she was washing her clothes often enough.

About this time, Freya’s GP also had con-cerns about the continuing OxyContin re-gime, and reduced her prescription. The idea sent Freya into a panic, says an Otago University friend we’ll call Mike.

“I remember her telling me how one day she decided not to take it because she didn’t think she’d need it and she went into ter-rible 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 co-deine for a high since the age of 14 and bought his first OxyContin on the street when he

On April 15, 29 days before the operation, she wrote in her diary: “Every day, make yourself happy. Don’t rely on other people. Surround yourself with friends. Talk to par-ents. 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.

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 connota-tions of this have deterred many patients from taking it. Not so OxyContin. And yet it’s stronger, about twice as expensive and potentially more addictive.

“I didn’t give two thoughts about it,” says Denise Stephen. “It seemed to be just like prescribing Voltaren [a commonly used anti-inflammatory drug]. I never thought to ask why she was on OxyContin. There were so many questions I could have asked and didn’t 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 didn’t 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 Oxy-Contin 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.

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 guide-lines to help doctors manage the pain of genuine patients and to better identify those seeking medicines illegally.

In the first 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 Or-

ganisation “analgesic ladder” guidelines. Start with the simple stuff such as Paraceta-mol and if that doesn’t work, move up to step two – weak opioids including Tramadol and codeine. It’s when those drugs still don’t 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 pre-scribed 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

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.

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.

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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.

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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 pret-ty 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 first person he knew who had died after becoming addicted to Oxy-Contin. “We just didn’t know what we were playing with. We didn’t see it coming.”

In October 2008, Denise Stephen noticed for the first time the red-dened and infected lump on the in-side of Freya’s arm, right over the vein into which she was injecting OxyContin – and possibly other drugs by this stage.

Freya, who’d been given lop-eared bunny George for her 19th birthday, explained the wound away as a rabbit bite. “I said, ‘That’s 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 rabbit’s 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 be-ing 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, she’d taped a handwritten note to the kitchen range and left a bunch of flow-ers beneath. “Hey mum, I love you heaps. You’ll understand how much your life means to me. These flowers are for you for brightening up my life.”

Denise recalls Freya coming home about 10pm from what might have been a Guy

To Hell and Back

They 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 first person to go through

a public health medical detoxification programme in Auckland for OxyContin addiction. They were the worst days of her life.

As she lies on her bed in her Sandringham flat recounting the experience, it’s 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 first 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 findings 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 Hawke’s Bay.

She was home alone when she took the first two 5mg pills. “I remember being really scared. It was like, ‘Whoa, I’m utterly and absolutely hammered.’ I was petrified. There was a knock at the front door and I remember trying to make it downstairs, holding on to the banister. It was my flatmate who was training to be a nurse. She took one look at me and said, ‘What are you on? What’s going on?’ When I showed her the pills she swore and said, ‘That’s what you give people who are dying of cancer – who gave you this?’ I was screwed. I was under the influence of something I hadn’t experienced before. But now I’d 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 he’d never used it before but because it was giving me pain relief, he’d 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 who’d 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

stabilisers and antidepressants were added to the medicinal mix. By 2009, Jessie was taking around 200mg of OxyContin and OxyNorm a day.

She first 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, I’m having some kind of fit.’”

When she went to a different pharmacist to fill her prescription the next day, “he couldn’t believe I didn’t know what I was on. He said, ‘Jessie, you’re 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 petrified. 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 find 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 shuffling 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 I’m not going to make it. That I’d rather die than have to do this.”

When the 14-day programme ended, Jessie was discharged home.

She thought she’d already reached the bottom – but worse times were ahead. At 4am on her third day at home, she went into post-withdrawal 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 fingers so I wouldn’t 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 finally began to mentally and physically return to normal. She hasn’t 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 invalid’s benefit.

Despite her experiences, Jessie is not condemning the drug but the lack of knowledge about its appropriate use.

“If it’s given for the right amount of time for the right level of pain and it’s watched over, it’s a great painkiller. But if it’s not, it’s extremely dangerous.”

“I had about every withdrawal symptom you can have. I was absolutely freezing, my feet were extraordinarily painful. I was shuffling around like an old person. I had diarrhoea and constipation.”

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

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Pain relieF: the changing drug oF choice

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 fluid leaking from the site of her operation, said no. It’s a decision she will always regret. “I blame myself for not

Oxycodone prescribing has overtaken morphine – but at what cost?

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.”

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

associated with a rise in overdose deaths from the drug.

Coroners’ figures from New Zealand show OxyContin has contributed to the deaths of five 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, “they’re still marketing a product where they perhaps don’t 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 pre-scribe 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 prop-er and adequate analgesia led in turn to doc-tors with other patients in chronic or acute pain applying the same rationale – surely we’re all entitled to adequate pain relief? “The medical profession has got past its opi-oid phobia,” says Geoff Robinson.

It’s difficult to believe that after all the evidence internationally of the prob-lem oxycodone abuse and addiction has caused, New Zealand authorities didn’t warn prescribers much earlier

to take special care with the drug.The oxycodone problem was compounded

by the 2010 withdrawal of two popular pain-killers, Capadex and Paradex, for health rea-sons. Nearly 80,000 people were on those drugs at the time and it’s likely some doctors transferred their patients onto oxycodone, despite it being far more powerful.

Medsafe’s medical director Dr Stewart Jessamine says much less was known about abuse problems in 2001 than subsequently, but that would not have changed the regis-tration process for oxycodone.

“For any new opiate-type drug, there’s a potential for diversion, abuse and addiction. We weren’t 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

cases may well be incorrectly treated with opioids”.

“If your chronic pain lasts longer than six months, is going to grumble on but you’re not going to die of it, there’s increasing awareness that opioid drugs – like mor-phine, 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 can’t just say, don’t use them in chronic pain, but you can say they appear to have been overused in chronic pain. We’re 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

the preferred option.That’s 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 of-ten coming to them on oxycodone after a hospital admission and were reluctant to have a family doctor change what a “spe-cialist” had given them.

Tilyard said while a large proportion of oxycodone prescriptions were initiated in hospitals, all prescribers had to take respon-sibility. “GPs are saying don’t blame me, but it’s a joint responsibility – primary care can’t just blame secondary.”

He said patients often didn’t realise they were on a morphine-like drug “and when you tell them they’re often quite surprised and shocked”. Those same people, asked if they would take morphine, would probably say “no way”.

He’s only ever prescribed oxycodone once in his career, to an elderly patient with severe osteoporosis of her spine, where other op-tions were discussed and rejected.

He said oxycodone came in “with a rip and a roar” but was not “a wonder drug”.

“I don’t believe it should be marketed as a potential first-line drug for osteoarthritis pain. Personally, I’ve never used narcotics [for this group]. I think the volume of oxycodone pre-scribing in New Zealand is a significant issue. That will mean there are people who have been inappropriately pre scribed it or contin-ued on it and of those, a significant proportion are most probably addicted to the medication but they may not know it.”

Dr Jeremy McMinn, consultant psychia-trist and addiction specialist at the Wel-lington Opioid Treatment Service, said of the patients he’d seen recently, most have mentioned oxycodone among the drugs they were using to maintain their habit.

His concern was that oxycodone could cre-ate a different group of addicts. “The risk is people have a perception oxycodone isn’t that dangerous, which is wholly unfounded. I think it’s the opposite – some people have argued oxycodone is more addictive. It ap-pears to have a surging onset. One of the things that gets you addicted is how quickly the drug starts to have an effect and that’s 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

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For nearly a year, 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.

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.

Osteoarthritis sufferers aged 50 to 70 have been targeted in ad campaigns by Mundipharma, which sells oxycodone in New Zealand.

seeing that night that something was wrong, and putting something in place that might have saved her life. Every mother would blame herself, wouldn’t 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

the bottle on her bedside table before re-turning to bed to go to sleep for the last time.

For 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 in-

appropriately prescribed oxycodone. He was alerted to its potential for abuse at an addic-tion conference in Australia last year and now wants to prevent the “tsunami” of prob-lems 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 don’t detect it – a doctor would have to suspect and ask for a specific test to pick it up.

Although oxycodone milligram for milli-gram 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.

Pharmac’s medical director Dr Peter Moodie said it was the agency’s policy to fully fund all newly listed medicines and the 2005 decision came after a positive rec-ommendation from its analgesia sub-com-mittee. He said the agreement to fund the drug did not include the agency getting a better deal for any other Mundipharma products – a tactic that’s 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 oxyco-done’s 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 officer 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 don’t know why it’s become flavour of the month but it has.”

The health board’s medicines committee had last year noted the prevalence of oxy-codone prescribing in Wellington Hospital and issued guidelines that morphine was

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the regulatory and funding arms of the Health Ministry. This is designed to reduce the possibility for forgery or altering pre-scriptions and to assist monitoring of pre-scribing. Prescriptions are restricted to 28 days’ supply. Data sheet and consumer in-formation contains details on the drug’s safe use, risks and side effects.

Of 1700 people registered here as being addicted to prescription medicines and un-der restriction orders, only five or six are addicted to OxyContin.

Jessamine says Medsafe wants to express its sympathy to Freya Stephen’s family. How-ever every opioid carried the risk of addic-tion and harm.

Dr Dave Woods, chief pharmacist at the Best Practice Advisory Centre, says better communication between agencies to en-courage safe and rational prescribing for new medicines at the time they are regis-tered or funded would be helpful.

“That would perhaps put an alternative point of view to the marketing. The medi-cine was made available for prescribing in primary care and I suspect the manufactur-ers went full bent into marketing – they could get in first before all the rational guid-ance came along [such as those issued by the Best Practice Advisory Centre].

“[Now] there’s been a lot of people doing and sending out educational material but I guess the unfortunate thing is it’s all a little bit late. The question is, whose responsibil-ity is it? Pharmac will say their responsibil-ity is to make the drugs available at good cost and Medsafe’s responsibility is to de-cide if it’s safe to be registered. Pharmac’s line is that it’s an individual prescriber’s responsibility to decide on the appropriate-ness and safety of a medicine’s use.”

As part of her campaign to raise aware-ness of the risks of OxyContin abuse, Denise Stephen says she phoned around drug clin-ics asking what they knew of people who’d become addicted.

“One CEO told me I was about two years too soon for this story. I told him, ‘I think we’re about three years too late.’” +

isn’t 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 don’t think we have evidence there’s a big enough problem yet to warrant going down that pathway. There would be issues around how to make it work and how to fit 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

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

“There’s been a lot of people doing and sending out educational material but I guess the unfortunate thing is it’s all a little bit late. ”