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First Appeared in CSAM NEWS - Summer 2002
OxyContin and the Olympics: An Addiction Medicine
Perspective
By David Smith, MD
Having returned from the Winter Olympics where I served as doping control
officer at Soldier Hollow in Utah, I was asked to share my observations and
experiences with my Addiction Medicine colleagues in CSAM. I was also asked to
write some comments about the current swirl of media attention being given to
OxyContin addiction. The first question of course is what does one have to do
with the other except that they both start with "O". Having learned educational
objectives from my esteemed colleague, Dr. John Chappel of the University of
Nevada, I will try from an experimental point of view to show how the two "O's"
integrate.
First, it is interesting how I even became a member of the Volunteer Olympic
Medical Team. Our Haight Ashbury Free Clinics has a Rock Medicine Section,
headed by Glenn Razwick, or Raz, which delivers medical services to all the Bill
Graham Presents rock concerts throughout the Bay Area. Raz, who was also
involved in the Olympic Medical Program, asked if I wanted to be on the Olympic
Medical Team as a doping control officer. Since I am an ASAM-certified Medical
Review Officer and am scheduled to present on the role of the MRO to the CSAM
Review Course in October, I felt that it would be a good learning experience. My
motivation was enhanced when Dr. Larry Brown, ASAM's President, said that little
was known about performance enhancing drugs.
My application was accepted as a doping control officer and I found that the
Olympics provided no travel arrangements or housing expense reimbursement
(sounds a little like volunteering for CSAM!). However, I did receive a great
uniform (see picture) and I learned from Raz that physicians would volunteer
long hours at Rock Medicine for a T-shirt, so a uniform was a great stimulus to
work. But fortunately, thanks to Gary Fischer, CEO of the
Cirque Lodge, a fine drug treatment program at Sundance, I was able to stay at
their extended-care studio (which was the old Osmonds recording studio), located
in a beautiful, but remote area in the mountains of Utah close to Soldier
Hollow.
My vision was that I would work at doping control in Soldier Hollow in the
morning, ski at Sundance in the afternoon, and then take in the Olympic events
in Park City. This turned out to be a simplistic and inaccurate vision. In fact,
I got up at 4:30 a.m. every morning, drove in the dark, and passed through
rigorous security before reporting to my duty station at 6:30 a.m. The Doping
Control Station was very well run technically and very tense as they tested both
blood and urine.
I was assigned to blood doping, which is a technique used by athletes in the
endurance contents. Some endurance athletes were taking a synthetic and more
powerful erythropoietin (diarbepoetin), which is sold under the brand name of
Aranesp) to artificially stimulate their red cell production to build up their
hemoglobin and oxygen carrying capacity. This was the first Olympics for which
comprehensive blood doping technology testing was available.
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Before competition all athletes had their blood drawn. For females, if the
reticulocytes were 2% and/or hemoglobin 16 or greater, a second blood sample was
drawn and the urine was tested for darbepoetin or its derivatives at the Central
Doping Control Lab in Salt Lake City. For the male the level was 2% for
reticulocytes and hemoglobin was 17.5.
The greatest tension occurred when the Russian cross-country skier had a
positive blood doping test and couldn't compete. Germany won the Gold Medal and
Russia threatened to withdraw. I thought WWIII was going to break out.
Ten days later, exhausted, but proudly wearing my Olympic uniform, I boarded a
plane in Salt Lake to fly to Reno to visit and ski with John Chappel in order to
work off tension and return to San Francisco with a semblance of health. During
my time at the Olympics, I was so tired; I skied only one day at Sundance and
watched only one Olympic event, the women's bobsled, where the U.S. won the gold
medal.
As the plane took off, I noted a young woman in distress sitting next to me with
a patch on her left shoulder. I asked what the patch was and she said it was a
Catapres Patch for OxyContin withdrawal. I introduced myself and this started a
long conversation. She was 23 and addicted to 200 mg of OxyContin and was in
acute withdrawal. She had left treatment to go to her 21-year old cousin's
funeral who died of an OxyContin overdose. I advised her that it was a mistake
to leave treatment and that she was at high risk to relapse. I noticed that she
had ordered two small bottles of vodka to calm her nerves. I offered her any
help I could give and she proceeded to share her OxyContin abuse story.
She indicated that she bought OxyContin for 50 cents per milligram and therefore
had a $100 per day habit. Her OxyContin came from physicians who freely
prescribed it to pain patients who sold part or all of their prescription to
addicts in the drug culture. She described in detail how she ground it up,
solubilized it and injected the OxyContin. She showed me her tracks including an
OxyContin abscess scar for which she was recently treated. Her experience was
very similar to those related to me by Dr. Ken Roy, in New Orleans, including
interviews with his patients as well as conversations. I had with addiction
medicine doctors in Florida where there is a major OxyContin abuse and diversion
problem and prescription narcotic overdoses exceed heroin overdose.
In contrast to the Olympics, which were confined to Utah, the OxyContin
diversion problem is nationwide. I recognize that a majority of pain patients
take their narcotic pain medication in a safe and effective fashion. However,
there is a significant OxyContin diversion and abuse problem that involves
pharmaceutical industry clientele, physician over-prescribing, pain patient drug
sales and serious addiction of young people in the drug culture. I acknowledge
that the issue of pain and addiction is very complex. I feel the broader issue
of OxyContin diversion and abuse needs to be responded to by our profession. I
welcome CSAM membership questions and comments on both my Olympic and OxyContin
experience. You may send comments to Dr. Smith at
drsmith@hafci.org.
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