Download Should patients in chronic pain be allowed whatever pain

Should patients in chronic pain be
allowed whatever pain
remediation possible including
the use of the strongest opioids
such as heroin? (Algology)
Elizabeth Liu
Duy Tran
BINF705
Definition of Chronic Pain
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Originally defined as pain that has lasted 6
months or longer.
Pain that persists longer than the temporal
course of natural healing that is associated with
a particular type of injury or disease process
An unpleasant sensory and affective experience
induced by the exposure to noxious stimuli i.e.
injury incipient or substantive in nature. (The
International Association for the Study of pain)
Management
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It is rare to completely achieve absolute and sustained
relief of pain. Thus, the clinical goal is pain management.
Pain management covers the spectrum of medications,
injections, infusions as well as neuroablative procedures.
Therefore, pain management is often multidisciplinary in
nature.
Medications
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Opioids and non opioids
Antidepressants and Antiepileptic Drugs
Injection, Neuromodulation and Neuroablative Therapy
Rehabilitation
Medication
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The drugs used in pain management may be broadly categorized as
opioid and nonopioid medications.
Opioids are derived from opium, modestly effective analgesics in
chronic pain management. However, they are associated with
adverse effects, especially during the commencement or change in
dosing and administration.
When opioids are used for prolonged periods drug tolerance,
chemical dependency and addiction may occur.
The other major group of analgesics are nonsteroidal antiinflammatory drugs. This class of medications has limited benefit in
chronic pain disorders and with long term use is associated with
significant adverse effects
OxyContin and Medical Marijuana are the two interventions for pain
have been in the news recently
Controlled Substances Act (CSA)
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Enacted into law by the Congress of the United States as Title II of
the Comprehensive Drug Abuse Prevention and Control Act of 1970.
The CSA is the legal basis by which the manufacture, importation,
possession, and distribution of certain drugs are regulated by the
federal government of the United States. The Act also served as the
national implementing legislation for the Single Convention on
Narcotic Drugs.
The legislation created five Schedules (classifications), with varying
qualifications for a drug to be included in each.
Two federal departments, the Department of Justice and the
Department of Health and Human Services (which includes the
Food and Drug Administration) determine which drugs are added or
removed from the various schedules, though the statute passed by
Congress created the initial listing. Classification decisions are
required to be made on the criteria of potential for abuse, accepted
medical use in the United States, and potential for addiction.
The Department of Justice is also the executive agency in charge of
federal law enforcement. State governments also regulate certain
drugs not controlled at the federal level.
Schedule I Drugs
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Findings required:
 (A)
The drug or other substance has a high potential
for abuse.
 (B) The drug or other substance has no currently
accepted medical use in treatment in the United
States.
 (C) There is a lack of accepted safety for use of the
drug or other substance under medical supervision.
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No prescriptions may be written for Schedule I
substances, and such substances are subject to
production quotas by the DEA.
Schedule I Drugs Include
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GHB (Gamma-hydroxybutyrate), which has been used as a general
anesthetic with minimal side-effects and controlled action but a limited safe
dosage range. It was placed in Schedule I in March 2000 after widespread
recreational use
12-Methoxyibogamine (Ibogaine)
Cannabis (includes tetrahydrocannibinols found in marijuana, hashish, and
hashish oil). Cannabis has legal medical uses in some countries and the
U.S. Consequently, extreme controversy exists about its placement in
Schedule I. Main article: Cannabis rescheduling in the United States.
Dimethyltryptamine (DMT)
Heroin (Diacetylmorphine), which is used in much of Europe as a potent
pain reliever in terminal cancer patients. (It is about twice as potent, by
weight, as morphine.)
MDMA (3,4-methylenedioxymethamphetamine,Ecstasy), which continues to
be used medically, notably in the treatment of post-traumatic stress disorder
(PTSD).The medical community originally agreed upon placing it as a
Schedule 3 substance. The government denied this suggestion from the
medical community, without any discussion. The FDA approved this PTSD
use in 2001.
Psilocybin, the active ingredient in psychedelic mushrooms
Schedule I Drugs Include Cont.
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5-MeO-DIPT (Foxy / Foxy Methoxy / 5-methoxy-n,ndiisopropyltryptamine)
Lysergic acid diethylamide (LSD / Acid), which has historically been
used to treat alcoholism and other addictions, helped to stop cluster
headaches, and has been shown to be useful in treating
schizophrenia, bi-polar, and other psychological disorders.
Peyote, one of the few plants specifically scheduled, which has a
narrow exception to its illegal status for religious use by members of
the Native American Church;
Mescaline, the main psychoactive ingredients of the peyote cactus;
Methaqualone (Quaalude, Sopor, Mandrax); It was previously used for
similar purposes as used for barbiturates, until it was scheduled up.
2,5-dimethoxy-4-methylamphetamine (STP / DOM)
2C-T-7 (Blue Mystic / T7)
2C-B (Nexus / Bees / Venus / Bromo Mescaline)
Cathinone (β-ketoamphetamine) is a monoamine alkaloid found in the
shrub Catha edulis (Khat).
AMT (alpha-methyltryptamine)
Schedule II Drugs
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Findings required:
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(A) The drug or other substance has a high potential for abuse.
(B) The drug or other substance has a currently accepted
medical use in treatment in the United States or a currently
accepted medical use with severe restrictions.
(C) Abuse of the drug or other substances may lead to severe
psychological or physical dependence.
These drugs are only available by prescription, and
distribution is carefully controlled and monitored by the
DEA. Oral prescriptions are allowed, except that the
prescription is limited to 30 doses, although exceptions
are made for cancer patients, burn victims, etc. No refills
are allowed. Also, Schedule II drugs are subject to
production quotas set by the DEA.
Schedule II Drugs Include
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Cocaine (used as a topical anesthetic)
Methylphenidate (Ritalin)
Morphine
Phencyclidine (PCP)
Most pure opioid agonists: meperidine, fentanyl,
hydromorphone, opium, oxycodone (main ingredient in
Percocet and OxyContin), or oxymorphone
Short-acting barbiturates, such as secobarbital
Amphetamines were originally placed in Schedule III, but was
moved to Schedule II in 1971. Injectable methamphetamine has
always been in Schedule II
Schedule III Drugs
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Findings required:
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(A) The drug or other substance has a potential for abuse less
than the drugs or other substances in schedules I and II.
(B) The drug or other substance has a currently accepted
medical use in treatment in the United States.
(C) Abuse of the drug or other substance may lead to moderate
or low physical dependence or high psychological dependence.
These drugs are available only by prescription, though
control of wholesale distribution is somewhat less
stringent than Schedule II drugs. Prescriptions for
Schedule III drugs may be refilled up to five times within
a six month period.
Schedule III Drugs Include
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Anabolic steroids (including prohormones such as androstenedione
and androstenediol)
Intermediate-acting barbiturates, such as talbutal or butalbital
Buprenorphine
Dradorn
Ketamine, a drug originally developed as a milder substitute for PCP
(mainly to use as a human anesthetic) but has since become
popular as a veterinary anesthetic
Xyrem, a preparation of GHB used to treat narcolepsy. Xyrem is in
Schedule III but with a restricted distribution system
Hydrocodone / codeine, when compounded with an NSAID (e.g.
Vicoprofen, when compounded with ibuprofen) or with
acetaminophen (paracetamol) (e.g. Vicodin / Tylenol 3)
Marinol, a synthetic form of Tetrahydrocannabinol (THC) used to
treat nausea and vomiting caused by chemotherapy, as well as
appetite loss caused by AIDS
Paregoric
Phloemate
Schedule IV Drugs
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Findings required:
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(A) The drug or other substance has a low potential for abuse
relative to the drugs or other substances in schedule III.
(B) The drug or other substance has a currently accepted
medical use in treatment in the United States.
(C) Abuse of the drug or other substance may lead to limited
physical dependence or psychological dependence relative to
the drugs or other substances in schedule III.
Control measures are similar to Schedule III.
Prescriptions for Schedule IV drugs may be refilled up to
five times within a six month period.
Schedule IV Drugs Include
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Benzodiazepines, such as alprazolam (Xanax), chlordiazepoxide
(Librium), diazepam (Valium), flunitrazepam (Rohypnol) (Note that
Rohypnol is not used medically in the United States, and some
states have placed it in Schedule I under state law.)
Zolpidem (sold in the U.S. as Ambien)
Dextropropoxyphene (sold in the U.S. as Darvocet)
Long-acting barbiturates such as phenobarbital;
Some partial agonist opioid analgesics, such as pentazocine
(Talwin);
Certain non-amphetamine stimulants, including pemoline and the
pseudostimulant modafinil.
Schedule V Drugs
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Findings required:
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(A) The drug or other substance has a low potential for abuse
relative to the drugs or other substances in schedule IV.
(B) The drug or other substance has a currently accepted
medical use in treatment in the United States.
(C) Abuse of the drug or other substance may lead to limited
physical dependence or psychological dependence relative to
the drugs or other substances in schedule IV.
Schedule V drugs are sometimes available without a
prescription.
Schedule V drugs Include
Cough suppressants containing small
amounts of codeine
 Preparations containing small amounts of
opium or diphenoxylate (used to treat
diarrhea);
 Pregabalin, an anticonvulsant and pain
modulator.
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Opioid
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The main use is for pain relief. These agents work by binding
to opioid receptors, which are found principally in the central
nervous system and the gastrointestinal tract. The receptors
in these two organ systems mediate both the beneficial
effects, and the undesirable side effects.
There are four broad classes of opioids:
 endogenous opioid peptides (opioids produced naturally in
the body);
 opium alkaloids, such as morphine and codeine;
 semi-synthetic opioids, such as heroin and oxycodone;
 Fully synthetic opioids, such as pethidine and methadone.
History of Opioids
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1817, Friedrich Wilhelm Adam Sertürner reported the isolation of pure
morphine from opium after at least thirteen years of research and a nearly
disastrous trial on himself and three boys.
Morphine was the first pharmaceutical isolated from a natural product, and
this success encouraged the isolation of other alkaloids
1820, isolations of narcotine, strychnine, veratrine, colchicine, caffeine, and
quinine were reported.
Morphine sales began in 1827, by Heinrich Emanuel Merck of Darmstadt,
and helped him expand his family pharmacy into the massive Merck KGaA
pharmaceutical company.
Codeine was isolated in 1832 by Robiquet.
Heroin, the first semi-synthetic opiate, was first synthesized in 1874, but
was not pursued until its rediscovery in 1897 by Felix Hoffmann at the Bayer
pharmaceutical company in Elberfeld, Germany.
History of Opioids
Cont.
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From 1898 through to 1910 heroin was marketed as a non-addictive
morphine substitute and cough medicine for children.
By 1902, sales made up 5% of the company's profits, and
"heroinism" had attracted media attention.
Oxycodone, a thebaine derivative similar to codeine, was introduced
by Bayer in 1916 and promoted as a less-addictive analgesic.
Preparations of the drug such as Percocet and Oxycontin remain
popular to this day.
A range of synthetic opioids such as methadone (1937), pethidine
(1939), fentanyl (late 1950s), and derivatives have been introduced,
and each is preferred for certain specialized applications.
No drug has yet been found that can match the painkilling effect of
opium without also duplicating much of its addictive potential.
Heroin
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A semi-synthetic opioid.
It mimics endorphins and creates a sense of well-being upon entering the
bloodstream It is thus used both as a pain-killer and a recreational drug.
The body responds to heroin in the brain by reducing (and sometimes
stopping) production of the endogenous opioids when heroin is present.
Endorphins are regularly released in the brain and nerves and attenuate
pain. Their other functions are still obscure, but are probably related to the
effects produced by heroin besides analgesia
Internationally, heroin is controlled under Schedules I and IV of the Single
Convention on Narcotic Drugs.
It is illegal to manufacture, possess, or sell heroin in the United States;
however, under the name diamorphine, heroin is a legal prescription drug
in the United Kingdom
Diamorphine (Heroin)
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The UK Department of Health's Rolleston Committee
report in 1926 established the British approach to heroin
prescription to users, which was maintained for the next
forty years: dealers were prosecuted, but doctors could
prescribe heroin to users when withdrawing it would
cause harm or severe distress to the patient.
This "policing and prescribing" policy effectively
controlled the perceived heroin problem in the UK until
the 1960s.
1964 only specialized clinics and selected approved
doctors were allowed to prescribe heroin to users.
By 1970s, the emphasis shifted to abstinence and the
prescription of methadone, until now only a small
number of users in the UK are prescribed heroin.
Oxycodone
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Oxycodone is a semi-synthetic opioid derived from the alkaloid thebaine,
unlike most early opium-derived drugs which instead used the morphine or
codeine alkaloids also found in the plant.
Oxycodone was first synthesized in a German laboratory in 1916, a few
years after the German pharmaceutical company Bayer had stopped the
mass production of heroin due to addiction and abuse by both patients and
physicians. It was hoped that a thebaine-derived drug would retain the
analgesic effects of morphine and heroin with less of the euphoric effect
which led to addiction and over-use.
To some extent this was achieved, as oxycodone does not "hit" the central
nervous system with the same immediate punch as heroin or morphine do
and it does not last as long. The subjective experience of a "high" was still
reported for oxycodone, however, and it made its way into medical usage in
small increments in most Western countries until the introduction of the
OxyContin preparation radically boosted oxycodone use.
OxyContin
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OxyContin is a medically prescribed pill that contains
Oxycodone,
A synthetic opioid with analgesic properties similar to
opium-derived painkillers like morphine or codeine.
OxyContin is a Schedule II drug under the Controlled
Substances Act (CSA), which includes legal drugs that
are subject to the maximum amount of government
control and regulation. The FDA approved OxyContin in
1995 and Purdue Pharma introduced the drug in 1996.
Unlike Percocet, whose potential for abuse is limited by
the presence of paracetamol, OxyContin contains only
oxycodone and inert filler
OxyContin Cont.
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In 2001, OxyContin was the number one opioid painkiller sold and in
2000 over 6.5 million prescriptions were written.
OxyContin is prescribed for patients with moderate or severe pain
who need extended relief from treatment of terminal cancer and
severe injuries.
Addiction to OxyContin is rare for those who use the drug as
recommended, however, due to pharmacy break-ins, growing levels
of recreational use, and increased media reports of Oxycontin
abuse, the DEA heavily regulates prescriptions.
Some pharmacies now no longer stock the drug and many doctors
are afraid to prescribe OxyContin and other legitimate pain
medications out of fear of government sanctions.
This stigmatizes patients in need of pain medication and makes it
more difficult for them to obtain relief.
The Need For Pain Management
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Natural opiate and synthetic derivatives have been lauded as
excellent painkillers, while at the same time criticized as highly
addictive substances.
Over the last two decades, the medical community has been more
attentive to pain and pain management. As a result, the use of
opioid medicine has increased, especially among cancer patients
who were previously under treated.
According to the American Medical Association (AMA) and the
National Institutes of Health (NIH), approximately 17 million
Americans suffer from unyielding pain. A 1997 report by the AMA
stated that a major problem in American medicine was inadequate
treatment of pain. In addition, The American Pain Foundation
estimates that 50 million U.S. citizens suffer from significant pain
daily.
What To Do About OxyContin
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The National Foundation for the Treatment of Pain has
concluded that OxyContin abuse is a minor problem
compared to the millions of untreated, under treated,
mistreated, and abandoned patients.
The FDA has stated that, "Although abuse, misuse, and
diversion are potential problems for all opioids, including
OxyContin, opioids are a very important part of the
medical armamentarium for the management of pain
when used appropriately under the careful supervision of
a physician." The agencies will "help to ensure that these
important drugs remain available to appropriate
patients."
Medical Marijuana (Medical
Cannabis)
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Medical cannabis refers to the use of the drug Cannabis as a physician recommended herbal
therapy, most notably as an antiemetic.
Cannabis has been used for medicinal purposes for over 4,800 years.
Surviving texts from Ancient India confirm that its psychoactive properties were recognized, and
doctors used it for a variety of illnesses and ailments. (gastrointestinal disorders, insomnia,
headaches and as a pain reliever)
Cannabis as a medicine was common throughout most of the world in the 1800s, It was used as
the primary pain reliever until the invention of aspirin.
The term medical marijuana post-dates the U.S. Marijuana Tax Act of 1937, the effect of which
made cannabis prescriptions illegal in the United States.
Later in the century, researchers investigating methods of detecting cannabis intoxication
discovered that smoking the drug reduced intraocular pressure. (High intraocular pressure causes
blindness in glaucoma patients)
In the 1970s, a synthetic version of THC, the primary active ingredient in cannabis, was
synthesized to make the drug Marinol.
Users reported several problems with Marinol, however, that led many to abandon the pill and
resume smoking the plant.
Patients complained that the violent nausea associated with chemotherapy made swallowing pills
difficult. The effects of smoked cannabis are felt almost immediately, and is therefore easily dosed.
Marinol (Dronibanol), like ingested cannabis, is very psychoactive, and is harder to titrate than
smoked cannabis.
Marinol has also consistently been more expensive than herbal cannabis. Some studies have
indicated that other chemicals in the plant may have a synergistic effect with THC.
Medical Marijuana
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Marijuana is the most commonly abused illicit drug in the United
States. A dry, shredded green/brown mix of flowers, stems, seeds,
and leaves of the plant Cannabis sativa, it usually is smoked as a
cigarette (joint, nail), or in a pipe (bong). It also is smoked in blunts,
which are cigars that have been emptied of tobacco and refilled with
marijuana, often in combination with another drug. It might also be
mixed in food or brewed as a tea. As a more concentrated, resinous
form it is called hashish and, as a sticky black liquid, hash oil.
Marijuana smoke has a pungent and distinctive, usually sweet-andsour odor.
Marijuana is a Schedule I substance under the Controlled
Substances Act (CSA). Schedule I drugs are classified as having a
high potential for abuse, no currently accepted medical use in
treatment in the United States, and a lack of accepted safety for use
of the drug or other substance under medical supervision.
Medical Marijuana
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It is illegal to possess cannabis under federal law in all fifty states.
While federal law does trump state law, most law enforcement regarding
cannabis is handled at the state and local law enforcement level.
Currently, there are twelve states with effective medical marijuana laws on
the books: Alaska, California, Colorado, Hawaii, Maine, Maryland, Montana,
Nevada, Oregon, Rhode Island, Vermont, and Washington. It should be
noted that Maryland's law does not legalize possession of medical
cannabis, but rather makes it unobtainable legally, the offense of which is a
maximum penalty of a $100 fine.
Twenty Additional US States have resolutions on their books affirming the
medicinal value of marijuana. (Alabama, Arizona, Arkansas, Connecticut, Georgia,
Illinois, Louisiana, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, New York,
North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and Massachusetts.
Florida and Ohio formerly had medicinal marijuana resolutions that have since been repealed)
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Eighteen US States do not recognize the medicinal value of
marijuana.(Delaware, Florida, Idaho, Indiana, Iowa, Kansas, Kentucky, Mississippi, Missouri,
Nebraska, North Dakota, Ohio, Pennsylvania, South Dakota, Utah, West Virginia, Wisconsin, and
Wyoming. )
Facts On Medical Marijuana
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University of Mississippi has grown marijuana since 1968 funded by Nature
Institution on Drug Abuse (NIDA), then later by National Institution Health
(NIH). Grow 1.5 to 6.5 acres of marijuana.
Every state residence voted for medical marijuana except South Dakota
which is 48% to 52%
According to the US government marijuana alone has never cause a death
from overdose.
The British Lung Foundation reports that 3-4 marijuana cigarettes a day are
as dangerous to the lungs as 20 or more tobacco cigarettes a day.
A UCLA study found no association between marijuana and lung cancer.
In 1978 the U.S. government started the Compassionate Investigational
New Drug (IND) program, which supplies about 300 marijuana cigarettes
per month to seriously ill patients approved for the program. The program
was shut down in 1991, but seven of those patients (as of 7/31/06),
continue to receive the free government marijuana.
Marijuana extracts were one of the top three most prescribed medicines in
the United States each year from 1842 until the 1890s.
Four Categories of Pharmaceutical
Drugs Based on Marijuana
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Drugs that contain chemical taken directly
from the Marijuana Plat (1)
Name
Sativex
Manufacturer Medical Use Related
Properties
GW
neuropathic
Pharmaceuticals pain and
spasticity
chemical
compound is
derived from
natural extracts
of the cannabis
plant
Four Categories of Pharmaceutical
Drugs Based on Marijuana
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Drugs that contain synthetic versions of
chemicals naturally found in marijuana (2)
Name
Dronabinol
Manufacturer Medical Use Related
Properties
Solvay
Pharmaceuticals
nausea and
vomiting,
appetite
stimulant, ease
neuropathic
pain
Synthetic Delta9 THC
Four Categories of Pharmaceutical
Drugs Based on Marijuana
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Drugs that contain chemicals similar to those in
marijuana but not found in the plant (6)
Name
Dexanabinol
Manufacturer Medical Use Related
Properties
Pharmos
Neuroprotective
(protects brain
from damage)
Synthetic nonpsychotropic
cannabinoid
which blocks
NMDA receptors
Four Categories of Pharmaceutical
Drugs Based on Marijuana
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Drugs that do not work like marijuana but use
the same brain pathways (4)
Name
Rimonabant
Manufacturer Medical
Use
Related
Properties
Sanofi-Aventis
Synthetic chemical
that blocks
endocannabinoids
from being
received in the
brain
Anti-obesity
Pros of Medical Marijuana
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Overwhelming that marijuana can relieve certain types of pain, nausea,
vomiting and other symptoms caused by such illnesses as multiple
sclerosis, cancer and AIDS. Compared with cigarettes and alcohol, the
health risks and societal costs associated with even chronic marijuana use
are mild. Yet we don't ban those items, while we deny marijuana to seriously
ill people who could get a lot of relief from it. This is misguided and cruel.
Prohibition of marijuana doesn't work. It has only spawned an enormous
black market, eroded our civil rights and corrupted our justice system.
No one overdoses on marijuana because it has a negligible therapeutic
ratio; that is, you don't have to use much to get the desired effect.
Prohibition of marijuana over the past decades has not diminished the
demand in the US
Cons of Medical Marijuana
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The government has an obligation to protect public
health
The 'Gateway' Thesis: Pot smokers are much more likely
than non-users to graduate to harder drugs like cocaine
and heroin
No hardcore evidence that prove marijuana is a effective
drug as medicine, 20 year research have produce no
reliable scientific proof
Legalization of drug, crime will increase due to a higher
increase of pot users which will eventually become
addicts and will steal or kill in order to get their drugs
Case 1
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Woman Denied Right to Use Marijuana as Life-saving
Medication
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Angel Raich, 41yr old mother from Oakland California,
suffer from inoperable brain tumour, a weight-loss
disorder, seizures, chronic nausea and scoliosis. Doctor
has claim that marijuana is the only drug keeping her
alive. She takes marijuana every few hours, under her
doctor’s advice to control pain and give her an appetite
otherwise she would “starve to death”.
Case 1 Cont.
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Raich v. Ashcroft, 2003 U.S.
Summary: The Ninth Circuit held that the federal Department of Justice
should be temporarily enjoined from enforcing the Controlled Substances
Act with respect to medical marijuana users in California pending trial of the
case. The plaintiffs, a patient and two unnamed growers who supply her
with the drug and another patient who grows her own marijuana, filed suit
after a series of DEA raids against medical marijuana patients and suppliers
in California, which allows medical marijuana use. The plaintiffs argued that
because the medical use of marijuana by California residents does not
cross state lines and is not commerce, Congress is without power to
regulate it under the Commerce Clause. The three-judge panel of the Ninth
Circuit found that the plaintiffs’ argument that the federal law is
unconstitutional as applied to them was likely to succeed. The court found
that “the appellants’ class of activities - the intrastate, noncommercial
cultivation, possession and use of marijuana for personal medical purposes
on the advice of a physician - is, in fact, different in kind from drug
trafficking.” The appellate panel remanded the case to the district judge and
ordered him to enjoin raids by federal officials pending trial of the case. The
ruling may be appealed by the Justice Department to a larger panel of the
circuit court or to the U.S. Supreme Court.
Case 2
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Jenks v. State, Fla. Dist1991
Summary: Jenks and his wife, who both suffered
from AIDS, were convicted of manufacturing
cannabis which they used to control nausea.
This opinion acquits appellants, noting that they
met the elements of the medical necessity
defense and that marijuana’s presence on
Schedule I did not preclude the use of that
defense because these drugs are subject to
limited medical uses.
Case 3
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Seeley v. State Wash.1997
Summary: This challenge to a Washington law, which
names marijuana as a Schedule I controlled substance,
was brought by a patient with terminal bone cancer who
claimed therapeutic benefits from smoking marijuana.
The Washington Supreme Court held that the law did not
violate the Washington Constitution and that the right to
smoke marijuana also fails federal equal protection
analysis because it is not a fundamental right and is not
within a zone of privacy.
Case 4
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Allen v. Purdue Pharma L.P. (Stamford, CT 2002)
Plaintiff alleges that Mrs. Allen took OxyContin and, as a
direct and proximate cause there from suffered addiction
to the drug and other related damages, which caused
her to inject the pill in her vein, which resulted in her
death.
Judge Rowe's ruled when you ignore safety warnings
and take an otherwise safe and effective product in an
irresponsible and illegal manner, no personal injury
lawyer will be able to help you cash in on your own
misconduct by suing the product's maker.
Case 5
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Doctor Guilty in OxyContin case (FL, 2002)
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Dr. James Graves ,Florida's top OxyContin
prescriber, was convicted of manslaughter for
prescribing the drug to 4 patients who
overdosed and died. He was making $500,000
a year from his pain management practice.
References
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http://www.soyouwanna.com/site/pros_cons/pot/pot.html
http://www.painandthelaw.org/palliative/marijuana_cases.php
http://www.medicalmarijuanaprocon.org/pop/cannabisdrugs.htm
http://www.medicalmarijuanaprocon.org/pop/testing.htm
http://www.nida.nih.gov/about/organization/nacda/marijuanastatement.html
http://www.usdoj.gov/dea/pubs/csa.html
http://www.law.cornell.edu/uscode/21/usc_sec_21_00000812----000-.html
http://www.wikipedia.com
http://stopthedrugwar.org/chronicle/467/support_for_marijuana_legalization_low_in_europe
http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm#What_is
http://www.ampainsoc.org/advocacy/opioids.htm
http://www.medscape.com/viewarticle/549294
http://www.painreliefnetwork.org/prn/how-expert-testimony-distorts-the-standard-preemptive-analgesia-ethics-anunderlying-principle.php
http://www.jhu.edu/~jhumag/0699web/pain.html
http://jama.ama-assn.org/cgi/content/full/292/11/1394
http://en.wikipedia.org/wiki/Controlled_Substances_Act
http://www.medicalmarijuanaprocon.org/
http://www.sptimes.com/2002/02/20/State/Doctor_guilty_in_OxyC.shtml
Thank You