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The Haight Ashbury Free Clinics - The 1999 HAFC Logo
The Haight Ashbury Free Clinics

OxyContin and the Olympics:
 An Addiction Medicine Perspective
By David Smith, MD

Dr David Smith Web Site.
Dr Dave's Web Site

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.

 
Click on Photos

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 [email protected].

More Photos from the Olympics
Olympic Museum Lausanne
OLYMPIC MUSEUM LAUSANNE
Salt Lake City 2002
SALT LAKE CITY 2002


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