'HILLBILLY HEROIN' FINDING ITS WAY INTO SOUTH CAROLINA

It is hard to believe such power rests in such a little pill.

But the small size of OxyContin, a prescription narcotic pain medicine
related to morphine, belies its potential to either help those who use it,
or hurt those who abuse it.

Doctors say OxyContin can be a mighty, life-enriching weapon against
crippling pain for patients who have conditions such as cancer, arthritis,
or chronic back pain when the drug is used correctly.

However, once this pill is crushed and snorted or injected, it unleashes a
demon of addiction that can wreck lives, destroy health or even cause death.

The abuse of the drug, once concentrated mostly in Appalachian states, is
slowly creeping into South Carolina, officials say.

Is the abuse of OxyContin a growing problem in Charleston?

"Oh boy, yes. Very much so," says Ed Johnson, administrator for the narcotic
replacement program at the Charleston Center.

Forty percent of the center's 165 patients are struggling with addictions to
prescription narcotics, especially OxyContin. When Johnson started at the
center nine years ago, only about 5 percent of his patients were addicted to
prescription drugs, and OxyContin was not even on the market.

Because of its potential for abuse, the painkiller, introduced on the market
in 1995, is causing headaches for law enforcement agencies across the
nation.

Many law enforcement agencies and counselors consider OxyContin a "Trojan
Horse" drug because it is often abused by occasional drug users who don't
realize how quickly they can become psychologically and physically dependent
on the drug. Once their addiction takes hold, these users then often turn to
less expensive opiates like heroin or other painkillers to avoid withdrawal.

Long-term abuse can cause the same kinds of health damage as heroin, said
Kristi Lenz, an associate professor of pharmacy at the Medical University of
South Carolina.

It can cause psychosis, neurological damage, and seizures. The abuse of high
doses can cause heart failure, Lenz said.

In her classes, Lenz teaches her students how to assess patients for their
pain management needs, and how to recognize warning signals in someone who
might be abusing it.

The abuse of the drug, which produces a euphoric, heroin-like high when
crushed and snorted or injected, has hit communities in Virginia, West
Virginia and Maine especially hard.

Across the region, there have been reports of people robbing pharmacies and
family members to feed their habits, and dying from overdoes of the drug,
which is sometimes called "hillbilly heroin", according to Associated Press
reports.

In South Carolina, the Department of Health and Environmental Control, which
tracks the abuse of prescription drugs, made 420 arrests last year statewide
for prescription drug abuse, and 32 of them were related to OxyContin,
spokesman Thom Berry said.

Since July of this year, DHEC has made 103 arrests, and 13 of them were for
the abuse of OxyContin, Berry said.

"We saw an increase in cases, but we think it may be leveling off as more
people become aware of how it can be abused," Berry said.

Prescription drug addictions can be particularly insidious, Johnson said.

"One of the dynamics with any prescription drug is that abusers often have
the attitude that if their doctor prescribed it for them, it can't be wrong.
It's easy to rationalize. Minimization is part of addiction," Johnson said.

"It's a very good pain medicine, but it's also highly abusable. That's the
tragedy of the whole deal," Johnson said.

Dr. Frank Brescia knows firsthand how the correct use of OxyContin can
change his patients' lives for the better.

Consequently, he is concerned that the controversy over the drug's abuse
could cause doctors to hesitate to prescribe it, patients who could benefit
from it to avoid it, or regulators to make it more difficult to get.

Brescia is the director of palliative care service at the Medical University
of South Carolina Hospital, and his practice includes caring for patients
who are dying or suffering from other kinds of debilitating pain.

For those patients, OxyContin is a revolutionary drug, he said.

"For patients who have chronic pain that is not going to go away, it's a
great medication," he said.

One of OxyContin's most important benefits is that the oxycodone, the active
ingredient in the medicine, is released gradually over 12 hours. In the
past, the medicine for patients who needed relief wore off every two to
three hours, Brescia said.

In addition, OxyContin has fewer side effects than some other pain
management medicines, he said.

The publicity about the drug abuse has caused many patients to be afraid
that using it properly could cause addiction, Brescia said.

But legitimate, doctor-supervised use of OxyContin is no cause for fear, he
said. The drug, like many substances, does cause a therapeutic dependency,
which means that patients' bodies may react with withdrawal if they stop
using it suddenly, rather than gradually reducing their dosage under a
doctor's care.

This is different from a true addiction, which is a psychological and
pathological problem as well as physical dependency, Brescia said.

"A therapeutic dependency has nothing to do with craving a drug. I've never
had a patient rob a drugstore," he said.

As an illustration, Brescia tells of a 40-year-old woman he treated who is a
well-educated career woman with children and many awards for her volunteer
work.

"She was the paramount of a good citizen," he said.

After major traumatic injury, she suffered from crippling pain and was in a
wheelchair when she came to him.

"Her doctors had refused to prescribe significant pain medicine saying it
was for her own good, but she could not function," he said.

She has been on opioids, including OxyContin, for eight years with no dosage
increase and has found great relief.

"To look at her, you would never know that she still has chronic pain. It
has made her quality of life acceptable again. She's walking. She's back to
her volunteer work and taking care of her children. Does her body still need
the pain medicine? Yes. Is she an addict? No," he said.

The drug has been blamed for contributing to more than 100 deaths
nationwide, according to Associated Press reports.

Purdue LP of Stamford, Conn., which has become the target of lawsuits in
Maine, West Virginia, Ohio, Kentucky and Florida, says those estimates are
unreliable and that in the vast majority of those cases, the victims were
abusing other drugs at the same time.

Last month, Charleston attorney Akim Anastopoulo filed a lawsuit against
Purdue Pharma and others on behalf of five Orangeburg residents, including
one who died of an overdose, who claim that they were adversely affected by
OxyContin.

Purdue Pharma spokesman James Heins could not discuss the South Carolina
lawsuit specifically.

"I haven't seen the allegations in the South Carolina lawsuit, but the
others are baseless. There is nothing in these cases that is going to stop
us from making sure that our medication is available for patients who need
it," he said.

Purdue Pharma has developed a number of programs designed to help reduce the
abuse of the drug, Heins said.

In addition, Purdue Pharma is in clinical trials testing an abuse-resistant
formulation of OxyContin that, if taken correctly, would still provide pain
relief. However, the new formulation would include an agent that cancels the
pain relief function and euphoric effect if crushed. The new drug is still
several years away from Food and Drug Administration approval, he said.