OTHERS' ABUSE OF OXYCONTIN ADDS TO PAIN OF THOSE IT HELPS

Riddled with pain from rheumatoid arthritis and a degenerative bone
disease for years, Diana Rose rarely left the house. Then in
November, a doctor prescribed the painkiller OxyContin, dramatically
changing her quality of life.

"I can actually go shopping at the mall, play with my grandchildren
and even swim in our pool," said Rose, a 57-year-old Kentucky woman.
"This drug has enabled me to do things without being in pain."

OxyContin, a powerful drug that is a chemical cousin to opiates such
as morphine and heroin, has enabled thousands of people, such as
Rose, to resume the normal activities of life. But now some doctors
fear that a backlash triggered by rampant street use of the drug
dubbed "hillbilly heroin" will derail significant advances in the
field of pain management. They worry that U.S. drug officials may
respond to rising illicit use of OxyContin by yanking it from the
market, place stricter limits on the use of all opiates, commonly
used to treat cancer patients, severe back pain and other chronic
pain conditions.

"This is not just about OxyContin," said John Giglio, executive
director of the American Pain Foundation, a nonprofit consumer group
in Baltimore. "This is about the potential for rolling back progress
made in pain management. It's been an extremely hard uphill climb to
get physicians to become more comfortable prescribing opiates and
overcoming the stigma among patients about potential addiction and
abuse."

OxyContin is a synthetic opiate that has fewer side effects than
other potent pain medications, including morphine or codeine, which
can cause nausea, constipation or drowsiness. What's more, OxyContin
is formulated to keep steady levels of the drug circulating in the
blood for as long as 12 hours. Patients don't experience the intense
peaks and valleys of taking other narcotics, like Vicodin or Lortab,
which can take an hour to provide pain relief and whose effects wear
off in four hours.

Abuse, Addiction

Soon after OxyContin was approved in 1995, recreational drug users
discovered that, rather than letting the pill dissolve in the
gastrointestinal tract, they could produce an intense high by chewing
the drug or crushing it into a power that can be snorted or
intravenously injected. Within a few years, areas in rural Maine and
Appalachian communities of Virginia, West Virginia and Kentucky
reported a wave of users who had become addicted to the drug.

Since then, illicit use of the drug has spread throughout the
country. It is estimated that more than 200,000 Americans have abused
OxyContin, which also has been implicated in more than 100 deaths
from suspected overdoses. Several doctors have been convicted of
illegally dispensing the drug, while "Oxy" addicts increasingly turn
to crime to feed their habits.

The growing alarm about illicit use is having a chilling effect on
legitimate use of the drug. Six states -- Florida, Maine, Ohio, South
Carolina, Vermont and West Virginia -- have set strict limits on the
number of pills that can be prescribed for people on Medicaid. That
means that doctors may not be able to increase dosages for patients
who need stronger pain relief.

In the wake of several robberies at drugstores across the country,
many pharmacies now refuse to stock it and physicians are reluctant
to prescribe it.

"Since all this hysteria began, some patients have been abandoned by
their doctors," said Dr. J.S. Hochman, executive director of the
National Foundation for Treatment of Pain in Houston. "I had two
patients, a mother and daughter with severe rheumatoid arthritis, who
had to fly from Boston to Houston to find a doctor -- and were
willing to do so be-cause they were so desperate. "

Patient Fears

Some patients are so concerned about the negative publicity,
especially fears of addiction, that they've asked their doctors to
take them off the drug.

"The day after an OxyContin story aired on one of the TV
newsmagazines, I had two cancer patients come in the next day,
telling me they wanted off the drug," said Dr. Neal Slatkin, director
of supportive and palliative medicine at City of Hope National
Medical Center in Duarte, Calif.

"Their pain was well-controlled, and they weren't having side
effects," he said. "So I spent a lot of time reassuring them that
this drug was OK. But the whole incident was very distressing."

Patients who continue taking the drug often face serious obstacles in
getting their prescriptions. In Pulaski, Va., a small town in
Appalachia, for example, police began fingerprinting patients who had
OxyContin prescriptions. Under threat of a lawsuit by the American
Civil Liberties Union, authorities later backed down.

"I've been refused treatment in the ER because they think I'm a drug-
seeker," said Jeannette Murray. The 31-year-old nurse, who lives in
an area of southwestern Virginia that is a hotbed of OxyContin
addiction, takes the drug to relieve chronic pain from an injury to
her right arm.

"It's been difficult finding a pharmacy to get my prescription
filled," Murray said. "I've been cautioned not to carry my
prescription on my person, which just adds more stress to an already
stressful situation."

"Smart' Pill

In response to reports of OxyContin abuse, Purdue Pharma, a Stamford,
Conn., pharmaceutical firm, in May stopped marketing the 160-mg
version of the drug, then the strongest dosage available.

The company also recently announced plans to introduce a "smart"
version of the pill, which will lose its potency if it's crushed or
snorted; however, the new formulation won't be available for a few
years.

And beginning in July, the FDA required that OxyContin boxes carry
the agency's strongest warning: a black box label that calls
attention to the drug's potential for abuse.

"But all this hoopla just exacerbates patients' underlying anxiety
about taking opiates, which we know are really quite effective," said
Dr. Richard Payne, chief of pain and palliative care service at
Memorial Sloan-Kettering Cancer Center in New York.

"There is still a pervasive undertreatment of pain," he said, "and
thousands of people are suffering needlessly."