PAINKILLER'S DARK SIDE EMERGES IN RURAL AREAS

Rampant Abuse Of Prescription Drug Disrupts Va. Town; 'It's Costing Lives'

PULASKI, Va. - The armed robberies of pharmacies have the police chief of
this little town concerned, but then he has a lot on his mind these days.

There are the reports of girls prostituting themselves and of some elderly
residents suddenly becoming drug dealers. One officer had to shoot a man
who allegedly tried to run him down.

In addition to all of that, a lot of people around him are dying young.

"And," says the chief, Gary Roche, "I got a public interest in people not
dropping dead."

Pulaski's problems stem from the prescription pain reliever OxyContin,
which is being so abused in southwest Virginia and other rural areas that
many pharmacies have stopped selling it and doctors have stopped
prescribing it.

Simply put, residents here, elsewhere in Appalachia and in a few other
scattered regions have developed a drug habit the likes of which neither
they nor anyone else has ever seen.

Hailed as a godsend for cancer sufferers and others with chronic pain,
OxyContin is showing its devilish side. Demand for the drug among
recreational users has led to a wave of robberies, thefts, prostitution and
black-market dealing usually more associated with crack cocaine and heroin
in the country's urban areas. Dozens of people who have gotten their hands
on the drug and abused it have died of overdoses. The luckier abusers are
merely among a whole new brand of junkie.

Unlike crack cocaine and other illegal drugs that have taken their toll in
big cities, OxyContin is striking places like Pulaski - isolated,
economically depressed areas with large elderly populations that have
embraced what they regard as a magic pill that eases their pain.

It is just beginning to appear in Maryland, in Allegany County and other
rural areas, but also in Baltimore and Baltimore County, where law
enforcement officials say it is often used as a substitute for heroin.

"What makes it so tough is it's legal," says Roche, raising his voice to
talk above a train chugging down the railroad tracks that helped spawn his
town. "I find it on you and you have a prescription for it, there ain't
nothing I can do."

OxyContin is a powerful painkiller, a brand produced by Purdue Pharma of
Stamford, Conn. Last year it generated more than $1 billion in revenue for
its manufacturer.

Officials of the company, while acknowledging the crime and abuse
associated with the drug, maintain prescription drugs have always been
misused and if their drug weren't around, some other painkiller would be
generating problems.

"OxyContin has become the poster child for prescription drug abuse," says
the company's spokesman, James W. Heins. "There are other drugs being
abused, it's just that OxyContin is getting all the attention."

Addictive qualities

Law enforcement officials and many members of the medical community say
there is good reason for that - that OxyContin is different from any
approved drug they have seen abused.

The drug's primary ingredient is oxycodone, a man-made opiate similar to
heroin, morphine and codeine.

OxyContin contains up to 16 times as much oxycodone as other pain relievers
do. Aside from that, what has made it so attractive among legitimate users
is how it travels through the bloodstream. It does not offer a quick
numbing the way the painkiller Percocet does, for example. Instead,
OxyContin is designed to be released by pill into the bloodstream
gradually, easing pain for up to 12 hours while causing far less fatigue
among patients than other such drugs.

But abusers of the drug figured out how to compress that 12 hours into a
single bursting rush so that it provides a buzz that rivals heroin.

Some abusers chew the tablet to break down the time-release mechanism.
Others crush the tablets into powder and snort it. The worst-off among
them, like Eric Proffit, a 28-year-old father of four, turned to using a
needle to shoot it into their veins.

"I was chewing it, getting off, getting off, but then I needed more and
more," says Proffit, a lifelong Pulaski resident working at a carnival to
earn some money. "Then this dude tells me I'm just wasting it that way."

So he snorted, he recalls, and then he began shooting up. And it wasn't
long, he says, before he was hooked on more than 280 milligrams a day, an
all-out assault on his body - and a $280-a-day habit. He funded it, he
says, mostly by stealing cigarettes from grocery stores in his county and
those surrounding it. He was arrested seven times for shoplifting before
going clean four months ago.

Why OxyContin is showing up in rural areas rather than in larger cities is
a matter of conjecture, but law-enforcement officers say part of the reason
is as simple as the age-old business concepts of supply and demand - and
risk and return.

Major drug dealers, they reason, don't find it worth the risk to travel to
sparsely populated areas with a car full of marijuana, cocaine or heroin,
where the market isn't as lucrative as New York, Philadelphia or Baltimore.
Unlike along the Interstate 95 corridor, a pipeline for illegal drugs from
Florida into New England, the demand for the product is too low in the
rural areas along Interstate 81 - and new faces in town are too easily
noticed - to make it worthwhile.

OxyContin, on the other hand, is as close as the neighborhood drugstore. In
Pulaski, there are seven pharmacies, and the sudden popularity of the drug
among an increasingly hooked population has a lot of people nervous.

Pharmacy robberies

Two pharmacies in the county have been robbed by gunmen in the past eight
months. Three drugstores in nearby Tazewell County were robbed as well.
Nationwide, there have been 800 robberies or thefts of OxyContin last year
and the first half of this year, including 10 in Maryland, according to the
Drug Enforcement Administration.

"I suppose if the police station wasn't 300 yards behind me, we'd be
robbed, too," says Eddie Hale, a pharmacist at Martin's Family Pharmacy on
Pulaski's Main Street. "When someone's desperate, there's no telling what
they'll do."

Not long ago, because of what has happened to other pharmacists, he
purchased a remote-control alarm that will silently inform the police
department if he is being robbed.

A mining town named after a Polish general killed in the siege of Savannah
during the American Revolution, Pulaski is an old town in ways that go
beyond its beginnings in 1865. More than 30 percent of its 9,700 residents
are senior citizens, according to the U.S. census.

Including residents of Pulaski County, the city's Parks and Recreation
Department attracted 2,000 kids and young adults last year. The senior
center attracted 6,300.

With an aging population, much of it retired from the zinc and iron mines,
doctors treat a steady stream of people looking for relief from their
pains. Most of those people, Hale says, use the drug legitimately. But he
and law enforcement officers say that others go "doctor shopping," hitting
office after office until they find a physician willing to prescribe
OxyContin, and then the patients set up shop.

"They sell half of it, even, and they make $1,200, maybe $1,400 from a
prescription," says Roche, the police chief. "These are people on fixed
incomes. Where else are they going to get that kind of money?"

Although abuse of the drug has popped up in places such as Boston and West
Palm Beach, Fla., it is most concentrated where jobs are scarce, the
economy is lagging and geography has created a form of isolation. The
description fits Pulaski. On the way into town, the closed Rose's dime
store stands like a gateway to a region of shut-down businesses. Every
restaurant except the fast-food joints has closed, there's not a bar to be
found and the only movie theater is long dark.

Many residents in such places have long abused prescription drugs,
according to law enforcement officials, but OxyContin, after short use, can
be intensely physically addicting, and the hunt for more can be as
debilitating as some of the pain it was designed to stem.

"Things are only going to get worse if you have a bunch of families without
guys working," says Capt. E.T. Montgomery of the Pulaski Police Department.
"There's a whole lot of impact that never shows up in the crime statistics."

Much of the evidence of OxyContin's emergence is not found in figures
compiled by law enforcement but by medical examiners. There are no reliable
statistics on the number of deaths caused by OxyContin, because autopsies
detect only the drug oxycodone, which is found in a number of pain relievers.

In Maryland, the Office of the State Medical Examiner reports that there
were no deaths last year directly caused by oxycodone. But
oxycodone-related deaths - meaning the drug was found in overdose victims
along with other drugs - increased from 27 in 1998 to 69 last year.
Nationwide, oxycodone was found in more than 150 overdose victims,
according to drug enforcement officials.

Even as they defend the drug, Purdue officials are trying to reduce abuse
of OxyContin, which was prescribed more than 6 million times last year.
Among other steps, Purdue has produced prescription pads that include
security features that make them tough to reproduce or forge - a common way
for abusers to obtain the drug. It is also working - as it and other drug
companies have been doing for years - to find a way to manufacture a
pain-relieving drug that does not offer a high when abused.

Legitimate uses

Heins, the Purdue spokesman, says that media accounts of OxyContin abuse
are making it difficult to get it to legitimate users. Six states have
placed restrictions on the drug.

"Obviously, the concerns about abuse and all the attention and adverse
publicity has had an impact on how doctors prescribe it," he says.

Doctors who believe a patient would benefit from the drug now often
prescribe something less effective because of concerns they will be accused
of doling it without discretion, Heins says.

In Pulaski, Mayor Charles W. Stewart says he's tired of his town's
addiction but that the problems go beyond perceptions.

"It's costing lives, it's costing careers, it's costing everything," he says.

Pulaski's police chief says whatever programs are put in place to reduce
abuse of OxyContin, matters almost certainly will get worse before they get
better. That's because of the addictive quality of the drug when abused. As
with heroin, users who try to kick the habit suffer from severe cramps and
other ailments.

"What's happening is we're creating a bunch of junkies," Roche says.

At the beginning of the OxyContin abuse in his city, a man trying to steal
the drug from an elderly woman was hit in the head with a frying pan for
his trouble. That, he says, was kind of funny.

But recently, someone fleeing a robbery in the county tried to run over one
of his officers. The man in the car was shot.

"I don't have heroin dealers on every corner," he says. "I don't have LSD
dealers on every corner. I do have a lot of pharmacies, and that ain't
going to change. So, as far as I can see, this OxyContin problem ain't
going to change either."