OxyContin Invasion

PRESCRIPTION ABUSES TURN A NEW DRUG BAD

A Powerful Painkiller Brings A Deadly High

First Of Three Parts

Ron Hyman, co-owner of Esterson's Pharmacy in Fishtown for more than a
decade, had never heard of a Bensalem doctor named Richard Paolino before
last July - much less handled one of his prescriptions.

So Hyman was more than surprised by the flurry of prescriptions that began
to come from Paolino, 16 miles away, for patients Hyman did not recognize.
And the pharmacist was alarmed that the prescriptions called for unusually
large doses of the powerful painkiller OxyContin, often coupled with orders
for the sedative Xanax.

Hyman says he began questioning and challenging Paolino. He refused to fill
most of the prescriptions, then called other pharmacists and state and
federal drug agents to alert them to his suspicion that OxyContin was being
abused for a heroin-like high.

"I said to my partner, 'This guy is going to end up killing someone,' "
Hyman recalled.

Hyman's alarm came as OxyContin-related deaths began making news across the
country. In October, deaths began reaching into the Fishtown, Kensington
and Port Richmond neighborhoods. By March, six people, including four
teenagers and a mother of four children, would be dead in those
neighborhoods alone.

Prosecutors and pharmacists say Paolino's prescriptions for OxyContin and
Xanax, an often lethal drug combination, flooded those neighborhoods,
starting last summer. From Nov. 1 through March 1 alone, prosecutors say
Paolino wrote more than 1,200 prescriptions for the drugs.

Paolino, 58, is scheduled for trial on Aug. 6 in Bucks County Court - not
on charges that he killed anyone, but on charges that he wrote numerous
prescriptions for controlled substances without a valid medical license. He
has denied the charges.

"He was literally the number-one source of supply for that area,"
Pennsylvania Attorney General Mike Fisher said Friday.

While prosecutors make no link between Paolino and any of the deaths, they
say that stemming the flood of prescriptions into those neighborhoods will
reduce the likelihood of OxyContin abuse and death.

"There will be some lives saved as a result of his arrest," Diane E.
Gibbons, Bucks County's district attorney, said in an interview.

Paolino is among a small but growing number of medical professionals to be
charged with trafficking in OxyContin.

And the attention given to those cases has illuminated how a legitimate
drug that was virtually unknown to the public a year ago can so rapidly get
into the hands of abusers willing to risk their lives for a fleeting high.

OxyContin, on pharmacy shelves only since 1996, was formulated by Purdue
Pharma of Stamford, Conn., as a long-acting painkiller for cancer patients
and others. Hailed by those who legitimately need it, OxyContin has also
been thrust into national notoriety for its deadliness when misused.

Just last week, the U.S. Food and Drug Administration and Purdue Pharma
moved to halt illegal OxyContin use by urging 800,000 doctors across the
country to prescribe it only for patients with serious pain. Purdue Pharma
is facing more than a dozen lawsuits from patients, claiming they have
become addicted to the painkiller, and others blaming the company for
abusers' overdoses and deaths. Purdue Pharma has disputed the allegations,
saying victims were using the drug illegally or improperly.

At least two other area medical professionals have been accused this year,
in cases unrelated to Paolino's, of illegally diverting the painkiller.

John Levin, a doctor in Northeast Philadelphia, was arrested in February on
charges that he sold OxyContin to an undercover agent at St. Joseph's
Hospital. And a pharmacist operating less than a mile from Paolino's
office, Lewis Winokur, was charged in April with producing fake blank
prescription slips on his home computer. Winokur allegedly sold the blank
slips for OxyContin and Xanax for up to $100 each and then used them to
fill prescriptions at his pharmacy. Levin and Winokur have pleaded not
guilty and await trial.

OxyContin abuse, meanwhile, has left many of Philadelphia's neighborhoods
in mourning, killing at a rate nearly double last year's. This year, 39
bodies tainted with oxycodone - the key ingredient in OxyContin - have been
rolled on gurneys into Philadelphia's morgue. Forty-one deaths were
recorded in all of 2000. In the eight-county region, the unofficial
oxycodone-related death count this year is about 50, a toll rising fast,
reaching deeper into the suburbs and claiming younger victims. In Delaware
County alone, police say at least 22 people have died of oxycodone-related
causes since January 2000.

For 1997-1999, a federal survey shows, the Philadelphia region led the
nation with 115 oxycodone-related deaths; federal and state authorities
don't know whether that reflects the nation's worst problem or the best
reporting.

One who died was Dawn Weber, 28, a Kensington mother of four who
accompanied her cousin on a Jan. 17 ride to Paolino's Bensalem office. The
cousin, who would not allow her name to be used, said she visited with
Paolino and came out with her usual prescriptions for OxyContin and Xanax.

Two days later, Weber was found dead of OxyContin-related drug
intoxication. Her cousin says she shared her OxyContin with Weber; the pill
bottle that held that prescription - with Paolino's name on the label - was
discovered in the pocket of the jacket Weber wore the night before. Paolino
did not prescribe the medication for Weber.

Interviews and police affidavits show that Weber and her cousin were among
scores of residents from the neighborhoods who hustled up Interstate 95 to
Paolino's office at 3554 Hulmeville Rd., apparently eager to pay up to $85
cash for their cursory visits. Agents say drug abusers and sellers left
with generous, no-hassle prescriptions for the coveted painkillers and
sedatives.

The pills would feed their own cravings or would be quickly sold for
thousands of dollars. OxyContin is prized by abusers who chew or crush the
pills to release its 12-hour dosage for an immediate, heroinlike rush. That
alone can kill by causing respiratory arrest. The death risk rises when
OxyContin is taken with Xanax or alcohol.

'He'll Give You What You Want'

In a police affidavit, undercover agents described a grim scene in
Paolino's 12-by-12-foot waiting room, crowded with gaunt and haggard
patients - some of them addicted or in withdrawal.

"The doctor will work with you; he'll give you what you want. I get 40- or
80-milligram OxyContin and 100 Xanax," an agent later reported that one man
told him.

District Attorney Gibbons said Paolino knew what he was doing.

"He's trained to know what these drugs do," she said. "And he saw the
people who were in his waiting room. He could see their physical
deterioration, and he gave it to them anyway."

Patients attracted to what Paolino described as a "pain-management"
practice said examinations were optional and tests were few. Some reported
that he attempted to measure their "pain" with a fancy machine that shone
red lights when pain was located.

His diagnoses were usually the same: lumbar sacral strain/sprain or
cervical strain/spasm. The relief? How about 120 pills of OxyContin, say 80
mg, and 120 pills of the sedative Xanax, patients recalled him asking.

Teens chewed what one called "white-kids' heroin" and
neighbors-turned-pushers, using welfare cards with $1 copays, pocketed as
much as $3,000 for each 120-pill prescription.

"It was a real racket," said one Fishtown woman who said in an interview
that she cashed in. ". . . People around here were using the money they
made to pay the rent."

Now described by friends as penniless and homeless, Paolino, a onetime
millionaire, is depending on a public defender, Doylestown lawyer Geoffrey
A. Graham, who has had the case only since June 20. Neither Paolino nor
Graham would comment publicly.

Paolino had been left financially devastated after one of Philadelphia's
longest-ever bankruptcy cases, a 16-year legal battle that did not end
until 1999. By March 1998, Paolino either neglected to pay or could not
afford a major bill: his malpractice insurance premium of several thousand
dollars. The result was costly. His medical license lapsed, then expired
late last year.

A Case Takes Shape

Halting the drug scourge in his neighborhood took months of determined
effort by Hyman, who feared early on that Paolino's OxyContin prescriptions
- - in high dosages and large amounts - could kill.

But Hyman's warnings to authorities went unheeded, he says. It was only
when the pharmacist, eventually joined by other area druggists, threatened
to tell his story on television that authorities began to investigate.

By November, investigators said they had Paolino in their scopes when he
made it easy on them by letting his medical license lapse. Now all they had
to prove was that he wrote prescriptions for controlled substances without
a license.

They did not have to come after him to establish whether his patients
really needed OxyContin or Xanax or whether their dosages were too strong.
Prosecuting a physician for such improper prescriptions is very difficult,
authorities say.

"It's almost impossible," Hyman said. "Doctors are up there on a pedestal.
Even if what they prescribe is beyond the manufacturer's guidelines, they
can just argue that they disagree."

Agents would later explain that they could not move more quickly against
Paolino because of the complexity of the case.

A Good Life, Then Legal Troubles

When Paolino was arrested in March and led from district court in
handcuffs, the dapper doctor with a shock of curly red hair paused and
smiled at reporters.

"The charges are erroneous," he announced confidently.

Those charges include delivery of a controlled substance, forgery, and
practicing osteopathic medicine without a valid license. He has been in the
Bucks County prison since his arrest, unable to post his initial $8 million
bail, later reduced to $1 million.

Paolino grew up in South Philadelphia, graduating from Cardinal Dougherty
High School before attending Temple University, where he earned an
undergraduate degree in pharmacy and a master's in chemistry. He worked for
a time as a pharmacist before he entered the Philadelphia College of
Osteopathic Medicine.

Licensed to practice medicine in July 1975, Paolino built a thriving
medical practice and, by all accounts, a good life with his wife, Elaine, a
preschool teacher. Living in Washington Crossing, Bucks County, the couple
raised two sons, both of whom became Eagle Scouts. By 1981, the Paolinos'
stated net worth was $1.7 million.

But the doctor began to encounter legal problems. He was imprisoned for
three months in 1990 in Montgomery County, convicted in an elaborate, $1.8
million check-kiting scheme. He refused to show up in federal court to face
a 1991 sexual harassment suit filed by four of his nurses and was ordered
by an indignant judge to pay them a total of $250,000.

And he and his wife, who died of ovarian cancer in 1997, were parties in
the bankruptcy case. But the financial tailspin had cost him his home and
all his assets; by the time it was over, he was struggling to keep his
medical practice afloat.

"He had every advantage in life. He had a good education, a good job . . .
he just had to have more, at other people's expense," said Gibbons.

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