OXYCONTIN EASES PAIN, LURES ADDICTS

On a scale of 1 to 10, Barry Tuttle figures his pain measured about 8 or 9.
It wasn't the sudden, sharp pain you might get from dropping a bowling ball
on your foot or from banging your toe on the bathroom door in the middle of
the night. That kind of pain goes away after a few excruciating,
expletive-filled minutes.

This was worse. This pain pulsated through Tuttle's back 24 hours a day,
clinging to him like an unwanted lover for six years, through seven
surgeries, countless doctor's appointments, thousands of pills, acupuncture
and other alternative treatments. It cost him his job, his active
lifestyle, and nearly his life.

One day last August, the pain drove him to write a farewell note to his
wife, Elaine, and to carefully plan his suicide by carbon monoxide
poisoning in the garage of their North Plainfield, N.J., home. He would
start the car and the gas-powered weed-eater and lawn-mower -- anything
that might contribute fatal fumes -- and be found dead by neighbors before
Elaine returned from work to make the dreadful discovery herself.

After he'd written the note, though, something -- Tuttle still doesn't know
what -- drew him to the computer to search one last time for an answer to
the pain caused by his degenerative disc disease. This time, he found
something he had missed before, the Web site for

The American Society for Action on Pain, which mentioned a drug he'd never
heard of, OxyContin, and included names of doctors considered sympathetic
to people like him, people who had been dismissed by others as chronic whiners.

"I must have run across the Web site before, but for some reason that night
I started reading it," said Tuttle, 45. "And then I started crying like a
baby, and that's not like me. But right then I knew I was not going to have
to go through with this suicide. I knew I was going to be helped."

Now, Tuttle rates his pain level at an acceptable 2 or 3 and credits
OxyContin, which was prescribed to him eight months ago by a doctor he
found via the Web site. "I'm free to do a lot more things. I'll never be
pain-free. Most people never will be pain-free if they're chronic pain
sufferers," said Tuttle, who sold plumbing supplies before going on
disability in 1994. "But I can get out and work in the yard. I can mow the
front and the back lawn in the same day."

For every person like Tuttle, though, say critics of OxyContin -- who
include doctors, lawyers, and ex-users -- there are hundreds of people like
Russell Fitch of rural Maine, who have become addicts of the opiate since
it came onto the market five years ago and have been driven to crime to
support their habits. Fitch, 40, was prescribed OxyContin after
hip-replacement surgery. When his prescription ran out, Fitch became
desperate, said his attorney, J. Hilary Billings. In 1999, he stole guns to
sell for money to buy OxyContin, which sells for about $1 a milligram on
the street. In May, while on probation for the firearms theft conviction,
Fitch allegedly walked into a pharmacy with a gun and pushed a note across
the counter that read: "Give me all your OxyContin or I will shoot you."

"It's just, bang! The addiction cut in and all this criminal activity
arises directly out of that," said Billings, who has two other clients
charged with OxyContin-related crimes. Fitch faces a maximum 20 years in
prison if convicted in the pharmacy hold-up, one of hundreds of crimes
linked to OxyContin since the drug has been on the market.

In the past week alone:

A 21-year-old Merrick man was arrested in Boston and charged with aiding
and abetting a robbery that netted $250,000 in OxyContin and other drugs
from a Boston pharmacy. Joshua Friedman, a Northeastern University
journalism student, admitted helping plan the May 24 holdup, according to
an FBI affidavit.

A Virginia man pleaded guilty to murder and drug distribution for giving a
fatal injection of OxyContin to a friend. Robert Stallard, 43, faces up to
81 years in prison following his plea Monday in Tazewell, Va.

Not since the 1970s have doctors and drug agents faced such a quandary over
how to balance the medical needs for a drug with the high danger of abuse
of the same drug. Thirty years ago, the problem was Quaaludes, the brand
name for the depressant methaqualone. The prescription sedatives rapidly
became the rage among abusers looking for the hazy high they offered, and
they were finally pulled off the market in 1984.

That's not an option with OxyContin, say Drug Enforcement Administration
officials, despite Justice Department warnings that OxyContin abuse is a
"major problem" in several states and spreading rapidly. "The problem is
that this is such a good drug for those people in severe pain," said DEA
spokeswoman Rogene Waite. "The DEA is really walking a tightrope. We want
to prevent diversion of it, but we don't want to prevent it from getting to
people who need it."

When Quaaludes were pulled off the market, there were substitutes doctors
could prescribe that did not share Quaaludes' addictive qualities.
OxyContin advocates say there are no real substitutes for it, and many of
the drug's critics agree. Other drugs might dull pain, but not with the
slow, time-released method that gives OxyContin users many hours of comfort
and reduces the need to pop pills constantly.

If crushed into powder and snorted or injected, however, or if taken in
larger doses than prescribed, OxyContin provides a euphoric high similar to
heroin's and can release potentially fatal amounts of its active
ingredient, oxycodone, into the blood system. Users who try to quit
experience painful, heroin-like withdrawals, with vomiting, sweats, chills
and convulsions.

The DEA's Diversion Control Program says emergency hospital visits linked
to oxycodone have tripled, from 3,190 in 1996 when it came onto the market
to 10,825 in 2000. Prescriptions have increased 20-fold to about 6 million
last year, according to the DEA. Waite says there are no firm numbers on
OxyContin-related deaths, but the DEA cites reports from 20 metropolitan
areas indicating a 400-percent increase since 1996 in deaths blamed on
oxycodone misuse.

The problem is most acute in poor, rural areas and small towns, where
heroin isn't easy to find. Drug abusers in such areas have found OxyContin
to be a good substitute, said Chuck Miller of the Justice Department's
National Drug Intelligence Center. Since many rural areas have large
populations of elderly residents -- people prone to pain problems that
would require OxyContin -- they are a breeding ground for abusers.

The drug also is moving into urban areas as dealers, trying to keep a step
ahead of law enforcement, leave rural areas for the cities.

"As much damage as it has done in small areas like ours, can you imagine
what it's going to do when it hits the big cities?" said Debbie Trent, a
mental-health counselor who runs a support group for OxyContin abusers and
their families in the tiny hamlet of Gilbert, W.Va. At the first meeting
held last October, 20 people attended. By the third meeting, about 100
people were there, said Trent, who tells of marriages being destroyed by
OxyContin abuse and young professionals ending up in jail after becoming
addicts.

The DEA says states with prescription monitoring programs, which require
reporting of prescriptions of certain potentially dangerous drugs such as
OxyContin, have far fewer problems than other states. Eighteen states,
including New York, have such programs. "New York is not on our radar right
now compared to other states," Waite said. "It's not in the big time."

The drug's manufacturer, Purdue Pharma of Stamford, Conn., took the
strongest OxyContin tablets, 160 milligrams, off the market in May, citing
concerns about abuse. Wednesday, the Food and Drug Administration urged
doctors to be more discriminating in prescribing OxyContin, and it said the
drug will carry the FDA's strongest type of warning, calling attention to
its addictive qualities and explaining that chewing, snorting or injecting
it can kill.

Many critics are demanding more action, such as restricting 80-mg. tablets
to hospitals and hospices only. Some doctors have called for removing the
drug from the market altogether and reformulating it into a less-addictive
medication. At least one class-action lawsuit has been filed and others are
being prepared that demand Purdue Pharma pay damages to OxyContin addicts
and accuse the company of concealing the drug's addictive qualities from
doctors and pharmacists.

Purdue Pharma rejects the allegations. "Purdue believes the answer to drug
abuse and illegal trafficking of pain medications is not to punish needy
patients or responsible health care providers. Rather, it is to support law
enforcement officials and enhance drug education and rehabilitation
programs," said Purdue attorney William Eskridge, who warns that such
lawsuits will end up hurting cancer patients and others in chronic, severe
pain by scaring doctors away from prescribing OxyContin.

That's already happening in some places, say pain sufferers and doctors.

Sarah Murray, who has kidney and liver disease on top of a variety of other
painful ailments, drives 125 miles from her home in Franklinton, La., to
Natchez, Miss., because she can't find a doctor in Louisiana to prescribe
OxyContin. She must visit the Mississippi doctor each week to allay his
fears of potential OxyContin abuse.

"I don't mind this and understand all the problems with prescribing
OxyContin, but it is a terrible hardship for me. I have to drive two hours
to get there, and two hours back, plus I have Medicaid, which only pays for
12 visits a year," said Murray, 50. "I don't know how long I can keep going
every week, as it is costing me a lot of visits and time, but it is hard to
find a doctor anymore who will prescribe the OxyContin."

Dr. Charles Argoff, a neurologist and pain-management specialist at North
Shore University Hospital, has prescribed OxyContin to dozens of patients,
but in ways he says are crucial to preventing abuse. He will not prescribe
it over the phone, he demands that patients provide past medical records,
and he requires regular evaluations to chart the patient's progress and
spot possible addiction. "A practicing physician has to be mindful that
someone, even if they don't come with 'addict' written all over them, may
be one," said Argoff, who blames much of the OxyContin problem on doctors
who casually dole out prescriptions or who never request a new patient's
medical history. "You have to have some kind of system in your office. The
physician has to establish a relationship with the patient they're taking
care of on a long-term basis."

Lawyers involved in the class-action suits, though, say that whether
doctors or the pharmaceutical company are at fault, the victims are the
people who are given the medication without proper warning of its potential
for addiction.

Frank M. Armada, a West Virginia lawyer who filed the country's first
lawsuit against Purdue Pharma related to OxyContin addiction, says he has
been contacted by hundreds of people in that situation. His own daughter
became hooked on the drug when she was prescribed it for a knee injury,
said Armada, who practices in rural Appalachia.

In Barry Tuttle's mind, though, some people can't handle any form of a
powerful drug, be it OxyContin or something else, and targeting the drug
rather than the abusers denies pain patients the medication they need. "If
they're not taking OxyContin they're going to be sniffing glue or taking
heroin. They're going to be addicted to something," he said. "Drugs don't
addict people. People addict people."