OXYCONTIN'S STORY OF ONE LIFE SAVED, ANOTHER RUINED

When A Painkiller Kills: OxyContin Is An Epicemic Of Abuse That Is Sweeping
Southwest Virginia

The bars of the Lee County Jail are all that keeps Emmanuel Ketron from
injecting more OxyContin into his tattooed, needle-scarred arms.

Ketron is so addicted to the prescription painkiller that he became a thief
to finance his habit. He stole guns and tools from his neighbors, jewelry
from his parents, Nintendo games from his handicapped brother.

He has been locked up for four months now. But he still craves the drug
that gave him the best high of his life, then took him to the worst low.

"It got to where I didn't care to eat," he said. "I would go four or five
days without eating, staying on the needle.

"It ruined my life."

Two years ago, Dan Pellitteri broke his back in a motorcycle accident.

Surgeons spent nine hours reconstructing his crushed vertebrae. The
procedure left him a half-inch shorter and with a scar that runs from his
navel around his side to the middle of his back.

Most mornings, the pain is so bad that Pellitteri has to wait in bed for
his wife to bring him a glass of water and two 40-mg OxyContin pills.

Only then is he able to pick up his 18-month-old son and move around his
Roanoke apartment without hurting. "To a person who is in pain, it's like a
miracle drug," Pellitteri said. "It gave me my life back."

One life ruined. Another life salvaged. Since OxyContin was approved by the
Food and Drug Administration in 1995 as a treatment for moderate to severe
pain, it has become both an effective painkiller and a devastating pain-maker.

When abused by addicts who crush the pills and then snort or inject the
powder, OxyContin is the pharmaceutical equivalent of heroin.

The drug has swept through the rural counties of far Southwest Virginia in
the past two years, bringing to the coalfields the big-city problems of
addiction and high crime rates.

West of Roanoke, 37 people have died of fatal overdoses attributed to
oxycodone, the active ingredient in OxyContin, since 1998. Cocaine, by
comparison, caused nine fatal overdoses during the same period.

OxyContin abuse has driven crime up, as addicts rob pharmacies, con doctors
into prescribing the drug, and steal from rural residents who until now had
no reason to lock their homes and cars.

"It's taken away a way of life that makes a rural area what it is," Lee
County Sheriff Gary Parsons said. "It's taken away an innocence that our
area once had."

What is happening in places like Lee County "is a tragedy, and I'm not
trying to belittle that," said David Haddox, senior medical director of
Purdue Pharma L.P., the Connecticut-based company that makes OxyContin.

"But there is every bit of a tragedy going on in this country with
untreated pain."

With an estimated 50 million Americans suffering from chronic pain, the
company is concerned that people who need OxyContin soon may not be able to
get it.

In recent months, the drug has come under siege. More than 5,000 people
have signed a petition seeking to have it recalled; a lawsuit is pending
against Purdue Pharma in West Virginia; and both the federal Drug
Enforcement Administration and a state task force are starting to ask
questions about its use.

Doctors spooked by often-exaggerated reports of abuse are becoming more
reluctant to prescribe OxyContin, Purdue Pharma spokesman James Heins said.
He declined to release sales figures to back that statement.

If there is a backlash, it comes at a time when the medical profession is
just beginning to recognize that treatment of pain - often a foggy concept
when compared with treatment of easily diagnosable diseases and injuries -
has been overlooked for years.

Earlier this year, the Joint Commission on Accreditation of Healthcare
Organizations mandated that pain should be considered the fifth vital sign,
behind heart rate, blood pressure, respiration and temperature.

Doctors are now asked to have their patients rate pain on a scale of one to
10, and then to treat it accordingly. They need OxyContin to do that, said
Dr. Richard Wilson, head of the New River Valley Pain Society.

"We seem to be in the cradle of OxyContin abuse, which is taking a good
medication and demonizing it," Wilson said. "We need to be more concerned
about our patients than what a bunch of felons are doing with the drug."

Purdue Pharma is a private company and does not disclose details about how
much OxyContin it produces or where sales are most heavily concentrated.

But according to the market research firm Scott-Levin, sales are up.
OxyContin was prescribed 5.5 million times last year, generating sales of
more than $1 billion. The year before, 3.2 million prescriptions were
written for $602 million in sales.

Those figures alarm law enforcement officials, who say the potent,
addictive narcotic is being dispensed not just for cancer patients and
those in severe pain, but also as a remedy for such things as toothaches
and menstrual pain.

Kathryn Daniels of the DEA says she believes the way Purdue Pharma markets
OxyContin is a significant part of the problem.

"Who really needs this drug? said Daniels, the DEA's diversion program
manager for a three-state area that includes Virginia. "Are you marketing
the drug to the people who really need it?"

Purdue Pharma disputes suggestions that its drug is overpromoted.

But some in law enforcement say it clearly is overprescribed.

"From my perspective, the physicians are part of the problem," said Julia
Pearson, a toxicologist for the state Division of Forensic Science. "You
have physicians who are prescribing the pills to people who have a
headache. That's not managing pain. That's feeding an addiction."

When a new drug sweeps the country, it usually starts in big cities and
gradually spreads to the hinterlands.

Illegal use of OxyContin appears to be doing the opposite.

Southern Maine and far Southwest Virginia were among the first regions hit.
Both areas have common demographics: low-income populations far from the
large cities where cocaine and heroin are readily available.

And both areas depend heavily on high-risk industries - logging in Maine,
coal-mining in Virginia - that are likely to generate large numbers of
disabled residents and, consequently, high use of pain medication.

As abuse of OxyContin took off in 1998 and 1999, it generally followed the
Appalachian mountain range up and down the East Coast, causing havoc in
such places as western Pennsylvania, Ohio, West Virginia, eastern Kentucky
and Alabama.

Many of those areas are medically underserved. Parts of far Southwest
Virginia have a population-to-physician ratio of more than 4,000-to-1,
compared with the statewide average of 1,695-to-1.

That means rural doctors overwhelmed by high patient loads might use
OxyContin as a time-saving cure-all.

"It's supposed to be the medication of last resort," said Beth Davies,
co-director of Addiction Education Services in Lee County. "But in many
cases, it's the one of first resort."

As the drug began to flow from pharmacies across the country, the number of
people seeking emergency room treatment for oxycodone overdoses doubled -
from 3,190 cases nationwide in 1996 to 6,429 in 1999.

Now, the problem is making inroads into larger cities. Daniels, of the DEA,
said abuse has been reported in such places as Philadelphia and Northern
Virginia. South Florida is another hot spot.

In Roanoke, two people have died of oxycodone overdoses since 1998. City
police have made about a dozen OxyContin arrests, and parts of the New
River Valley are also experiencing problems.

Although abuse in urban areas pales in comparison to what is happening in
the coalfields, state and federal officials are joining the fight.

Last month, the National Association of Attorneys General began looking for
ways to stop abuse of prescription drugs in general and OxyContin in
particular.

And in April, the DEA asked Purdue Pharma to limit distribution of the
drug, rethink its marketing strategy, and consider reformulating OxyContin
to make it less appealing to addicts. It was the first time the agency has
targeted a particular brand name in its efforts to police prescription drug
abuse.

"In my entire history with the DEA, I've never seen anything like this,"
said Daniels, a 25-year veteran of the agency.

Purdue Pharma has devised a 10-point plan to curb abuse of its product.
Among the actions: mailing educational brochures to nearly a half-million
doctors and pharmacists, distributing tamper-proof prescription pads,
emphasizing a more cautious pitch by sales representatives in high-risk
areas, sponsoring medical education programs that advocate responsible pain
management, and airing public service announcements warning about the
dangers of abuse.

The company has also stopped distributing its most potent form of
OxyContin, the 160-mg pill, and reduced shipments to Mexico in light of
reports that the drug was being smuggled back into the United States.

"We want to be part of the solution, not part of the problem," Haddox said.

Dr. Art Van Zee, a Lee County physician who is organizing a national
petition drive to have OxyContin recalled, is not convinced.

"They will always give lip service to the fact that this is a drug that's
dangerous when abused," he said of Purdue Pharma.

"But there's never been a real attempt to make physicians aware that in
some areas of the country, there has been major, disastrous abuse of this
drug, and caution should be exercised when prescribing it."

When Lee County's drug subculture began to buzz about "Oxies," Emmanuel
Ketron knew he had to try the drug.

The 22-year-old had already experimented with prescription sedatives such
as Lortab and Xanax, but word on the street made those sound like aspirin
compared with OxyContin.

Ketron went to a feed store and bought a syringe used for injecting
livestock with medicine. His next trip was to an OxyContin dealer.

He went straight home and shot up. "It was the best feeling I ever had in
my life," he said.

Ketron soon began to steal to support his habit. His addiction made him a
sloppy thief, and it wasn't long before sheriff's deputies came knocking on
his door. After being placed on probation for burglary and grand larceny,
Ketron was charged again with stealing a garden tiller.

This time, the judge sentenced him to three years in prison.

Ketron's father was outraged. Bobby Ketron said his son is an addict who
needs treatment - help that no one in Lee County seemed interested in
providing. A brief stay at a drug detoxification center in Russell County
didn't keep Ketron clean for long. Supervised probation worked no better.

Frustrated and bitter, Bobby Ketron made signs and put them up in the front
yard of his Dryden home.

"If you are hooked on OxyContin, get help," one of the signs reads. "Out of
Lee County, because the law and the judges won't help our children. They
will send them to prison."

The way Lee County Commonwealth's Attorney Tammy McElyea sees it, more
people need to be sent to prison. Time after time, McElyea said, the
state's sentencing guidelines call for little or no incarceration for the
people who use and deal OxyContin.

"They're beating me out of the courtroom," she said of defendants who plead
guilty and are placed on probation. "They laugh at me on the way out."

But when Emmanuel Ketron comes out of prison three years from now, will he
be any better? his father wonders. "When he comes out of there, he'll be
bitter," Bobby Ketron said.

And if the first four months behind bars are any indication, Emmanuel
Ketron may well go back to drugs.

"If they let me out today," he said. "The first thing I would do is go find
me some dope."

All of the controversy over OxyContin has Dan Pellitteri a little worried.

Even though he takes the drug exactly the way his doctor prescribes it,
he's concerned about getting hooked.

"As soon as my back is fixed, I want off this," the 34-year-old said. "It's
got my mom scared to death."

Legitimate pain patients may become dependent on OxyContin and other
opium-based narcotics, but can gradually come off the drug under a
physician's care. Addiction is rare; a study by the National Institute on
Drug Abuse found that it happened to only four of more than 1,200 patients
who were prescribed opium-based drugs.

The real danger seems to come when OxyContin goes from the medicine cabinet
to the streets.

Last month, a state task force headed by Attorney General
(http://www.markearley.com) Mark Earley began to study ways to curb
prescription drug abuse.

The panel, law enforcement officials and the health care community have a
tough job ahead of them: finding a way to keep OxyContin away from abusers
such as Ketron, while making sure it remains available to patients such as
Pellitteri.