ABUSE OF POWERFUL PAINKILLER HITTING HARD IN APPALACHIA

Heroin-Like Medication Linked To Deaths

GILBERT, W.Va. -- Kristen Rutledge had watched friends slowly kill
themselves with OxyContin. Her own cousin, just 18, shot herself in the
head when she couldn't get more of the drug. Girlfriends were prostituting
themselves for another fix.

Still, when someone offered her a yellowish 40 milligram pill, she took it,
chopped it up and snorted it. It was the start of a three-day binge, and
she was hooked.

"When I got down to two, I started panicking," the 20-year-old said as she
took a drag off her umpteenth cigarette. "I had to get out and buy some more."

Over the next year, her habit grew to eight "40s" a day, she said. When her
dad, Tim Rutledge, a former mayor, found out, she tricked him into giving
her more money by saying she was being threatened by drug dealers.

Many people in Appalachia call OxyContin "hillbilly heroin." Its abuse may
not have started in the mountains, but it exploded here.

Across the region, people have overdosed on the powerful prescription
painkiller and robbed pharmacies and family members to feed their habits.

"If this was an infectious disease, the Centers for Disease Control would
be in here in white vans," said Tim Rutledge. "There's no doubt it's very
much a plague."

To cancer patients and chronic pain sufferers, OxyContin is a wonder drug.

While most strong pain medicines last only about four hours and take an
hour or so to work, Oxy gives a steady 12-hour release of pain medicine
with fewer side effects.

But to addicts who chew the pill or crush it to snort or inject, Oxy
produces a one-shot, heroin-like high that can kill.

Purdue Pharma, the drug's maker, is willing to concede that Oxy abuse has
led to "somewhere between dozens and hundreds" of deaths in the past two
years, says David Haddox, the firm's medical director.

"I am sure it has caused some deaths," he said, "but my feeling is there is
a magnification of this in the media."

Purdue Pharma has taken steps to limit the damage. The company has stopped
shipping its 160 milligram pills and has offered tamper-resistant
prescription pads to doctors, among other things.

Law enforcement officials insist the problems have not been overblown.
Dealers have been charged with homicide in Virginia and Florida; doctors
have been convicted of illegally dispensing OxyContin; Oxy-related burglary
and armed robbery charges abound nationwide.

Monday, the state of West Virginia sued the drug's makers, accusing them of
pressuring and enticing doctors to overprescribe Oxy and of failing to
adequately warn of potential abuse, charges the company denies.

Michael Pratt, a prosecutor focusing on drug crimes in Kentucky, Tennessee
and West Virginia, sees reasons why OxyContin hit Appalachia especially hard.

The Appalachian economy has long been dependent on coal and timber. Those
are industries that produce serious injuries, so there are large numbers of
people on painkillers.

In addition, OxyContin sells on the street for $1 a milligram -- up to $160
for the highest-dosage pill. In an area with chronic unemployment, that
kind of money is hard to turn down.

For years, prescription fraud for Valium and other drugs has been a
problem. But, Pratt said, "Oxy rolls in. It's so powerful, it just lays waste."

"This is a nuclear bomb," said Gregory Wood, a health-fraud investigator
with the U.S. attorney's office in Roanoke, Va. "I was a cop in Detroit and
saw crack come through the ghettos, and I've never seen anything like this."