OXYCONTIN - ANGEL OF LIFE ANGEL OF DEATH

'It ruined my life' 'It gave me my life back'

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 OxyCont

"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 mat 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 Keny 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 ladelphia and Northern Virginia. South Florida is another
hot sp

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 fig

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 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 S

"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 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.