IS OXYCONTIN A MIRACLE OR A KILLER?

Cancer patients could die a painful death without it, and drug addicts
could die from abusing it.

Medical professionals and law enforcement officials are struggling to make
sure neither happens.

OxyContin _ a miracle drug to some, a killer to others _ has become the
recreational narcotic of choice in Southwest Virginia and quickly is
reaching urban areas like Washington as well.

``I've never seen anything like this _ heart disease, cancer, AIDS,
anything. It's killing a generation of people,'' said Jimmy Woodward, a
sheriff's major in Lee County _ one area that has been hit hard by
OxyContin abuse.

William Massello, a state medical examiner in Roanoke, said 43 deaths in
Western Virginia have been attributed to the abuse of oxycodone,
OxyContin's generic name, since 1998.

That number has increased each year, from one in 1997 to three in 1998, 16
in 1999 and 18 in 2000, he said.

One recent fatal overdose was in Bristol Tennessee, where authorities said
Robert Allen Phipps, 35, died from using the drug on March 10.

On Wednesday, Travis Wayne Phillips, 22, of Mountain City died from an
overdose of the drug, authorities said.

Gregg Wood, a health fraud investigator for the U.S. attorney's office in
Roanoke, said that about 160 deaths attributed to oxycodone have been
reported in Florida, 59 have been reported in Kentucky, Pennsylvania has
had 23, Alabama has had about 20, and Maine and Ohio have had fewer than 10
each.

In Southwest Virginia, five physicians have been convicted of
misprescribing the drug. One of them, Dr. Frank Sutherland of Grundy, was
found guilty Friday of 430 counts of prescribing narcotics without
legitimate medical purpose and could face multiple life prison terms.

Abuse of the drug also has been blamed on an increase in crime.

A Richlands man was killed last year in the state's first OxyContin-related
slaying, and several area pharmacies have been robbed and burgled by those
seeking the drug or the money to buy it, police have said.

Wood said OxyContin abuse has come on so quickly that it is difficult to
get exact figures on its impact.

``It's come upon us so fast that we don't have the infrastructure to track
it,'' he said. ``You would imagine the numbers are very high. Just one
doctor-shopper going to the emergency room and faking an injury can cost
$1,000 to the system easily. And that's one person doing it one time, so
the cost of Medicaid alone must be enormous.''

Elsewhere, The Washington Post reported in February that addicts there who
formerly preferred heroin, morphine or methadone were setting their sights
on OxyContin.

According to the January issue of the U.S. Justice Department's Information
Bulletin, Kentucky, Maine, Maryland, Ohio, Pennsylvania and West Virginia
all have reported either a steep increase in OxyContin abuse or are calling
it the state's new most popular drug.

Local incidents, and the popular belief that OxyContin is a dangerous
killer taking over the state and country, are leading concerned residents
and officials to take action.

On April 12, Virginia Attorney General Mark Earley named 25 lawmakers,
doctors and pharmacists to a task force formed to fight prescription drug
abuse, particularly that of OxyContin.

Wood said the Task Force on Prescription Drug Abuse is just one of many
across the state at both the federal and local levels.

At the first meeting of the task force, held May 17 in Abingdon, about 100
residents showed to talk about ways to curb OxyContin abuse.

Some of the suggestions included stiffer penalties for those dealing the
drug and more treatment centers for addicts and education programs for youths.

Officials from Purdue Pharma _ OxyContin's manufacturer _ said they were
taking steps to educate doctors about proper use and prescribing of the
drug and were planning to produce tamper-resistant prescription pads.

``I plead with you, whatever you do on this task force, you've got to have
a balancing act. You've got to make this drug and drugs like it available
for patients who need it,'' Dr. David Maddox, senior medical director for
Purdue, told the group.

The company also recently donated $100,000 to the commonwealth to be used
to study whether Virginia should institute a prescription-tracking system
similar to one in Kentucky.

A few weeks ago, Purdue announced an indefinite suspension of distribution
of the most potent 160 mg OxyContin pills. A company spokesman said earlier
that the company was concerned about possible illicit use of the
high-strength pills.

Law enforcement officials have said the company also has provided placebo
pills for undercover drug-sting operations.

Police estimate that Bristol Virginia has seen a 10 percent increase in
crimes in the last two years.

``There's no doubt that this epidemic has caused this increase,'' said
Donnie Bradley, an officer with the police department's Special Operations
Unit, acknowledging that neighboring localities have seen a much higher jump.

He said he believes the statewide database might be the best way to catch
OxyContin addicts as well as doctors and pharmacists who misprescribe or
illegally fill prescriptions for the drug.

``The biggest problem with (OxyContin) is that somewhere along the line it
is legally obtained,'' Bradley said.

According to Bristol Tennessee Police Capt. Blaine Wade, two burglaries and
one armed robbery of city pharmacies have been connected with OxyContin, in
addition to the city's only reported fatal overdose.

``Bristol Tennessee is just one department,'' Wade said. ``If you start
looking at all of it in Southwest Virginia, you could have quite a bit of
(crime) where there once was very little. OxyContin must be horribly
addictive.''

One of those localities with a much higher OxyContin-related crime rate is
Tazewell County, where Commonwealth's Attorney Dennis Lee estimated that 75
percent of crime is drug-related and half of that is connected to OxyContin.

Woodward, the sheriff's major in Lee County, said most of the crimes there
in the past three years have been attributed to the drug.

``Probably 80 percent of our larcenies are due to the problem, and it's
risen from last year,'' he said. ``We've probably had about six to eight
deaths from OxyContin here. ... Now you've got people stealing off their
parents and grandparents to feed their habit.''

More than 1,500 people gathered in Lee County in March to protest abuse of
the drug.

There, Dr. Art Van Zee, a strong opponent of the drug, collected hundreds
of signatures for a petition asking the U.S. Food and Drug Administration
to recall OxyContin.

Van Zee, of St. Charles Community Health Clinic, also has criticized Purdue
Pharma for its heavy marketing of the drug.

OxyContin ranks 25th in advertising dollars spent in medical and surgical
journals. Sales of OxyContin have surpassed Viagra, figures show.

While Van Zee believes OxyContin's risks outweigh its benefits as a
painkiller, some medical professionals disagree.

``I've heard people say it's an addictive drug,'' said Dr. Ben Cowan, a
Bristol Tennessee doctor who treats cancer patients, some of whom depend on
OxyContin's strong painkilling properties. ``That choice of words demonizes
the drug. It excludes from the discussion a patient's abuse.

``It's kind of like saying `Those murdering guns' or `Those killing
cars,'^'' he said. ``The person operating the guns or cars is just as
responsible for the damage done as the abuser is for misusing OxyContin.''

Cowan said that illicit use of prescription drugs constitutes about 30
percent of the drug-abuse problem in rural America.

``Do we have a problem in Southwest Virginia? You bet. Has it been there
for years? It has. Do the data suggest it's all from OxyContin? They do
not,'' he said.

Cowan said that carelessly throwing out numbers _ and not including all
pertinent data _ has caused a panic over OxyContin and has misled the public.

The doctor suggests that some commonly overlooked pieces of information are
toxicology reports from those who have fatally overdosed on OxyContin.
Those reports might show that other drugs, like alcohol or cocaine, were
taken with OxyContin, he said.

``Polypharmacy abuse is part of the addictive personality. They will stick
a banana up their nose if they think it will get them high,'' he said.
``It's hardly confirmed in my mind that these were OxyContin deaths without
seeing toxicology reports of what else these people had taken.''

The bottom line, Cowan said, is that doctors and pharmacists should be
well-educated and work together to ethically handle the problem facing the
area _ something he feels certain he cannot do if OxyContin is taken off
the market.

``I can't cure patients with chemotherapy. I can't make them live longer
than the good Lord's planned. But I can make their days more comfortable.
OxyContin and pain relief are a major part of my practice,'' he said.

``How can I legally, ethically, morally tell you that I am practicing
state-of-the-art medicine in 2001 if I don't have access to the things that
work?''