PAIN PILL NEW DRUG OF CHOICE ON STREET

It Offers Relief -- And A `Heroin' Rush

When law enforcement officials decry the evils of OxyContin, a
painkiller gaining popularity as a recreational drug, they see the
faces of people such as Alan, a former addict who chewed the drug for
an immediate high and sold spare pills on the street.

When doctors tout the wonders of OxyContin, they see the faces of
people such as Madeleine Thompson, who suffers from searing cancer
pain that a single pill of the powerful prescription medication can
drive away for long stretches of time.

OxyContin, a time-release version of the compound found in Percodan,
delivers steady pain relief to people with severe or chronic pain
when used properly. For a huge, heroin-like rush, abusers consume the
drug after removing the pill coating.

The lure of the drug has contributed to scores of deaths in Florida
alone, and sparked a mini crime wave. In the last five months,
OxyContin has been stolen from five pharmacies in Broward and one in
Dade. There have been 12 other break-ins involving OxyContin from St.
Lucie south, according to the Drug Enforcement Administration.

On Friday, OxyContin manufacturer Purdue Pharma announced it would
temporarily suspend shipment of the 160-mg version of the pill.

The company has announced it will spend millions of dollars to try to
develop a tamper-proof version of OxyContin. The DEA and the Food and
Drug Administration are discussing how to reduce the illicit use of
OxyContin.

To Curb Abuse

To further curb abuse, some doctors have tightened up on prescribing
OxyContin and the state has limited Medicaid reimbursement for the
drug.

In the past year, oxycodone -- the primary component of OxyContin --
has been implicated in a rising number of drug overdose deaths in
many states, including Florida. Oxycodone was found, often in concert
with other drugs, in 52 of the 166 overdose deaths in Broward in
2000. In Miami-Dade County, oxycodone was present in 11 drug
overdoses last year.

This year in Broward at least eight people have died of overdoses
that included oxycodone among other drugs, but that number will
likely rise once toxicology reports are completed on a backlog of
overdose cases at the medical examiner's office. In Miami-Dade, 11
people have died this year also from taking oxycodone -- most likely
mixed with other drugs, according to the Miami-Dade medical examiner.

Since 1999, South Florida hospitals have seen at least 221 oxycodone
overdoses, about 150 of them last year. About 40 oxycodone overdoses
have been identified this year, said Dr. Richard Weisman, director of
the Florida Poison Information Center at the University of Miami.

Bearing The Blame

While OxyContin accounts for only a quarter of the prescriptions of
oxycodone drugs, authorities believe this particular drug bears the
blame for the increase in oxycodone deaths.

``What's alarming from an enforcement standpoint is that there have
been so many overdoses across the country,'' said Joe Kilmer, a
spokesman in the Miami field office of the DEA.

The Substance Abuse and Mental Health Services Administration, the
federal office that tracks drug and alcohol abuse, has no hard
nationwide data on oxycodone or OxyContin abuse because its illegal
use has grown so quickly.

One Point

For Thompson, who credits the drug with easing severe pain, the
debate boils downs to one point: ``My only cause for concern would be
if they tighten it up and make it unavailable to patients who really
need it. OxyContin allows me to lead a fairly normal life.''

Last fall, the 53-year-old Fort Lauderdale woman developed
debilitating abdominal pain stemming from pancreatic cancer. When not
on OxyContin, she said, ``you just want to crawl up in a little ball
and not be touched.''

``That gave me a clue of what it would be like to be off it,'' she said.

In the past, patients with her condition would have relied on
short-acting drugs that created peaks and valleys of relief, said Dr.
Pamela Sutton, Thompson's physician at Broward General Medical Center
in Fort Lauderdale. Pain management specialists like Sutton welcomed
the arrival of OxyContin in 1995 as a medicine that would offer
continuous relief to those who needed it.

``It's a wonderful addition to the possible medicines you can give to
people with moderate to severe pain,'' Sutton said. ``In many ways
it's changed the way pain management is done.''

While on OxyContin, Thompson can drive, run errands, meet friends for
lunch. Her chemotherapy treatments often leave her exhausted but at
least, she says, cancer pain has not dictated her life. Most
important, perhaps, without pain sapping her stamina, she can devote
herself to beating the cancer.

``It enables you to concentrate on being well and gives you the
strength to fight the disease,'' she said.

Former Addict

Strength is something that Alan will need in the coming months.

A former cocaine addict, Alan, who asked that his real name not be
used, began taking OxyContin when a doctor prescribed it to him to
reduce the pain he suffered as a side effect of HIV medications.
Friends told Alan the drug would deliver a mind-blowing high if he
broke through the time-release coating and consumed the opiate all at
once.

``When you break the tablet, chew it or snort it, it goes into your
bloodstream immediately,'' he said. ``It got me very hyper and it got
rid of the pain.''

Eventually Alan went to another doctor, one willing to write patients
prescriptions without asking questions. After a perfunctory
examination, Alan said, the doctor gave him a prescription for 40
tablets. Alan wrote him a check for $150 and promptly headed to the
street to resell a good portion of the OxyContin, which can go on the
street for as high as $1 per milligram.

``That opened the door for me to return to using crack cocaine,'' he
said sheepishly. After about a month, Alan resolved to stop abusing
the OxyContin and returned to his original doctor.

OxyContin appealed to Alan because he could snort it just as he would
cocaine. It appealed to Lisa, another recovering addict who went on
an OxyContin binge a few months ago, precisely because she did not
have to snort or inject it.

Like Alan, Lisa identified a doctor whom she knew would not ask too
many questions. The doctor never ascertained that she was already on
methadone to curb a long-standing habit of abusing prescription drugs.

``It's a business, everybody's making money,'' she said.

Horrified Doctors

But many doctors who see OxyContin as an excellent alternative for
fighting pain are horrified to learn how it might be abused.

Dr. Robert Glasser, a hematologist-oncologist at Memorial West in
Pembroke Pines, said in most cases he will prescribe the drug only
for patients with malignant cancer.

``I'm trying not to flood the streets,'' he said. ``We want to limit
the supply as much as we can.''

The state's Agency for Health Care Administration recently placed a
limit on the number of OxyContin pills a Medicaid patient can receive
per prescription. The cap depends on the dosage. The agency is
reviewing other steps it could take to curb illicit use of the drug.