OXYCONTIN: BAD MEDICINE?

Escalating abuse of a powerful and effective painkiller has some physicians
and patients worried about a backlash that could hamper prescriptions for
those who need them most. At the same time, law enforcement officials are
intrigued and concerned about the drug's uncharacteristic spawning ground in
rural communities.

OxyContin has been available to people suffering serious pain since 1996.
But accounts of OxyContin abuse and overdoses have risen sharply each year
since 1997, primarily along the East Coast, according to the National Drug
Intelligence Center (NDIC).

The drug, a more potent dose of the opioid oxycodone, is released into the
body over several hours. But abusers quickly discovered they could destroy
the pill's time-release coating and snort the powder or add water to inject
the drug, which mimics a heroin high.

Diane T. Brackett, a special agent with the New England field division of
the Drug Enforcement Administration, said OxyContin abuse appeared first in
rural communities in Maine and Massachusetts in New England, and also in
Kentucky, Ohio, Virginia and West Virginia.

"We're talking about a drug trend that's gotten its roots in a rural area
instead of an urban area," she said.

That trend is rare, she said, but officials speculate that abusers in rural
communities, where access to illegal drugs is limited, are more creative
when seeking a high. And when that creativity proves effective, the result
is almost immediate, she said.

"Word of mouth on the drug scene is pretty powerful," Brackett said.

But because the drug has no established distribution network and is
prescribed often for legitimate use, tracking abuse can prove difficult,
Brackett said.

The black market for oxy, as the drug is known on the streets, is lucrative.
At the pharmacy, oxy sells for between 50 cents and $1 a milligram. But on
the street, the 10-, 20-, 40-, 80- and 160-milligram pills are hawked for 10
times their legal cost. A bottle of a hundred 40-milligram pills, which
might cost $400 at the pharmacy, can fetch between $2,000 and $4,000 on the
street, according to the NDIC.

Although Brackett said the DEA is not ready to label oxy a club drug, she
said it is beginning to surface at raves alongside ecstasy, GHB and other
popular club drugs.

The quest for oxy has prompted some abusers and dealers to burglarize
pharmacies or steal it from legitimate users. Some Maine dealers have lifted
prescription pads and wrote false prescriptions that were later filled in
southern Maine and New Hampshire, according to the NDIC.

Others seek out several doctors in what's called "doctor shopping," hunting
for one who will prescribe OxyContin for their alleged pain. Some doctors
simply turn the other cheek. A pain management doctor in Florida was charged
last June with drug trafficking for providing OxyContin to known drug
dealers.

And since insurance companies often pick up the tab for the drug, the
illegal trade can prove especially lucrative.

In response, the Maine Attorney General's office is stepping up efforts to
curb OxyContin abuse, including proposed legislation that would make it a
felony to possess a large quantity of OxyContin. The DEA has shuffled a team
of special investigators to Maine, Brackett said.

"We're concerned about the situation in Maine," she said. "What's taken off
in Maine can spread to other areas. We're trying to keep ahead of it."

Despite its proximity to the problem, New Hampshire officials have not seen
or heard accounts of oxy abuse in the Granite State.

"I just haven't seen it," said Jeff Mutter, a supervisor for the Attorney
General's Drug Task Force.

Neither has Rochester Police Capt. Don Donlon, although abuse of
prescription drugs is a persistent problem.

"There's always an investigation at any given time," he said. "There are one
or two in the office now."

Laconia Police Chief William Baker said his community also appears to be
free of oxy abuse, but like Rochester, diverting prescription drugs for
illicit use remains a problem, including the theft of Ritalin from schools
and students or its sale by older relatives.

Brackett said New Hampshire ranks fourth for oxy abuse among New England
states, behind Maine, Massachusetts and Vermont. However, Brackett and
others worry that increased media attention may change that ranking for New
Hampshire

Arrests for abuse of OxyContin in New Hampshire are rare, if not
nonexistent. Last year, two area arrests for misuse of the less-potent
oxycodone were reported, one in Durham and another in Meredith. Both people
charged were middle-aged.

Already, doctors are rethinking how they prescribe medication for chronic
pain and similar ailments. Dr. Michael O'Connell of Northeast Pain
Consultants said gauging and treating chronic pain is difficult, since signs
of pain are seldom visible.

"Our philosophy here is to believe what the patient tells you," he said.
"But there is no pain meter. How do you really know? I suppose, every once
in a while, we can be fooled."

O'Connell said word of OxyContin abuse does occasionally reach his office.

However, growing abuse may come at the expense of those people suffering
from severe pain or ailments now helped by progressive doses of OxyContin.

"Unfortunately, it's quite a useful drug for chronic pain patients," he
said.

Lisa Ball of Rochester, who suffers from chronic fatigue syndrome and who
represents the Seacoast chapter of the National CFIDS (chronic fatigue
immune dysfunction syndrome) Foundation, is concerned about the attention
that OxyContin abuse is attracting.

"OxyContin is good because it lasts 12 hours," she said. Many doctors are
already skeptical about chronic pain or fatigue, she said, and she worries
that more doctors will be reluctant to treat patients who need OxyContin,
based largely on the risk of abuse.

"This illness does have a face, but you can't see it because it's
invisible," she said. "Some people are so ill. But they look fine. It's real
frustrating for these people because their pain doesn't go away."

She likens those disorders to catching a flu that never leaves.

O'Connell said the spreading abuse of OxyContin will likely reshape how and
when the drug is prescribed.

"It's a nasty problem," he said of abuse. "It's made us nervous for years.
There probably will be a significant backing away from the drug by doctors."

But O'Connell said the abuse dilemma may be prod doctors to prescribe
alternatives that can be as effective as OxyContin.

One such alternative is methadone, he said, which is "dirt cheap." The
difficulty prescribing methadone is the stigma, he added. Methadone is often
used to treat recovering heroin addicts, often at methadone clinics.

OxyContin's manufacturer, Purdue Pharma L.C. of Norwalk, Conn., has been on
the defensive in recent months, countering media reports. Purdue released a
statement last week, citing several initiatives aimed at curbing abuse,
including a wave of educational pamphlets being mailed to pharmacies and
doctors, and a pilot program to distribute tamper-free prescription pads in
Maine and Virginia.

However, crimes committed by those abusing OxyContin recently prompted
Hannaford Brothers, based in Scarborough, Maine, to pull OxyContin from the
shelves of its 85 Shop'n'Save pharmacies in five states. The drug will only
be stocked by special order, according to Hannaford Bros.

Purdue also disagrees with the number of deaths attributed to misuse of
OxyContin. Dozens of deaths were reported last year, including 19 in
Kentucky alone. Purdue, however, maintains the state medical examiner's
office in Kentucky indicates there is "no reliable data in Kentucky that
proves OxyContin is causing a lot of deaths," according to a company
release.

"The company is spending millions of dollars on the research and development
of other pain management products that will be more resistant to abuse and
diversion than OxyContin and at the same time safe and effective for
legitimate patients," the company said this week.

Brackett said action like that taken by Hannaford Bros. and other businesses
is a sign that the business community is helping tackle the problem, which
she said is "very encouraging."

"It's a sign of the times," she said. "Businesses are picking up on the drug
trends."

(SIDEBAR)

OxyContin facts

OxyContin has been available to people suffering serious pain since 1996.

Abuse appeared first in rural communities in Maine and Massachusetts in New
England, and also in Kentucky, Ohio, Virginia and West Virginia.

Because the drug has no established distribution network and is prescribed
often for legitimate use, tracking abuse can prove difficult.

At the pharmacy, oxy sells for between 50 cents and $1 a milligram.

On the street, the 10-, 20-, 40-, 80- and 160-milligram pills are hawked for
10 times their legal cost.

A bottle of a hundred 40-milligram pills, which might cost $400 at the
pharmacy, can fetch between $2,000 and $4,000 on the street, according to
the NDIC.