PAINKILLER OXYCONTIN A FACTOR IN 120 DEATHS

The drug's producer did not adequately inform physicians about
potential for abuse, critics say

Dr. Peter Leong recalls the day when he finally snapped at a drug
company salesman pressing him to prescribe a powerful narcotic
painkiller called OxyContin.

The drug's producer, Purdue Pharma, had already failed to persuade
Leong with repeated offers of free weekend trips to Florida to discuss
pain management. But when the salesman suggested that OxyContin --
which is as potent as morphine -- was safe enough to treat short-term
pain, Leong exploded.

"We threw him out of my office," said Leong, who runs a pain clinic in
Bangor, Maine. He thinks OxyContin is potentially too dangerous to use
for anything but chronic, severe pain.

"OxyContin is a good drug," he said. "But the problem was, they were
pushing it for everything."

If Leong was not a convert, many others were. In a little more than
four years, OxyContin's sales have hit $1 billion, even more than
Viagra's. Although the drug has helped thousands of people in pain,
its success has come at a considerable cost.

An official of the Drug Enforcement Administration said no other
prescription drug in the last 20 years had been illegally abused by so
many people in such a short time.

OxyContin has been a factor in the deaths of at least 120 people, and
medical examiners are still counting, according to interviews with law
enforcement officials.

And doctors such as Leong, pharmacists and law enforcement officials
say part of the problem is that Purdue Pharma often oversold
OxyContin's benefits without adequately warning of its potential for
abuse.

The company also used an often criticized but increasingly common
marketing strategy: currying the favor of doctors in private practice
with free trips and paid speaking engagements.

Purdue Pharma, based in Norwalk, Conn., played host to hundreds of
doctors at all-expenses-paid weekends in spots such as Florida to
discuss pain management, a company consultant said. Doctors were then
recruited and paid to speak to other doctors at some of the 7,000 pain
management seminars that Purdue sponsored around the country.

Those meetings stressed the importance of aggressively treating pain
with potent, long-acting painkillers such as OxyContin.

Purdue Pharma also contributed to foundations supporting research on
pain, to pharmacy schools and to Internet sites aimed at educating
consumers.

As OxyContin's marketing message spread, the drug caught on with many
doctors whom medical experts said had little experience in prescribing
powerful narcotics. As a result, they often could not spot those who
intended to abuse the drug.

OxyContin, introduced in December 1995, has offered patients something
different: a tablet that slowly releases its powerful pain medication,
permitting patients, for example, to sleep through the night.

"It's a good drug in the right situation," said Dr. Art VanZee, a
physician in St. Charles, Va.

The drug has helped many people. Purdue Pharma officials say they have
promoted the drug responsibly and would have disciplined any sales
representative who did not. They also said that in informing doctors
about the drug, they told them how to spot potential drug abusers, and
the company has responded quickly to reports of spreading problems.

"We don't have strong medicines that don't have abuse potential," said
Dr. J. David Haddox, the company's senior vice president for health
policy. "What we have to do is walk the balance between helping the
greater good, knowing there are always some people who will divert
drugs."

Abuse and addiction involving OxyContin have spread quickly in the
last two years, flaring up in at least a dozen states. And while the
illegal use of OxyContin took root in rural areas along the East
Coast, it has begun moving into cities like Philadelphia.

"Nobody is immune from this," said Brantley Bishop, a narcotics
investigator in Alabama. "I'm seeing housewives; I'm seeing loggers,
nurses, mechanics. It doesn't matter what they are."

OxyContin was originally thought to be less prone to abuse because its
narcotic was locked in a time-release formula. That meant it would not
produce the quick spike of euphoria that drug abusers crave.

But abusers quickly discovered how to disarm the time-release formula;
they simply crushed the tablet, then swallowed, inhaled or injected
the powder to give themselves a high as powerful as heroin's.

Getting OxyContin was often easy. A person simply had to find the
right doctor, claim intense pain and get a prescription. Others stole
prescription pads and wrote their own.

Illegal use of OxyContin mushroomed even though no prescription drug
in this country is more tightly regulated. Unlike illegal drugs such
as cocaine or heroin, OxyContin is monitored by state and federal
health officials in its production, marketing and distribution. Now,
many of those regulators are trying to figure out how the outbreak
occurred and what they might have done to prevent it.

The Food and Drug Administration, for one, is reassessing how it
reviews prescription narcotics for potential abuse.

"We've learned something from this," said Dr. Cynthia McCormick,
director of the FDA's division of anesthetics, critical care and
addiction drug products. McCormick acknowledged that the FDA had
failed to research all the ways abusers might tamper with OxyContin,
an oversight she said her agency did not want to repeat.

Thursday, officials of five states met in Richmond, Va., to discuss
ways to halt illegal traffic in OxyContin. In recent months, Purdue
Pharma has also stepped up its efforts to halt the drug's abuse,
including working with law enforcement officials.