EXPERT: HARD-CORE DRUG ABUSE RAMPANT

BATH — Where you find OxyContin abuse, you probably will encounter heroin
as well, an addiction specialist told a group of residents Thursday.

"Where there's Oxy around there's heroin; there's no distinction," Martin
O'Brien told the group gathered in the Starlight Cafe on Lambard Street.
"Its significance in Maine cannot be underestimated."

No teen-ager attended the informal discussion about substance abuse among
young people, although they were invited to the event by an announcement in
the Morse High School "Navigator." But about 20 adults did, either
concerned parents ­ some with children having drug problems ­ or educators
and counseling professionals.

They listened quietly as O'Brien, a Bath native who works for Beech Hill
Hospital, a regional substance abuse hospital in Dublin, N.H., talked about
addiction, the signs of drug abuse and the difficulty of recovery. In 1998,
his niece died of a heroin overdose.

O'Brien gave a brief history of opiate use, beginning in ancient Egypt when
people learned to make opium from poppy plants. In the late 1800s, a German
laboratory first produced heroin, which was thought to cure morphine addiction.

After heroin was outlawed in the 1920s, it began to be imported illegally
from Turkey and Pakistan, through France and into the United States. By the
late 1960s, most heroin came from Southeast Asia, then from Europe after
the end of the Vietnam War. Heroin use died down during the 1970s as
cocaine became popular.

"Cocaine use is way down now," O'Brien said. "But when something goes down,
something else goes up."

That something is heroin.

Almost three-fourths of the heroin used today is "China White," 77 percent
pure, and developed in Burma but principally produced in Colombia and sold
in the eastern United States. The white or tan substance can be smoked,
snorted or injected. "Black Tar," produced in Mexico, is gummier, and
routed primarily to California and the Southwest.

Heroin costs about $6 for a thumbnail-size portion, and addicts need six
bags a day to maintain themselves without going into withdrawal. Most
heroin comes to Maine from Lowell or Lawrence, Mass., according to O'Brien.

O'Brien has seen the changing face of drug use at Beech Hill Hospital,
which treats patients from New England, New Jersey, New York and
Pennsylvania. "There was a rapid change in the number of heroin addicts
seeking treatment," he said. "Before, it was about one in every 30
patients. But in 1996 and 1997, we started seeing more patients, 28 and
younger, addicted to heroin. Many were young girls, 16 and 17 years old."

OxyContin, a powerful pain killer doctors prescribe to cancer patients and
for back pain, came on the radar screen shortly after. It comes in dosages
ranging from 10-160 milligrams. "Maine leads the nation in OxyContin use
per capita," O'Brien said. "Doctors love it because of the benefits to
patients ­ it can relieve pain for 12 hours. But it's become the drug of
choice among heroin users."

OxyContin, O'Brien said, turns into morphine inside the brain. "You have a
sense of warmth and euphoria, a sense that nothing bad can happen," he said.

The average age of a heroin or OxyContin addict today is 21, O'Brien said.
An estimated 1,800 addicts live in Portland alone, using 2 million bags of
heroin a year to maintain themselves. "Bangor north has been devastated by
heroin," he said. "Heroin use continues to rise, and this is where
OxyContin use comes in."

Using OxyContin by snorting or injecting it apparently began in northern
Maine. Presumably, OxyContin abuse began because prescription drugs are
cheaper in New Brunswick and Quebec. Now, abuse of OxyContin, or "Oxies,"
is becoming a national problem.

People are becoming more aware of it here because of the number of reported
crimes by addicts robbing drug stores or breaking into homes to steal
prescriptions. "For people with severe chronic pain, this is a wonder
drug," O'Brien said.

"Sixty pills is a one-month prescription. But 60 pills of 40-milligram
OxyContin can be sold for $2,400 on the street. Doctors and pharmacists are
in a difficult position right now. Addicts are stealing prescription pads.
In Sagadahoc County, people are watching pharmacies. Elderly people are
becoming victims of this crime."

Tough recoveries

"Why are kids using this drug? I guess there are a million answers to
that," O'Brien said. "But they don't realize you can only use it for a
little time and then it gets to you. You don't get to stop. These are the
most addictive drugs in the world. In-patient treatment is the only good
and manageable way of detoxifying patients safely."

A heroin high lasts five hours at most. After that, the body begins
detoxifying.

"It usually takes about 10 days," O'Brien went on. "Imagine the worst flu
of your life times 100. Your muscles and bones ache, you vomit. Sometimes
there is involuntary kicking ­ that's where 'kicking the habit' came from.
Then they hit the wall ­ the physical ramifications of the drug are out of
their system, but the profound psychological symptoms kick in. Their world
view is often framed around drug use. When addicts get sober, they have an
entirely different world view, and they leave feeling ill-prepared for life."

That leads to relapses. One in 100 heroin users who has taken the drug for
a decade or more succeeds in throwing off their habit. The success rate is
higher for younger users, but is still only about 7 percent, and many of
those people go through detoxification numerous times.

"One reason for the chronic relapses is the sense they can't do anything,"
O'Brien said.

Warning signs

The only physical signs of OxyContin abuse are pinpoint eye pupils,
although users will sometimes "go on the nod," nodding their heads while
almost falling asleep because of the extreme relaxation the drug provides.
"If a kid is smoking it, you might see tinfoil with brown scorch marks,
burnt matches, glass pipes," O'Brien said in answer to a question.

"If someone is shooting, you might see needles or find bent spoons, maybe
little sterno cans for a heater. You might see things like a camp stove in
a room. If they are selling heroin, you might find baking soda or powdered
milk." Most people do not inject themselves where any marks might be
visible, in the arms for example.

"Heroin and OxyContin addicts only call heroin 'dope.' Dope is not weed and
not acid," O'Brien said. "If you ask a kid if they are smoking dope they
will look at you like you're on another planet. Dope is heroin."

Most heroin or OxyContin users do not drink much alcohol. "OxyContin is a
group activity because of the network of users," O'Brien said. "They know
where it is, how they can get it and when they can get it. Kids today are
more mobile, they're in cars, they can go to apartments. The average heroin
addict in Maine is between 18 and 28 years old, and a 21-year-old won't
think anything of selling it to a 17-year-old. The fastest-growing group of
heroin addicts are girls 15 to 18 years old."

What can families do?

Parents and relatives can feel helpless in the face of addiction, and, in
frustration, can give up trying to help.

"You mean everything to them, but they don't see that," O'Brien said of
addicts. "You can't as a family get caught up in the addict's cycle. The
only thing they have is you. Love them and pray for them, sometimes there's
not much more you can do. I don't think we can ever give up, but that
doesn't mean giving them money when they're broke."

If a parent discovers his or her child is using OxyContin, O'Brien said the
best thing to do is force them into treatment immediately.

Preventing drug abuse is a community problem, he went on. "What are we in
the community doing for kids? What do the downtown storefronts in Bath say
to the teen-agers? Why isn't there a place in town for kids to play music?
How do we find what's missing? That's a community recovery problem."

Addiction, O'Brien said, starts to create pain, which the drug user is
trying to avoid. An addict seeks release from the pain of addiction by
becoming more addicted, a process that becomes a delusional belief system
that begins directing his or her life.

"Eventually, the addictive personality takes control," O'Brien said. "An
addict's focus and energy is directed inward to keep people away who would
threaten the addictive relationship. Addiction becomes isolation.

"What substance abuse is to me is a slow erosion of a person's essential
dignity."