DRUG REACTION

Cure For E. Kentucky Scourge Will Require Broad-based Effort

Abuse of prescription painkillers in Eastern Kentucky is one of those
recurring news stories that lose their power to shock until a new drug
starts killing people and addicting teen-agers.

U.S. Attorney Joseph Famularo said last week that illicit use of the
prescription drug OxyContin contributed to 59 deaths in just five counties
over the last 13 months. An investigation into OxyContin trafficking
produced more than 200 arrests.

Even if clinical reviews reduce the death toll, this trend has the makings
of a public-health crisis. Especially alarming is the drug's spread among
adolescents.

That, along with the surge in overdoses, has mobilized public agencies, and
more significantly, moved regular citizens and churches to search for
solutions. A recent meeting in Hazard drew 400 worried people. Famularo's
investigation was an outgrowth of this public concern.

The immediate need is detoxification and treatment for those in and out of
jail. Withdrawal from the drug is agonizing. Treatment reduces the chance
of relapse.

Education and greater public awareness also are needed to inform potential
abusers of this drug's particular dangers.

Beyond that, a thoughtful, long-range strategy is required, along with
recognition that OxyContin isn't the problem.

The problem is bigger, more complex and intractable than that. In this
poor, historically exploited region, life for many is a struggle that
leaves them broken in body and spirit, and desperate enough to seek
drug-induced escape.

The health and social factors that put most of southeastern Kentucky at
high or very high risk for substance abuse also increase the risk of
violence, child abuse and mental illness.

A few unscrupulous physicians and law-enforcement officials, some of them
addicts themselves, abet the illicit use of prescription painkillers and
sedatives.

In a region where jobs are scarce, the drug trade is lucrative.

Prescription drug abuse in Eastern Kentucky received considerable attention
from state policy-makers in the 1990s. Many physicians now are using a
state database created in 1998 to identify "doctor-shopping" patients who
obtain multiple prescriptions.

But the medical profession must better police itself. And government must
become more effective in intervening when patterns of abuse appear. As a
society, we must treat drug abuse as a disease, not just punish it as a crime.

Medicaid, the government health insurance for the poor and disabled, pays
out millions of dollars for painkillers in Eastern Kentucky. Most
prescriptions are medically justified, even if the pills end up on the
street. Medicaid won't pay for most drug treatment, however.

Taken as directed, OxyContin, a time-released synthetic morphine, is a
source of relief for the pain of cancer and other illness. Taken illegally,
crushed and inhaled or injected, it has an effect like heroin and is more
addictive and lethal than the other narcotic analgesics to which Eastern
Kentucky has become inured.

But OxyContin's arrival has only highlighted an all too familiar problem:
the tragic waste of human potential in Appalachian Kentucky.