RURAL CLINICS OVERWHELMED BY DEADLY DRUG

System Not Prepared For Danger Of OxyContin, Counselors Say

PRESTONSBURG -- The 23-year-old in the emergency room wasn't worn and weary
like a veteran addict, someone so used to the tremors and terror of
withdrawal that she's at just another low point in an ever-sliding life.
"She was just scared to death," said George Walker, who runs a residential
treatment center in Prestonsburg. "She wasn't savvy."

Ashen and shaking, the mother of two was swinging in a blink from euphoria
to despair, sweating and cramping as her body revolted at the absence of a
powerful painkiller now blamed in the deaths of dozens of Eastern Kentuckians.

She'd been using OxyContin for just three weeks.

The woman's quick trip from novice to crisis, and the fact that she'd been
shooting up the drug, made Walker realize, that night last summer, that
OxyContin would be a whole new kind of trouble for Eastern Kentucky.

"It's just everywhere," said Walker, who has been treating addicts for 14
years. "Regardless of age or gender, it's just everywhere."

Last week's arrests of more than 200 alleged OxyContin dealers and users
put a spotlight on a problem Walker and others in the region have known
about for months one that private residents in some communities, including
Hazard, have begun to fight in a very public way.

Less obvious is a treatment system officials describe as ill-prepared to
deal with the severity and volume of that problem. And because many abusers
are shooting up, OxyContin abuse presents a whole range of other issues,
including the potential spread of AIDS, not widely associated with drug use
in Eastern Kentucky.

"It's a major public health crisis," said Mike Vance, chairman of the state
board of certified alcohol and drug counselors and a counselor with Walker
in Prestonsburg.

Obscure to overwhelming Just last year, OxyContin was so obscure that
Hazard Police Chief Rod Maggard had to ask a pharmacist what it is. It came
across police radar, Maggard said, because shoplifters kept saying they
were stealing to get their supply of "OC."

Now, police, medical personnel and drug counselors in the region are all
too familiar with the overdoses, tattered families and deaths coming at a
pace they never imagined.

Last month, Vance was called to Eastern Kentucky emergency rooms five times
for crisis interventions in a single day. Four, he said, were related to
OxyContin. Before "OC," he said, he might respond to two crisis calls in a
week.

"I have been doing this for 30 years, but I have been shocked. Really
shocked," he said.

Walker said the increased cost of coping with OxyContin has pushed him to
spend his annual budget in just six months. There are 45 men on a waiting
list to get into his 28-bed facility from his five-county area Floyd,
Johnson, Magoffin, Martin and Pike.

OxyContin abuse is the edge of what many are worrying could become a
permanent blight on the community. Walker said a year ago he rarely saw a
needle user. Now, he said, with needles the preferred method among many
OxyContin users, "we are going to see an increase in HIV and hepatitis."

Bob Morgan of Lexington chairs a committee advising the state on AIDS
issues and intravenous drug abuse. He agrees the threat could be serious.

"Anytime you have people sharing needles, the danger of AIDS or hepatitis C
transmission is there," Morgan said.

"If it's 2 o'clock in the morning and everybody wants to get high but you
only have two needles and somebody already used them, what happens?" said
Morgan, a former drug user. "Do you wait until the drug store opens in the
morning? Probably not."

Vance said he has never seen any drug catch on so fast and with such
dramatic results. Just a year after OxyContin first appeared in
Prestonsburg, he's already struggling with lives wasted for want of a small
pill.

"You just get sick of it," said Vance. "You just get tired of the cycle."

His warning for the rest of the state: "Be prepared."

Limited resources A drug bust last week, dubbed OxyFest 2001, has attracted
attention from Kentucky newspapers, national TV networks and reporters from
The New York Times.

But Tom Collins, interim head of the state's program to combat IV drug
abuse, said Friday he'd never heard of OxyContin.

"I haven't heard about this drug from the street level yet," said Collins,
"so that makes me wonder whether we really do have a lot of it going on in
Kentucky."

Dr. Rice Leach, the state health commissioner, said that while state health
officials are continuing with normal drug surveillance, they are not taking
any special steps because of OxyContin.

"The law enforcement people are saying there have been 59 deaths (in
Eastern Kentucky) and I cannot refute that," he said. "But there are not
death certificates listing this as a cause of death."

But any measurable addition to the state's strained treatment system could
be significant, said Dr. Neil Scheurich, head of the detoxification center
at the University of Kentucky Hospital.

"My sense is that a lot of rehab programs have been overwhelmed by demand,"
he said.

Scheurich said the ideal treatment is four to five days of medically
supervised detox to get patients through the most severe physical symptoms
of withdrawal. That should be followed, he said, by a month-long
residential treatment, focused on rigorous therapy.

With 124 detox beds and about 630 long-term treatment beds across the
state, Carol Stange, administrator for the state division of substance
abuse, said a two-to four-week wait was common even before OxyContin.

"The problem is that a waiting list and substance abuse don't mix," she said.

People seek help only when they're desperate, she said. If it isn't
immediately available, they often go back to using. That leads to more
hospital visits, more domestic violence, more of all the things that go
along with abuse.

That includes, she said, overdoses and death.

There is an ongoing review of how the state treats substance abusers, she
said. But significant resources won't be available anytime soon.

"You can't put up residential treatment facilities overnight," she said.

Part of the problem, she said, is a widely held view that addiction is a
lifestyle choice, not a chemical chain reaction that physically takes over
people's lives.

"Even when you have money, you have to deal with community reluctance in
understanding that substance abuse is an illness and people need
treatment," she said.

That's a lesson that has come home to Hazard.

Opening a treatment center is the ultimate goal of a fledgling group called
People Against Drugs. But for now the group's organizer, Pastor Ronnie
"Butch" Pennington, said folks are still reeling from the depth of the
problem in their community, something that became clear to him at a Bible
study meeting in October.

Pennington can't remember who spoke first at that weekly church meeting at
Petrey Memorial Baptist Church. He just remembers that before the night was
over, most of the 50 people in the stained-glass sanctuary explained that,
somehow, OxyContin had come into their lives. Whether it was a neighbor, a
friend, a brother or a child, the drug had a hold on someone close to their
heart. The Bible study members formed People Against Drugs, and the group's
first public meeting drew 400 people.

"The devastation had just gotten so bad," he said, adding that earlier in
the day he visited a family whose child had overdosed. Over the past year
as a volunteer chaplain at the hospital, he said, he's heard so many
similar stories he's lost count.

Walker, the residential treatment director in Prestonsburg, also lost track
of that woman from the ER.

After just four days in treatment, the lure of the drug was stronger than
the hope of a better life.

"She's out there somewhere," Walker said, with the flat tones of someone
who's seen it all before but still can't help but care. "For all I know she
could be dead."