PAINKILLER SALES UP SHARPLY

MYRTLE BEACH, S.C. - People in the United States are living in a
world of pain and are popping pills at an alarming rate to cope.

The amount of five major painkillers - codeine, morphine, oxycodone,
hydrocodone and meperidine - sold at retail establishments rose 90
percent between 1997 and 2005, according to an Associated Press
analysis of statistics from the Drug Enforcement Administration.

Oxycodone, the chemical used in OxyContin, which came on the market
in 1996, is responsible for most of the increase. Oxycodone use
jumped nearly sixfold between 1997 and 2005.

It gained notoriety as "hillbilly heroin," often bought and sold
illegally in Appalachia. But its highest rates of sale now occur in
places such as suburban St. Louis; Columbus, Ohio; and Fort Lauderdale, Fla.

The DEA figures analyzed by the AP include nationwide sales and
distribution of drugs by hospitals, retail pharmacies, doctors and
teaching institutions. Federal investigators study the same data
trying to identify illegal prescription patterns. Numbers were
available for every year except 2000.

An AP investigation found these reasons for the increase:

. The population is getting older. As age increases, so does the need
for pain medications. In 2000, there were 35 million people older
than 65. By 2020, the Census Bureau estimates the number of elderly
in the U.S. will reach 54 million.

. Drugmakers have embarked on unprecedented marketing campaigns.
Spending on drug marketing has gone from $11 billion in 1997 to
nearly $30 billion in 2005, congressional investigators found. Profit
margins among the leading companies routinely have been three and
four times higher than those in other Fortune 500 industries.

. A major change in pain management philosophy is now in its third
decade. Doctors who once advised patients that pain is part of the
healing process began reversing course in the early 1980s; most now
see pain management as an important ingredient in overcoming illness.

Retired Staff Sgt. James Fernandez, 54, of Fredericksburg, Va.,
survived two helicopter crashes and Gulf War syndrome over 20 years
in the Marine Corps. He remains disabled from his service-related
injuries and takes the equivalent of nine painkillers containing
oxycodone every day.

"It's made a difference," he said. "I still have bad days, but it's
under control."

Such stories should hearten longtime advocates of wider painkiller
use, such as Russell Portenoy, head of New York's Beth Israel pain
management department. But they have not. "I'm concerned and many
people are concerned," he said, "that the pendulum is swinging too far back."

Consider:

. More people are abusing prescription painkillers because they are
more available. The vast majority of people use the drugs safely. But
the number of emergency room visits resulting from painkiller abuse
has increased more than 160 percent since 1995, according to the government.

. Spooked by high-profile arrests and prosecutions, some
pain-management specialists now offer guidance and support to
patients but will not write prescriptions, even for the sickest
people. The increase in painkiller retail sales continues to rise,
but only barely. There was a 150 percent increase in volume in 2001.
Four years later, the year-to-year increase was barely 2 percent.

. People who desperately need strong painkillers are sometimes forced
to search for doctors willing to prescribe high doses. Siobhan
Reynolds, the widow of a New Mexico patient who needed large amounts
of painkillers for a connective tissue disorder, said she routinely
drove her husband to see an accommodating doctor in Oklahoma.

Pill Mill or Witch Hunt?

Perhaps no place illustrates the trends and consequences better than
Myrtle Beach, S.C., a sprawling community of strip malls, hotels and
bars perched along a 60-mile strip of sand on the Atlantic Ocean. The
metro area is home to 350,000 people, but sees more than 14 million
tourists annually.

During the eight years reflected in government figures, oxycodone
distribution increased 800 percent in the Myrtle Beach area, partly
due to a campaign by Purdue Pharmaceuticals of Stamford, Conn. The
privately held company has pleaded guilty to lying to patients,
physicians and federal regulators about the drug's addictive nature.

Use of other drugs soared in the area, too: Hydrocodone use increased
217 percent; morphine distribution went up 180 percent; even
meperidine, most commonly sold as Demerol, jumped 20 percent.

Federal authorities came to suspect the area was home to a "pill
mill," a clinic that dispenses prescription medication without
verifying that it's needed.

The U.S. attorney for South Carolina secured a 58-count indictment in
June 2002 against seven physicians and one employee of Comprehensive
Care and Pain Management Center, a nondescript storefront on Myrtle
Beach's main drag.

Tipped off by local pharmacists concerned about an increase in the
volume of painkiller prescriptions, the federal investigation created
a furor in the medical profession.

The clinic's owner, D. Michael Woodward, was sentenced to 15 years
and has relinquished his license. A second physician, Deborah
Bordeaux, had worked at the clinic less than two months before
quitting in disgust. Dr. Bordeaux, now serving a two-year prison
term, was threatened with a 100-year sentence if she did not help the
prosecution.

Officials with the Justice Department and the DEA would not discuss
what some activists say is a "war on doctors."

Ms. Reynolds, who drove her late husband hundreds of miles for his
pills, became an activist after the Myrtle Beach indictments. She
contributed money to appeal some of the criminal convictions in South
Carolina and started the Pain Relief Network, an advocacy
organization for people living in pain. "It was a witch hunt," she said.

Dr. Bordeaux's husband, Edworth Swaim, agrees. He said his wife
didn't stand a chance of avoiding prison even though she had worked
at the clinic less than two months and eventually sued over what she
alleged was rampant Medicare fraud.

"She wasn't guilty of anything, so she wasn't going to plead to
anything," Mr. Swaim said. "She was absolutely railroaded, made an
example of."

But some Myrtle Beach physicians are not convinced that the "Myrtle
Beach Eight," as they became known, were innocent.

A Myrtle Beach internist who also works in addiction medicine, Brian
Adler, said physicians were flooded with patients seeking pain
medicine after the clinic was shut down. "There's a significant
problem with narcotics in this area," Dr. Adler said.

Other physicians were concerned about patients with legitimate needs
for painkillers.

'Fine Line' For Physicians

The DEA says it has prosecuted 108 physicians during the past four
years; 83 pleaded guilty or no contest, while 16 others were
convicted by juries. Eight cases are pending, and one physician is
being sought as a fugitive.

In congressional testimony, the agency's deputy assistant
administrator, Joseph Rannazzisi, estimated that fewer than 1 percent
of the nation's physicians - less than 9,000 - illegally provide
prescription drugs to patients. He told lawmakers it is far more
common for people to illegally obtain prescription drugs from friends
and family members.

It is impossible to reliably measure painkiller abuse.

A 2004 government study estimated between 2 million and 3 million
doses of codeine, hydrocodone and oxycodone are stolen annually from
pharmacies, distributors and drug manufacturers. The AP's analysis
included only retail sales, not estimates of diverted pharmaceuticals.

John Charles, director of medical affairs at the Grand Strand
Regional Medical Center in Myrtle Beach, practices pain management. A
few years ago, Dr. Charles said, he took a drastic step to reduce his
potential legal risks: He stopped prescribing painkillers.

The decision gave him peace of mind, but he does not expect there to
be less of a need for painkillers or physicians who prescribe them.

"People with cancer are surviving longer, elderly people are living
longer," Dr. Charles said. "So, physicians are walking a fairly fine
line. We're walking a narrow path. And I think we'll continue to see
it for a while."