MAINE TOPS MOST STATES IN PAINKILLER USE

Mainers use more prescription painkillers than people in almost any other
state, according to statistics that officials say help explain the state's
growing problem with prescription drug abuse.

Maine ranked 7th in the nation in per capita consumption of oxycodone, the
active ingredient in OxyContin, and was fourth in consumption of methadone,
according to federal Drug Enforcement Administration data for 2002, the
most recent available.

Maine's per capita consumption of fentanyl, a synthetic opiate often
prescribed to cancer patients, was higher than every other state. Some
other painkillers, like the active ingredient in Dilaudid, have
less-than-average consumption here. But the DEA statistics - compiled from
manufacturers and distributors - highlight a trend of above-average
painkiller consumption in the state that has existed since at least 1998.

Health professionals say it's no surprise Maine has a high rate of
painkiller use because of the state's relatively large number of elderly
people and because traditional industries such as papermaking and fishing
have a high risk of injury and chronic pain.

But, they acknowledge, the abundance of prescription narcotics may well
contribute to their abuse.

"It's like with any drug of addiction, availability is a key factor in what
people will use," said Kim Johnson, director of Maine's Office of Substance
Abuse and Treatment.

The magnitude of prescription drug abuse is elusive, say federal
authorities who rely on arrest data, drug seizures and treatment admissions
to estimate the problem's severity. But the misuse of prescription drugs is
contributing to a growing number of young people addicted to narcotics and
ultimately has led to an increase in burglaries, robberies and thefts,
authorities say.

Doctors, meanwhile, must balance their concern about drugs being misused
with their duty to relieve patients' pain.

"I think physicians have felt caught in the middle, pressured from both law
enforcement about diversion and yet on the other side, physician regulatory
bodies about undertreatment of pain," said Dr. David Simmons, former
president of the Maine Medical Association and a family practice doctor in
Calais.

There are legitimate reasons for Maine's high level of painkiller use.

The injuries inherent in forestry, fishing and manufacturing contribute to
that usage, as does some Mainers' tendency to work through pain.

"A person may have to take some time out from work or change how they work,
but it's a tough thing to do, especially when you have someone living day
to day as far as what they get for pay," said state Rep. Anne Perry,
D-Calais, a nurse practitioner.

Maine has the third-highest median age in the country and ranks 7th in the
percentage of its population over 65. As people age, they are more likely
to have chronic pain and illnesses that require pain medication.

Maine also rates better than most states in the number of doctors and
nurses trained in alleviating pain, said Kandyce Powell, executive director
of the Maine Hospice Council, citing a 2002 national survey of end-of-life
care.

The survey gave the state high marks for policies allowing physicians to
treat pain at the end of life without "undue scrutiny," she said.

Maine was among a handful of rural states that were the first to experience
a surge in the illicit use of OxyContin. As in those other states, the
abuse was centered in the poorest regions in the state.

"The common denominators are poverty and low levels of expectations with
respect to opportunity," said Simmons, an internist in Calais, where abuse
of drugs such as OxyContin, Dilaudid and Percocet is high.

Like parts of West Virginia and Kentucky, eastern Maine witnessed what
health professionals and law enforcement describe as an epidemic of
OxyContin abuse.

Prescription drugs are sometimes diverted for profit. A month's supply of
80 mg OxyContin costs $2 on Medicaid, and at $1 per milligram is worth
almost $5,000 on the street, said Gerry Baril, supervisor for the Lewiston
office of the Maine Drug Enforcement Agency.

That has led people to seek pain relief from multiple doctors, or use fake
prescriptions, or sometimes rob pharmacies, he said.

The U.S. Government Accounting Office studied the rise in OxyContin abuse
and found that Maine and other affected areas had previous problems with
prescription drug abuse.

Some recreational drug users believe that experimenting with prescription
medication is less dangerous.

"One of the reasons we saw a spike in use of drugs like oxycodone and
specifically OxyContin is that there was previously a relatively large step
between experimentation with marijuana and use of opiates," Simmons said.

The number of people admitted to substance abuse treatment programs across
Maine for opiates besides heroin - primarily prescription painkillers -
increased 80 percent between 2000 and 2002, from 571 to 1,030, according to
state figures. More people are seeking treatment for addiction to
prescription medication than to heroin.

Pharmaceutical abuse contributed to 63 percent of the accidental drug
overdose deaths in Maine from 1997 through 2002, according to figures
compiled by the state Medical Examiner's Office.

The Office of National Drug Control Policy said prescription drugs have
eclipsed cocaine as the second most commonly abused drug after marijuana,
not including alcohol.

Starting in June, an electronic database will track some prescriptions in
Maine to make sure patients are not visiting multiple doctors for the same
symptoms and doctors are not overprescribing pain medication.

The technique is employed by 21 other states, some with great success.
Maine doctors also now use tamper-resistant prescription pads.

Treating pain while preventing diversion can be a challenge for doctors,
said Simmons, who also runs a Washington County hospice. In a handful of
cases nationally, the DEA has brought charges against doctors for
inappropriately writing pain prescriptions, making some doctors skittish
about prescribing large amounts of narcotics.

"It's a very tough line for many physicians to walk and they're feeling
embattled from both sides and not feeling comfortable they can make the
distinction between chronic pain and a patient that may be manipulating
them for diversion," he said.

David Hench can be contacted at 791-6327 or at: dhench@pressherald.com

SIDEBAR:

DRUG FACTS

Oxycodone is a synthetic opiate twice as powerful as morphine and is the
active ingredient in OxyContin, a popular medicine for treating chronic
pain. The medicine can be stripped of its time-release coating to give a
high like heroin and it is now a popular street drug blamed for an
increasing number of people addicted to painkillers.

Methadone tends to be associated with treatment for addiction, but it is
also an effective painkiller. Methadone drew attention in 2002 for its role
in a number of overdose deaths in Portland and statewide.

Fentanyl is frequently provided as a patch on the skin that delivers an
ongoing dose of the painkiller. It is a popular alternative to OxyContin
for doctors treating pain because it is relatively difficult to divert and
abuse.

Prescription drug addiction accounted for 9 percent of new admissions for
treatment in 2002, compared to less than 1 percent in 1995, according to
the state Office of Substance Abuse. By comparison, heroin represented 7
percent of new treatment admissions. Alcohol treatment was 58 percent.

An increase in statewide drug deaths from 33 in 1997 to 90 in 2001
primarily was attributed to prescription drug abuse, according to state
agencies.

A 2002 survey of teenage drug use indicated 10.7 percent of 12th grade
students in Maine reported having abused prescription drugs in the past month.

The Maine Drug Enforcement Agency seized 5,274 dosage units of diverted
pharmaceuticals in 2002 and 94 diverted pharmaceutical-related arrests
accounted for 18 percent of the agency's arrests.