OXYCONTIN USE ALMOST TRIPLES FOR ADDICTS AT CLINICS

OxyContin, a powerful prescription painkiller, has overtaken heroin and all
other street drugs as the narcotic of choice for addicts lining up at
methadone clinics statewide.

Counselors say they fear the increased abuse could have dangerous, or even
deadly, consequences. OxyContin can be more harmful than heroin when it is
snorted or injected - leading to overdose, serious infection or loss of limbs.

Because the drug was designed to be absorbed by the body over 12 hours,
some of its substances don't completely dissolve when addicts inject it to
maximize the high, said Dr. Steven Ritchie, medical director of the state
methadone clinics in Nashville and Memphis.

"A lot of people are losing limbs, getting infections and even their heart
valves are getting infected," Ritchie said. "The drug company didn't
realize that making a drug that doesn't dissolve isn't going to make drug
addicts change their behavior."

Buddy Stephens, director of the state Department of Health's methadone
clinic program, said he noticed a dramatic jump in OxyContin use among
methadone patients statewide at the end of 2002 and decided that a new
drug-screening test should be added at the clinics to detect the drug. The
new testing rule went into effect last year.

In 2001, about 21% of those admitted to state methadone clinics reported
OxyContin was their drug of choice. The percentage jumped to 51% in 2002,
and last year it reached 62%, he said.

About 3,000 people sought help last year at seven methadone clinics in the
state, up from 2,000 in 2001, Stephens said.

There are also signs that OxyContin is gaining in popularity among all drug
users.

While marijuana remains the most-abused drug in the country, prescription
painkillers such as OxyContin rank second - outpacing cocaine,
methamphetamine and heroin, according to the Substance Abuse and Mental
Health Administration.

There are no studies specifically on OxyContin use alone, and no state or
federal agency tracks OxyContin overdose deaths.

Though it has been on the market for almost a decade, OxyContin has become
increasingly prescribed in the past three years for pain, leading to a
growing number of addicts, Stephens said. Its popularity with patients
derives from the 12 hours of relief it provides.

But addicts are drawn to it because they can get a 12-hour dose in one
sitting by crushing the tablets and snorting them or dissolving them and
injecting the solution.

"The street pharmacists figured out that if you crush the pills you can get
a stronger and better high than heroin," said Leah Young, a spokeswoman for
the Substance Abuse and Mental Health Administration.

OxyContin was initially used primarily to treat pain in terminally ill
patients, but it has since become widely prescribed for people with such
ailments as back and joint injuries, drug counselors said.

Addiction to OxyContin develops quickly, sometimes in a matter of weeks.
Because OxyContin is designed to be a time-release drug, taking multiple
doses a day can lead to a rapid buildup of the drug in the body, Ritchie
said. This results in addiction and increasing tolerance, leading addicts
to need more of the drug to get the same high.

Most people begin their addiction with a valid prescription for the pain
medication, Stephens said. But when the prescription runs out and
withdrawal symptoms set in, people quickly seek other ways to get it on the
street, on the Internet or from a different doctor - a practice known as
"doctor shopping."

With the rise in OxyContin addiction, methadone clinic counselors say
they're also seeing younger and wealthier patients.

Street prices of a single tablet range from $30 to over $150, depending
upon the potency and availability of the drug, so the financial burden of
the addiction can mount quickly. As a result, wealthier clients are able to
sustain their addictions for longer periods of time, Ritchie said.

"We see people of all economic classes," he said. "A lot of OxyContin
addicts tend to be upper-echelon people who can afford to stay on it longer."

Most people begin by taking the tablets orally but eventually progress to
snorting or injecting it to get a quicker "rush," Ritchie said.

To satisfy their craving for the drug, addicts often show up at emergency
rooms with elabo-rate tales of upcoming surgeries, lost prescriptions,
doctors on vacation and piles of medical records, said Corey Slovis, who
leads the Department of Emergency Medicine at Vanderbilt Medical Center.

Such requests occur every day, he said.

"They usually complain of severe, excruciating lower back pain and say
OxyContin was the only thing that worked before," Slovis said.

As a result, Slovis created a rule last year that prohibits emergency room
doctors from prescribing OxyContin in most cases. If the patient is being
treated by a Vanderbilt physician and has been prescribed the drug before,
an exception can be made. But, he said, a patient is given only a few days'
supply of painkillers, enough to last until they can see their physician.

"We never send anyone home untreated, but they're treated based on their
past history," he said.

One or two people a week are admitted to the emergency room after
overdosing on the drug, he said. While the numbers are not at what he calls
the "epidemic" levels of other cities, Slovis said, virtually nobody came
in with an OxyContin overdose a few years ago.

Ritchie said he thinks physicians can curb the tide of OxyContin addiction
by limiting their prescriptions of the drug.

"Physicians are finally learning they cannot leave people on the drug for
as long as they do," he said. "This is the most addictive thing we've seen
since heroin."

Dr. Robert Ripley, a Nashville cardiologist and member of the state medical
examiners board, agreed that doctors must do a better job of screening
their patients before prescribing narcotics - a process that requires time
and communication.

He said the state is creating a database to monitor which doctors are
prescribing narcotics and for whom they are prescribing them.

"Doctors have to police themselves and apply limits on the health care they
provide," Ripley said. "The whole culture of how medical care is delivered
in this state has to change."

OxyContin withdrawal long and difficult

When people take OxyContin for prolonged periods of time, their brain stops
producing endorphins, natural opiates in the body that are needed to
experience pleasure and gratification.

According to Dr. Steven Ritchie, medical director of methadone clinics in
Nashville and Memphis, most people spend years hooked on the drug before
seeking help, and it can take six to 15 months for the brain to begin
producing endorphins again, he said.

And when deprived of Oxy-Contin, addicts are often bedridden, with severe
body cramps and pain, nausea and vomiting, headaches, chills and drenching
sweats.

That's why the addiction is treated with methadone.

It works because it allows OxyContin addicts to continue to lead normal
lives without withdrawal symptoms, Ritchie said. The brain begins to
produce endorphins again, so when the methadone treatment ends, the addicts
do not experience the same level of depression and despair as they would
have had they quit cold turkey.

"People coming off OxyContin have a hard time getting any satisfaction at
all out of life," Ritchie said. "Methadone treatment is a necessary bridge
to sobriety."

The methadone is dissolved in liquid, and for the first month of treatment,
addicts are required to come to the clinic each day to get the solution,
said Foster Williams, spokesman for the state metha-done clinic in Nashville.

Clients who pass the required drug screenings and attend counseling
regularly are able to take multiple doses of methadone home with them so
they don't have to come to the clinic every day, he said.

After 12-18 months, most clients are taken off methadone under medical
supervision and are required to continue counseling to prevent a relapse,
Williams said.

"They still have to deal with all of the family issues or any other things
they have going on in their lives in order to be successful," he said. "We
have to deal with the problems that brought them here in the first place."

As the drug has gained in popularity, methadone clinics also report a
steady increase in the number of people seeking help.

Buddy Stephens, director of the state Department of Health methadone clinic
program, said demand for treatment is outpacing the clinics' ability to
provide it, leaving many addicts with no place to turn.

"We have an insufficient number of clinics to meet the needs of our
residents," said Stephens, who regulates the seven privately owned
methadone clinics in the state.

The treatment costs about $12 a day and is covered by TennCare for those
who qualify, Stephens said.

With the rise in the number of people seeking treatment, TennCare costs
have also risen, from $2.4 million in 2002 to $3.5 million last year,
according to cost estimates released last year by AdvoCare, a company
contracted by the state to provide mental health services and drug treatment.

OxyContin facts

. In Nashville and on average statewide, more than 60% of those seeking
help at methadone clinics are addicted to OxyContin. In some parts of the
state another painkiller, dilaudid, remains the drug of choice.

. In Knoxville - the state's OxyContin capital - more than 90% of the
clients at the clinic are addicted to the drug, and about 250 people are on
a waiting list for treatment

. Tennessee ranks 25th nationwide in the number of OxyContin prescriptions
per 100,000 people.

. There has been a 352% increase since 1994 in the number of people
nationwide needing emergency medical help for OxyContin use.

. 56% of those addicted to OxyContin nationwide began their addictions with
a prescription from their doctor.

. About 800,000 Web sites sell prescription drugs on the Internet, and most
don't require a prescription.

Sources: Tennessee Department of Health, The National Institute on Drug
Abuse, the Waismann Institute, U.S. Drug Enforcement Agency, and the U.S.
Department of Health and Human Services