PAINKILLER ABUSE ON RISE, WITH DEADLY SIDE EFFECTS

Lure of Fast High Creates Lucrative Black Market

TAMPA - Some people snickered when Rush Limbaugh admitted this month that
he was addicted to prescription pain medication. But there's more to the
story than a talk-radio moralist's public embarrassment.

Although the Limbaugh case is high profile - with reports of his maid
acting as a drug dealer, trading cigar boxes of cash for fistfuls of pain
pills - thousands like him are changing the face of drug abuse in the
United States.

Prescription pain pills and other medications are becoming mood- altering
substances of choice for many drug abusers, according to a National
Institute of Drug Abuse report of trends in major U.S. cities.

The abusers aren't likely to be pain patients hooked on pills after back
surgery, as Limbaugh has claimed to be. More often, they're addicts or
recreational users who crush pain pills to release heroinlike highs.

Demand is fueling a lucrative black market. A single 80- milligram tablet
of the popular pain pill OxyContin can sell for more than $100.

Suppliers range from small-time robbers who threaten pharmacies to "pill
mills," where thousands of illegal prescriptions are written.

The National Association of Drug Diversion Investigators, which includes
sheriff's deputies from throughout the United States, will meet in Fort
Lauderdale next month to discuss better ways of catching prescription pill
thieves.

Statewide Tracking

In Florida, prescription drug abuse has become such a problem that Gov. Jeb
Bush is pushing for a computerized, statewide tracking system of
prescriptions filled at pharmacies. Called the Prescription Validation
Program, it would allow doctors to review a patient's pharmacy records over
the Internet before writing drug orders.

The design is similar to one in Kentucky, a state where OxyContin abuse
became epidemic in the late 1990s. OxyContin, introduced in 1996, earned
the name "hillbilly heroin" for its widespread abuse in rural Appalachia.

By tracking prescription purchases, the system is supposed to flag patients
who "doctor shop" from physician to physician while faking pain to get
multiple prescriptions.

Bills to create the program have failed in the Florida Legislature in each
of the past two years. Opponents in the House said it smacked of a Big
Brother-style government invasion of privacy.

James McDonough, executive director of the Governor's Office of Drug
Control Policy in Tallahassee, uses a counter- argument: The abuse of
prescription medicines is adding up to more deaths in Florida than from
heroin and cocaine. A 2002 report from the Florida Medical Examiners
Commission showed prescription drugs were implicated in 60 percent of
suspicious deaths involving drug abuse. Bush is lobbying for the bill's
passage during the 2004 session.

Limbaugh's admission of prescription abuse offers a glimpse of the
problem's scope, McDonough said.

In the criminal investigation of a person accused of dealing pills in Palm
Beach County, Limbaugh was "at the bottom of the feeding chain .. one of
many, many addicts trying to feed his addiction," McDonough said.

"The investigation was never focused on him; it focused on the supplier.
When we got to the head of the snake, ... we made the arrest."

According to The Palm Beach Post, a Lake Worth pharmacist was accused of
illegal sales of hydrocodone, a prescription painkiller. Court records
showed that $806,000 and 73,000 pills were seized from his house, the
newspaper reported.

Innocent Patients

Limbaugh cited back pain and past surgeries when he explained to millions
of radio listeners why he was signing off to enter a rehabilitation program.

Meanwhile, the publicity - and any implication that powerful pain
medications cause addiction for innocent patients - makes people such as
American Pain Foundation Executive Director Penney Cowan cringe.

Cowan and others have fought to change attitudes about medication and
chronic pain.

They've succeeded in that medically supervised pain management has changed
radically in the past decade.

Doctors once were reluctant to prescribe the long-term use of opiate- based
medicine because of addiction fears.

But those worries have been dispelled in recent years in favor of the
patient's right for relief and a change in physician attitudes about the
aggressive treatment of pain.

The new theory is that only rarely will pills cause full-blown addiction in
pain sufferers who are dealing with conditions as such cancer and arthritis.

"The thinking has clearly come full circle," said Cowan, who founded the
Baltimore-based American Pain Association in the early 1980s as an
education resource.

"It's like anything else. ... How many people have a glass of wine with
dinner? But they're not alcoholics, are they?" she said.

Addiction specialists say pain patients who do get hooked often have
underlying problems.

"The majority of people will not develop addiction and will be able to use
opiate medications without any problem," said Marvin Seppala, corporate
medical director for Hazelden, an addiction-treatment company.

For a small percentage, though, psychological problems or family history
could trigger a problem, Seppala said.

Examples would be growing up as an abused child or being related to someone
with an addiction, he said.

In some cases, a patient who becomes hooked on pain pills could be reduced
to buying the medication illegally if a physician decides to stop writing
the prescription.

Addicts keep hunting for the pills to avoid the pain of withdrawal, which
can include tremors, anxiety and muscle pain. The symptoms are not unlike
withdrawal from substances such as heroin.

Some resort to using prescribed methadone, taking it in pill form or liquid
doses at clinics.

Steady Rise

The number of patients checking into drug rehab centers for prescription
drug addiction has increased steadily since 1995, said Carol Falkowski,
Hazelden's director of research communications.

From 1990 to 1998, the number of people in the United States who used
prescription pills nonmedically went up 181 percent, she said.

The climb has coincided with the 1996 release of OxyContin, a time-
released pill that was the first opiate-based medication to provide 12
hours of pain relief.

"Medically, it was a real breakthrough," said Jim Hall, of the Up Front
Drug Information Center in Miami.

"But it's a delicate balance between medical miracle and deadly street
drug," he said, because abusers learned that crushing the tablets delivered
a powerful hit.

At Up Front, a drug abuse prevention and education center, Hall tracks
trends in Miami-Dade County for the National Institute of Drug Abuse. He is
part of a group of investigators that includes 20 major U.S. cities.

The group's latest report was released last week. It implicated the abuse
of prescription drugs as an increasing danger.

"The major finding ... was that polysubstance abuse is proliferating across
the whole country," Hall said. "Patterns are changing rapidly."

Abusers are likely to combine prescription drugs with street drugs. Or they
switch between opiate-based medications and heroin, depending on supply.

"We used to talk about cocaine, heroin and marijuana. Now it's generally
drug abusers using a 'Whitman sampler' approach" to create multiple-drug
cocktails, he said.

Hall said he hopes Limbaugh's admission of abuse will raise awareness about
a national problem.

"That's what I look forward to in this situation, for Rush, to bring him to
the point of breaking his denial" about having a drug addiction, Hall added.

"When a famous person runs into this, ... it often can be very beneficial
in educating the public."

Sidebar #1: Prescription Drug Abuse In Florida;

a 2002 report highlights Fl;orida's problem with abuse of prescription
painkillers. Here's a look at the top five cities where medical
examiners reported oxycodone or hydrocodone abuse as the cause of
death or a factor in a drug-related death.

Oxycodone Deaths in 2002:

1. Ft Lauderdale 91
2. West Palm Bch 58
3. Melbourne 57
4. St.Petersburg 55
5. Jacksonville 50
19. Tampa 6

Hydrocodone Deaths in 2002:

1. St.Petersburg 58
2. Jacksonville 48
3. Ft Lauderdale 44
4.West Palm Bch 42
5. Melbourne 39
7. Tampa 29

Sidebar#2: Addictive Prescriptions

OXYCODONE

Trade Names: Oxycontin, Percocet, Percodan

Active Ingredients: oxycodone hydrochloride; Percocet a;sp contains
acetaminophen, and percodan contains aspirin.

What they are used for: relief of moderately severe and severe pain.

Why they are addictive: oxycodone is a morhine-type narcotic that provides
heroinlike effects; higher does are needed to achieve the drug's original
effects.

How they are abused: OxyContin and Percocet can be swallowed, chewed,
crushed for snorting or injected when dissolved. Percodan is abused in pill
form.

Withdrawal symptoms: Restlessness, perspiration, chills, irritability,
anxiety, backache, joint pain, weakness, abdominal cramps, respiratory rate
or heart rate.

HYDROCODONE

Trade Names: Vicodin, Lortab, Lorcet

Active Ingredients: hydrocodone bitartrate and acetaminophen are in all three.

What they are used for: relief of moderate to moderately severe pain.

Why they are addictive: relief from pain diminishes with prolonged use, and
more is needed for preferred effect.

How they are abused: orally in pill form, chewed, or crushed then snorted
like cocaine; Lortab also can be also be crushed then dissolved in water
and injected like heroin.

Withdrawal symptoms: Restlessness,muscle pain bone pain, insomnia diarrhea,
vomiting, cold flashes, goose bumps, involuntary leg movements, watery
eyes, runny nose, loss of appetite, irritability, panic, nausea, chills and
sweating.

BENZODIAZEPINE

Trade Names: Xanax, Valium, Librium

Active Ingredients: Xanax is alprazolam, which is an analog of
benzodiazepine. Valium is diazepam, which is a derivative of
benzodiazepine. Librium is chlorodiazepoxide, which is a derivative of
benzodiazepine

What they are used for: relief from symptoms of anxiety; Xanax is also used
for the management of anxiety disorders.

Why they are addictive: False feelings of well-being; when taken in
compination of alcohol or other narcotic they enhance the high.

How they are abused: Xanax is abused in pill form by being swallowed or
chewed, crushed for snorting, or crushed then dissolved in water and
injected like heroin. Valium and Librium usually are taken in pill form but
also are manufactured in an intravenous form.

Withdrawal symptoms: Convulsions, tremors, abdominal and muscle cramps,
vomiting, sweating, insomnia, or disturbed sleep.

Research by Michael Messano. Sources: U.S. Food and Drug Administration,
Physicians Desk Reference