HILLBILLY HEROIN

Phil Moberly's phone rang on a Saturday night.

The call itself wasn't out of the ordinary. As an assistant district
attorney, Moberly expects calls when local police run into illegal drug
use. But the officer on the phone that night asked Moberly a puzzling question.

A man had passed out in the bathroom of a local store, the officer said.
The guy had a surgical tube tied around his arm; needles and spoons lay
nearby, along with a bottle of 25 OxyContin pills, a prescription
painkiller. Only four pills were left.

What can we charge him with, the officer wanted to know.

Reckless endangerment, Moberly said; the man had dangerous drug equipment
in a public place. Obviously, he had been abusing the drug, but he had a
prescription for it so the officer's hands were tied. The only other thing
he could do is find out the name of the doctor who had prescribed the pills
and send him a copy of the police report, so he would know he had an addict
for a patient.

End of phone call.

The man on the bathroom floor is a prime example of why prosecuting cocaine
and methamphetamine addicts is clear-cut, while charging prescription drug
abusers is not. You cannot prosecute a person who has legal access to
OxyContin even if he's taking it incorrectly, Moberly said.

"It's a go-nowhere case," he said. "I can't win it."

Abuse of prescription narcotics is hardly new. What is new is potent,
time-release OxyContin. Teens and adults are lying to get it. They're
shopping around for doctors who will prescribe it. And they're forging
prescriptions and stealing it from pharmacies, then selling it on the
street. Just a few weeks ago, a man barged into the pharmacy at Providence
Alaska Medical Center during the day and stole OxyContin.

The U.S. Food and Drug Administration approved OxyContin in 1995. Since
then, reports of abuse have flourished in southern states, lending
OxyContin the nickname "Hillbilly heroin."

But national data shows the 49th state has an OxyContin problem too. Alaska
distributes more of the painkiller to pharmacists and physicians per capita
than any other state in the nation, according to the Drug Enforcement
Administration. The state received its No. 1 ranking for distributing 8,300
grams per 100,000 residents in 2000. West Virginia was second with 8,136
grams per 100,000 residents.

Washington state was 19th on the list with 4,418 grams per 100,000
residents."We've got to admit we've got a problem," said Capt. Audie
Holloway, who ran Anchorage Police Department's narcotics division for six
years and now oversees the patrol division.

Holloway's not surprised by the numbers; his officers encounter OxyContin
while serving search warrants and solving robberies. In the past two years,
thieves robbed five delivery vans filled with OxyContin and other
prescription drugs; sometimes they stole the whole van, sometimes just the
drugs inside.

"That tells me there's a huge market out there," Holloway said.

People mixed up in OxyContin are dying. Over the past two years, the DEA
reported almost 464 deaths in more than 30 states, including Alaska,
related to the painkiller. Since July 1998, at least 39 Alaskans died with
OxyContin, or oxycodone, the drug's main ingredient, found in their bodies,
according to the state medical examiner's office. Because not all deaths
are reviewed by the medical examiner, health officials say that number may
be low.

With all the attention OxyContin is getting, those with legitimate pain
worry. What happens if officials remove the drug from the market, taking
away the one thing that helps them function?

Dr. Leon Chandler Jr., an Anchorage pain doctor, said his patients are
already losing access. Some pharmacies on the Kenai Peninsula won't fill
narcotics prescriptions signed by Anchorage doctors.

"I have patients who deserve good care," he said. Some of them take OxyContin.

"It's the best drug we have right now."

The Addicts: Breaking Oxycontin's Code

OxyContin looks as innocuous as aspirin. It's a small, circular tablet
designed in pastel colors -- pinks, yellows and whites.

A person taking it correctly will swallow a pill whole, allowing it to
slowly release the main pain-killing ingredient, oxycodone. Purdue Pharma,
the drug manufacturer, said relief can last up to 12 hours.

But breaking OxyContin's code -- turning the painkiller into an illicit
drug -- is so easy it has become kid stuff. At 15, Calen Mount of Soldotna
realized all he had to do was crush the pill and consume it for an almost
instantaneous heroinlike high. One pill and whatever was worrying him
vanished. Other addicts snort or inject OxyContin and experience euphoria
and high energy.

But OxyContin's lift is a Jekyl and Hyde experience. Enjoying the added
energy means putting up with an all-over-body itch and horrible
constipation. Even when the painkiller made Mount throw up, he wouldn't
stop using it. The high was too good.

OxyContin addicts are filling up treatment facilities in Alaska. Kenai's
small residential program, called Serenity House, opened in February 2000.
By October, it had seen 25 clients, 13 with OxyContin problems, said
interim director Pat Burke-Peters.

Last year, the Center for Drug Problems in Anchorage admitted 64 people for
treatment, 25 were OxyContin users, said clinical director Erin Schlicting.
The numbers might be small, but Schlicting said staff can only handle so
many at once. People wait about three months before getting admitted.
Enrolled addicts attend counseling sessions and take a daily dose of
methadone, a synthetic drug that alleviates withdrawal symptoms from opiates.

In Alaska, OxyContin abusers are men and women, adults and teenagers.
Moberly said he has even prosecuted a half dozen nurses and medical
technicians for possessing OxyContin or passing forged prescriptions.

Calen Mount knew adults who could get prescriptions for old injuries. At
first, adults gave Mount the pills for free. But within a few weeks, he was
addicted and the agreement changed. Now they wanted money.

Abusers pay dearly to supply their habits. At a pharmacy counter, OxyContin
costs about 12 cents per milligram, or $9.50 for an 80 mg pill. But when a
drug dealer gets ahold of it, he can jack the price up to $1 per milligram.
That 80 mg pill is now $80 -- an 740 percent increase compared with the
pharmacy price.

The adults selling to Mount cut him a deal. Instead of paying the $80 going
rate, Mount got 80 mg pills for $30. He would snort half a pill and sell
the other half for $40. He would take this money, buy another 80 mg pill
for $30 and make a $10 profit.

Mount finished a residential treatment program out of state and then joined
an out-patient program at Cook Inlet Council on Alcohol and Drug Abuse in
Kenai. He doesn't abuse the drug anymore, he said, but if he wanted to the
pills are easy to acquire.

"They're just out there right now really, really thick," he said. That very
day he had heard at school that a shipment of pills was arriving. And some
kids have it even easier, he said; their moms use it at home.

Before founding a local support group called Pills Anonymous, one Anchorage
woman created her own games to get OxyContin. She declined to share her
first or last name for this story. Now in her 40s, she looks and dresses
like a professional businesswoman. No one would guess she's a recovering
drug abuser.

She was working when she got hooked on OxyContin, using her wages and
health insurance policy to pay for medical visits and pills she did not
need. She was suffering from depression and had turned to OxyContin to
self-medicate her emotional pain. Soon she was lying to get it. She faked
pain to get prescriptions and eventually used fake names too. At the
pharmacy, she paid with cash so no one would ask for an insurance card.

Once she even told a doctor someone had broken into her house and stolen
her medication. The doctor asked for proof.

"I went down and filed a police report," she said. "My house was not
burglarized. That's how sick I was."

She tried quitting on her own. Withdrawal threw her into a deep depression
that she called the "dark place." She would stay awake when she wanted to
sleep. Night sweats followed, then chills and diarrhea.

She finally enrolled in treatment programs and eventually managed to quit.
Along the way, she lost a marriage and a job. She's now working again and
attends support groups.

Two summers ago, 25-year-old Meghan McCord died after overdosing on
oxycodone. Her dad, Byron McCord, wrote the obituary.

"Her personal life was a turmoil filled with the highs of two beautiful
children, Alex, 8, and Ashton, 3, and the lows of substance abuse," he
wrote. "The pain of living with her is replaced by the pain of losing her,
but we are all better people for having known and loved Meghan."

McCord found power in his honesty.

"If you print a rosy obituary, perhaps that brings sympathy," he said. "If
you print an honest one, I think the repercussions are most constructive."

Families learned from it, he said, sharing their own stories about drug
abuse. McCord learned something too. As far as he knows, Meghan had a legal
prescription for oxycodone. That means she got it from a doctor.

McCord, a doctor in Soldotna, was concerned: If doctors prescribe drugs
that patients are abusing, then they must scrutinize each prescription
before signing it.

That's part of a doctor's job, he said.

The Doctors: Among The Accused

As OxyContin abuse spreads from state to state, people are looking for
someone to blame. One finger points directly at doctors misprescribing the
drug. Another points at the drug manufacturer, Purdue Pharma.

Last summer, Darrell McGraw Jr., attorney general for West Virginia, sued
Purdue Pharma and other companies promoting OxyContin as a way to stop
their aggressive marketing. McGraw has alleged the companies offered
physicians expense-paid trips to seminars where guests give paid speeches
on Purdue's behalf. He also charged that company representatives threatened
to take legal action against pharmacists who refused to fill OxyContin
prescriptions, even if the pharmacist believed the person wanting the pills
was a drug abuser.

Purdue Pharma rebutted these claims, calling them "baseless." James Heins,
spokesman for the company, said Purdue is taking action to prevent drug
abuse. It's sending representatives around the country to teach doctors how
to recognize an abuser's scams. It's also shipping free tamper-resistant
prescription pads to physicians in some states including Alaska.

The company recently made headlines when it announced it intended to
develop a new pain medication more difficult to abuse. When crushed, this
new pill could activate a substance that cancels the painkiller's potency,
Heins said. But with FDA safety checks, it could take a couple of years for
the new painkiller to hit the marketplace.

Doctors who prescribe OxyContin are also making news. In February, Dr.
James Graves of Florida became the nation's first doctor to be convicted of
manslaughter for an OxyContin-related death of a patient. Graves had been
charged with manslaughter because four patients died after overdosing from
OxyContin and other drugs he prescribed.

Alaska also has had problems with doctors. Last year, two physicians were
successfully prosecuted on drug charges. State documents cited Dr. Stephen
Grandstaff of Fairbanks for exchanging narcotics prescriptions for sex with
patients. Then jurors found Anchorage physician Jeffrey Gottlieb guilty of
prescribing OxyContin and other medically unnecessary drugs to addicted
patients and stealing from Medicaid.

A state investigation revealed how Gottlieb worked. In one case, a patient
allegedly visited him to get drugs for illicit sale. Gottlieb filled the
prescriptions so he would get paid by Medicaid and make money. In a single
month, Gottlieb wrote prescriptions for more than 650 pills, including
oxycodone, to this patient. That drug volume would allow the patient to
take almost 22 controlled narcotics a day, state documents said.

Often, though, doctors aren't intentionally giving drugs to addicts. The
Anchorage Police Department investigated a case involving a doctor who had
written a prescription for Valium. The prescription made its way to people
who covered the drug name with corrective tape, duplicated the form to
create additional prescriptions and then wrote in OxyContin. In this case,
the doctor didn't realize what had happened until a pharmacist called him,
suspecting a forgery.

Drs. Leon Chandler and Larry Stinson specialize in treating patients with
pain. Both have devised strategies to sift out drug abusers. They use
special prescription pads that are more difficult to forge. Chandler's pads
bear protective watermarks and are numbered, like a checkbook.

Both also make their patients sign pain contracts. If patients breach any
part of the contract -- such as seeing multiple doctors for pain medication
or taking drugs they aren't supposed to be using -- doctors say the
patients will be "fired" and no longer eligible for care at that clinic. In
the past two years, Chandler's office has fired almost 200 patients.

But Chandler, Stinson and any doctor who treats pain is at a disadvantage.
They can't test for pain like they can for strep throat; there's no exam
that guarantees a patient isn't faking to get narcotics. That means doctors
must decide which patients are legitimate. Sometimes they guess wrong.

"That is one of the most difficult things about the practice," said Carl
Bostek, a family nurse practitioner who works with Chandler. "There is no
objective way to measure pain. Basically we really have to take your word
on it."

The Cops: Catching The Addicts

OxyContin penalties confuse criminals. You can get it in a doctor's office
and the FDA has approved it as a safe drug, so how could it be taken as
seriously as crack or heroin?

Moberly has seen defendants use that line of reasoning, only to pay for it
later. The assistant district attorney told of a man accused of selling
cocaine and OxyContin. In an interview with police, the man denied selling
the cocaine, but admitted delivering the painkillers. They were just pills,
he said.

He didn't realize he had just admitted to a more serious crime, Moberly
said. In Alaska, delivering OxyContin is a felony punishable by five to 20
years in prison. The penalty for delivering cocaine is zero to 10 years.

Those caught possessing OxyContin or cocaine can expect the same
punishment, however -- zero to five years in prison.

"They're going to go to jail for a long, long time," Moberly said.

Putting together a solid case against an OxyContin abuser isn't easy. For
starters, if someone has a legal prescription for OxyContin, a prosecutor
can't charge him for taking more than what's prescribed. It's also not
illegal to crush or inject the drug, even though the correct way to take it
is swallowing it whole, said Stephen Branchflower, the retired director of
Alaska's Medicaid Fraud Control Unit.

Drug abusers find loopholes in pharmacies and doctors offices. Some
insurance companies will tell pharmacists if a customer has recently filled
a similar narcotics prescription at another pharmacy. But if a patient pays
with cash, no insurance card is necessary.

The founder of Pills Anonymous said pharmacists often didn't ask for
identification -- making it easy to use a fake name. Doctors didn't always
review her charts either, frequently failing to catch her long history of
pill-taking, she said.

Even though Alaska is the country's No. 1 per capita distributor of
OxyContin, it hasn't taken the preventative steps some states have. It
hasn't proposed legislation to increase penalties for abusing the drug nor
has it created a program to monitor narcotics prescriptions, which 17 other
states have done.

Alaska doctors and pharmacists have joined law enforcers to stop OxyContin
abuse. Once a month on the Kenai Peninsula, Dr. Byron McCord gets together
with police officers, pharmacists and treatment counselors to talk about
possible solutions. In Anchorage, pharmacists are on the lookout for forgeries.

Last winter, they caught one.

The Pharmacists: Off The Target List

Michele is a recovering OxyContin addict from a downtown Anchorage
methadone clinic. After agreeing to talk to a reporter, she failed to show
up for several appointments. By phone, she described her experiences with
the painkiller and how she got caught.

Friends had warned her: Don't go to the pharmacy at Carrs Aurora Village.
Pharmacists there catch addicts with fake prescriptions.

But the Anchorage mother decided to chance it. Cocaine long had been her
drug of choice. Now in her 20s, she was addicted to OxyContin. She started
with 20 mg but soon needed 40 to reach the high she wanted.

So when a friend wrote a forged prescription for OxyContin pills last
winter, Michele grabbed it.

At Carrs, the pharmacist was suspicious from the start. He checked the
handwriting and noticed it didn't match the doctor's. A phone call to the
doctor confirmed what the pharmacist thought: He had spotted a fake. He
called the police, and Michele's still paying for her crime with two years'
probation.

Pharmacists don't want to be put in that position. David Thompson with
MyDoktor's Pharmacy in Wasilla no longer stocks the drug, instead requiring
patients to special order it.

"It takes us off the target list," he said.

Stephen Srebernak, another pharmacist, also took defensive action.

Just before closing time one day in August 2000, Srebernak was filling
prescriptions at Family Pharmacy in Eagle River. His pharmacy was empty of
customers until the door swung open and a man walked in pointing a gun. The
man demanded all the OxyContin on the shelves.

Not knowing the man only had a pellet gun, Srebernak handed over about
1,000 pills, more than half OxyContin. The thief ran off with $1,900 of
stolen drugs; police officers caught him speeding away.

Still, Srebernak kept OxyContin on the shelf. But four months later, when
he heard that the pharmacy at Carrs Aurora Village had been robbed, he
changed his mind.

He pulled higher-dose OxyContin from his shelf, forcing people who really
needed it to go elsewhere. He alerted clients and criminals by taping this
bright pink sign to his front door:

"Family Pharmacy will no longer be stocking OxyContin 40 mg tab or
OxyContin 80 mg tab."
Help Available

Pills Anonymous, a support group for people who abuse prescription drugs,
meets twice weekly in Anchorage. Meetings are held from 3-4 p.m. Sundays
and 6-7 p.m. Thursdays at 8141 Briarwood Drive, off of Dimond Boulevard.
Those attending should park in the back of Viking Hall.

Everyone who attends the meetings can remain anonymous, the group's founder
said. For more information, call 907 272-2312.