NEW DRUG, OLD STORY

The Page One news stories sound ominous. The Courier-Journal reports that a
new, frightening type of abuse has begun to emerge:

"Especially in Eastern Kentucky, where poverty is greatest and the
recipient load heaviest, overuse of addictive drugs is causing grave
concern among Medicaid administrators and some doctors."

Computerized efforts to "pinpoint patients obtaining excessive
prescriptions for strong drugs, as well as doctors who prescribe them too
often, are not doing the job yet."

A legislative committee in Washington releases a report, sharply critical
of what it calls "sloppy administration and poorly drawn legislation that
permit excesses by doctors, hospitals and patients.

Are we talking about the current OxyContin debacle? No, this was the abuse
of barbiturates and narcotics that were prescribed under Medicaid, back in
the late 1960s and early 1970s, to relieve tension, induce sleep or ease
pain. As the newspaper's mountain correspondent reported back then, "Many
recipients have become users, who even supplement prescribed drugs with
supplies from illegal sellers, or pushers."

Nor did Medicaid introduce drug abuse to the mountains. For a whole range
of social and economic, even geographic, reasons, prescription drug and
substance abuse reach far back into the region's modern history. That
history, as well as the fecklessness, tolerance or participation of local
law enforcement agencies, also helps explain why Central Appalachia is the
source of perhaps 40 percent of the nation's supply of marijuana, not to
mention the OxyContin headlines.

This is not to blame Appalachia for its own misery, although it is, in
fact, the region where OxyContin abuse problems first reached epidemic
proportion.

But those who would blame only the pain-killing drug's maker, Purdue
Pharma, should remember the earlier mountain experience with such
pain-killing narcotics as codeine, meperdine, morphine and anilierdine, or
such barbiturates as pentobarbitol, secobarbital and phenobarbital. There's
a line that leads from there to the OxyContin craze.

Purdue Pharma must redouble its search for a less easily abused form of the
drug and must educate doctors and pharmacists about the abuse problem with
as much energy as it has devoted to marketing the stuff. But the drug firm
can't solve this dilemma by itself.

What's needed are public education campaigns, better prescription
monitoring and more accessible rehabilitation centers. Also, certainly,
tougher law enforcement is necessary -- both of the kind that resulted in
40 felony drug-trafficking arrests in Lee County last week and of the kind
that resulted in the federal arrest of an Indianapolis doctor for
defrauding Medicaid by illegally prescribing OxyContin to dealers.

Purdue Pharma's critics charge the firm with failing to move quickly
enough, when abuse of OxyContin began to show up. But the government has
been promising since the Great Society era to develop a computer system
that would effectively monitor the misuse of prescription drugs, and we
still don't have one.

There's enough fault to go around. What we don't have is time to waste.