PAINKILLER OXYCONTIN CAN BE SOURCE OF PAIN

After kicking $600-a-day habit, Helen McDonald knows...

Pain sufferers describe OxyContin as a miracle drug.

Law enforcement officials say it's by far the most abused drug of all time.

Addicts - who chew, crush, snort and inject the powder for a jolting, fast,
heroin-like high - say it's the most euphoric feeling ever experienced and
admit they'll do anything to get their hands on this synthetic version of
morphine.

Few may know the irresistible allure better than Helen McDonald of McComb,
whose doctor prescribed OxyContin for recurring pain from a knee injury.
And only a few know quite as well as she does the devastation and
debilitating withdrawal of OxyContin addiction.

"I lost a home, a 17-year marriage and a lot of respect because of
OxyContin," McDonald said, dabbing her tear-filled eyes with a tissue.

McDonald, a construction worker, started with 20-milligram doses of OxyContin.

Soon, the 34-year-old mother of three said she was taking 40-milligram
tablets - as many as a dozen a day.

Then, she had her prescription increased to 90 of the 40-milligram tablets
a month.

"I could do 90 in a week," McDonald said.

To support her growing dependence on OxyContin, McDonald became a dealer,
illegally buying large quantities from a source in Texas - paying $5 each
for 1,000 40-milligram tablets, then reselling them for $25 apiece to
supply her own $400- to $600-a-day habit. "I'd take five before I got out
of bed in the morning," she said.

One day, as federal narcotics agents prematurely moved in to arrest her -
an hour before her next 1,000-tablet shipment - she sought to hide any
evidence and gulped down 12 tablets in her possession. Only the drug's
time-release function may have kept her from overdosing.

Since Nov. 28, 2000, eight Mississippians, who crushed the tablets and
disabled the time release before using the drug, have died from OxyContin
overdoses.

Nationally, OxyContin, the nation's top-selling narcotic painkiller, and
oxycodone, its active ingredient, have been blamed by the Drug Enforcement
Administration for 117 deaths in 31 states in the past two years. The
agency believes the drug is the likely cause of 179 other deaths.
Juxtaposed with the drug's high potential for abuse is the painkiller's
ability to make life bearable for patients like Angela Williams, who
suffers from sickle cell anemia.

The 25-year-old woman, who lives in central Mississippi, has suffered pain
episodes from sickle cell since she was 8. "It's like a freight train
running through my veins," she said, describing the pain.

The disease elongates red blood cells into a sickle shape that prevents
them from flowing easily through small blood vessels. The passages clog,
reducing blood flow and oxygen to tissues and causing pain.

"I would probably have to make a lot of visits to the emergency room if not
for the OxyContin," Williams said.

Once sickle cell patients are in significant pain, "it takes a lot more
pain medication to suppress and get it under control," said Dr. Rick
Carlton, associate professor of emergency medicine at the University of
Mississippi Medical Center.

"Instead of a roller coaster, it's better to have a sustained level of a
narcotic on board," he said.

OxyContin's 12-hour, time-release aspect also works well for post-operative
pain and fractures, he said.

"It has revolutionized the lives of some chronic pain patients. It's really
made them be able to become functional," said Dr. Hugh Gamble, a thoracic
surgeon in Greenville and president of the Mississippi State Medical
Association. "The other side of the coin is it is obviously a drug with a
high potential for abuse."

But where are these drugs coming from? Gamble asks.

Dr. Buck Stevens, executive director of the Mississippi State Board of
Pharmacy, believes he can eliminate one possible source. "I would be
surprised if the quantities of drugs that are on the street came from
pharmacists," Stevens said.

"Our checks and balances are pretty good in pharmacy. One thing to always
remember is this - addicts who are at a stage where they have a real drug
need for high doses of narcotics are gonna find them somewhere, on the
street, in the drugstore, whatever. That's just a problem of our times."

Circuit Court Judge Keith Starrett sees firsthand the ravages of OxyContin.
McDonald was placed in Starrett's Lincoln-Pike-Walthall County drug court
after being arrested and subsequently going through a rehabilitation
program. Starrett's program is designed to help - not punish - addicts.
McDonald was charged with and pleaded guilty to unlawful possession of
OxyContin on May 7.

She has to complete the FED-UP, or Fostering an End to Drug Use Problems,
course. She's in Phase II of the program, which has five phases and can
last up to five years. At this phase of the program, McDonald must report
once a week to the court and is subject to drug tests anytime, 24 hours a
day, seven days a week, Starrett said.

"She's done amazingly well. She'd hit rock bottom. I'm just really proud
for how far she's come."

A first-time offender, McDonald had a choice: Complete the drug court
program or go to jail for up two years at the state penitentiary.

McDonald picked the program. She had to complete drug rehab, get a job and
go to support-group sessions, including a weekly after-care meeting. At
UMC, medical professionals use everything from patient contracts to
toxicology screenings to ensure patients in the pain management clinic
don't abuse medications, said Wanda J. Keahey, a pain management pharmacist
and drug information specialist. "Any medication - even Tylenol - can be
abused if you take too much of it or take it incorrectly."

OxyContin was introduced in 1996 by its manufacturer, Stamford, Conn.-based
Purdue Pharma L.P. Abuse of the narcotic first was spotted in rural Maine
and Appalachia because of the poor economy, a scarcity of cocaine and
heroin and large populations of injured workers and elderly people who used
the drug to relieve pain of cancer or other illnesses.

"It's the best-selling narcotic pain relief in the country," Dr. Jeff
Summers of Mississippi Pain Management said of the drug that saw $1 billion
in sales last year.

Summers said a few patients have asked to be taken off OxyContin because of
the bad media attention. "Then they were either dissatisfied with the
amount of pain relief or didn't like the side effects (of the alternate
drug)," he said." It will be disappointing if we have to switch everybody
off OxyContin."

Purdue Pharma L.P. has been under DEA attack because of abuse and deaths
associated with OxyContin. Jim Hinds, associate director of public affairs
for Purdue, said "90 percent of deaths attributed to OxyContin are in fact
due to use of multiple drugs. The pattern of drug abusers is that drug
abusers abuse more drugs than one."

The pharmaceutical company has manufactured a similar drug - MSContin - for
17 years. Introduced in 1984, "it didn't have this widespread pattern of
abuse. With that being the case, we didn't anticipate the level of abuse
we're seeing with OxyContin," Hinds said.

To help derail the abuse, Purdue Pharma has launched a number of
initiatives, which include medical education and a teen prevention program
that addresses prescription drug abuse and how to educate middle and high
school students about it.

The company is also offering tamper-resistant prescription pads to doctors.
"We've retrained our sales force to ensure they talk to physicians and
pharmacists to be sure they talk about diversion and abuse and how to be on
the lookout for it," Hinds said.

The company is working on a tamper-resistant form of the drug, which is
planned to be ready for FDA approval by the end of 2002, Hinds said.

To combat the growing problem in Mississippi, representatives from the
attorney general's office, the Mississippi Bureau of Narcotics, Blue
Cross/Blue Shield, Medicaid Commission and the Board of Pharmacy formed a
task force in April to strengthen regulation of controlled substances such
as OxyContin and other powerful painkillers.

On the task force's agenda was discussion of a prescription monitoring
system that once implemented would compile existing records into one
computer, said task force member Tim Rutledge, MBN's program manager for
its statewide diversion program.

The task force won't do anything to stop legitimate patients from getting
legitimate drugs, he said.

The committee proposed that the State Board of Medical Licensure pass a
regulation to require physicians to complete at least two hours of
continuing medical education in pain management; to keep carbon copies of
all controlled substance prescriptions in patients' charts; and to enter
into a physician/patient contract when controlled substances are prescribed.

A board committee is discussing the proposed regulations but probably won't
bring the discussion before the board until its January meeting, said board
Executive Director Dr. Joseph Burnett.

One thing the board unanimously agrees on is that OxyContin's benefits far
outweigh the drug's widespread abuse. "One thing for sure, we can't suggest
taking it off the market. It's too good of a drug for what it's designed
for. We've got to have that drug," Burnett said.