OXYCONTIN ABUSE MAY CURB PROGRESS IN PAIN FIELD

Riddled with pain from rheumatoid arthritis and a degenerative bone
disease for years, Diana Rose rarely left the house. Then in November,
a doctor prescribed the painkiller OxyContin, dramatically changing
her quality of life.

"I can actually go shopping at the mall, play with my grandchildren
and even swim in our pool," said Rose, a 57-year-old Kentucky woman.
"This drug has enabled me to do things without being in pain."

OxyContin, a powerful drug that is a chemical cousin to opiates such
as morphine and heroin, has enabled thousands of people, such as Rose,
to resume the normal activities of life. But now some doctors fear
that a backlash triggered by rampant street use of the drug dubbed
"hillbilly heroin" will derail significant advances in the field of
pain management. They worry that U.S. drug officials may respond to
rising illicit use of OxyContin by yanking it from the market, place
stricter limits on the use of all opiates, commonly used to treat
cancer patients, severe back pain and other chronic pain conditions.
"This is not just about OxyContin," said John D. Giglio, executive
director of the American Pain Foundation, a nonprofit consumer group
in Baltimore. "This is about the potential for rolling back progress
made in pain management. It's been an extremely hard uphill climb to
get physicians to become more comfortable prescribing opiates and
overcoming the stigma among patients about potential addiction and
abuse."

OxyContin is a synthetic opiate that has fewer side effects than other
potent pain medications, including morphine or codeine, which can
cause nausea, constipation or drowsiness. What's more, OxyContin is
formulated to keep steady levels of the drug circulating in the blood
for as long as 12 hours. Patients don't experience the intense peaks
and valleys of taking other narcotics, like Vicodin or Lortab, which
can take an hour to provide pain relief and whose effects wear off in
four hours.

Soon after OxyContin was approved in 1995, recreational drug users
discovered that chewing the pill, rather than letting it dissolve in
the gastrointestinal tract, crushing it into a power that can be
snorted or intravenously injected, produced an intense high. Within a
few years, Appalachian communities in Virginia, West Virginia and
Kentucky, and rural Maine reported a wave of users who had become
addicted to the drug.

Since then, illicit use of the drug has spread throughout the country.
It is estimated that more than 200,000 Americans have abused the drug,
which also has been implicated in more than 100 deaths from suspected
overdoses. Several doctors have been convicted of illegally dispensing
the drug, while "Oxy" addicts increasingly turn to crime to feed their
habits.

The growing alarm about illicit use is having a chilling effect on
legitimate use of the drug. Six states--Florida, Maine, Ohio, South
Carolina, Vermont and West Virginia--have set strict limits on the
number of pills that can be prescribed for people on Medicaid, the
state-federal health program for the poor. That means that doctors may
not be able to increase dosages for patients who need stronger pain
relief.

In the wake of several robberies at drugstores across the country,
many pharmacies now refuse to stock it, and physicians are reluctant
to prescribe it.

"Since all this hysteria began, some patients have been abandoned by
their doctors," said Dr. J.S. Hochman, executive director of the
National Foundation for Treatment of Pain in Houston. "I had two
patients, a mother and daughter with severe rheumatoid arthritis who
had to fly from Boston to Houston to find a doctor--and were willing
to do so because they were so desperate. It's pathetic."

Some patients are so concerned about the negative publicity,
especially fears of addiction, that they've asked their doctors to
take them off the drug.

"The day after an OxyContin story aired on one of the TV
newsmagazines, I had two cancer patients come in the next day, telling
me they wanted off the drug," said Dr. Neal Slatkin, director of
supportive and palliative medicine at City of Hope National Medical
Center in Duarte.

"Their pain was well-controlled, and they weren't having side
effects," he said. "So I spent a lot of time reassuring them that this
drug was OK. But the whole incident was very distressing."

Patients who continue taking the drug often face serious obstacles in
getting their prescriptions. In Pulaski, Va., for example, a small
town in Appalachia, police began fingerprinting patients who had
OxyContin prescriptions. Under threat of a lawsuit by the American
Civil Liberties Union, authorities later backed down.

"I've been refused treatment in the ER because they think I'm a drug
seeker," said Jeannette Murray. The 31-year-old nurse, who lives in an
area of southwestern Virginia that is a hotbed of OxyContin addiction,
takes the drug to relieve chronic pain from an injury to her right
arm.

"It's been difficult finding a pharmacy to get my prescription
filled," Murray said. "I've been cautioned not to carry my
prescription on my person, which just adds more stress to an already
stressful situation."

In response to reports of OxyContin abuse, Purdue Pharma, a Stamford,
Conn., pharmaceutical firm, in May stopped marketing the 160-mg
version of the drug, then the strongest dosage available.

The company also recently announced plans to introduce a "smart"
version of the pills, which lose their potency if they're crushed or
snorted; however, the new formulation won't be available for a few
years.

And beginning in July, the FDA required that OxyContin boxes carry the
agency's strongest warning: a black box label that calls attention to
the drug's potential for abuse and diversion.

"But all this hoopla just exacerbates patients' underlying anxiety
about taking opiates, which we know are really quite effective," said
Dr. Richard Payne, chief of pain and palliative care service at
Memorial Sloan-Kettering Cancer Center in New York.

"There is still a pervasive undertreatment of pain," he said, "and
thousands of people are suffering needlessly."