PAINKILLER CAN BECOME PRESCRIPTION FOR DEATH

OxyContin relieves severe chronic pain, but it is also attracting addicts.

Brandon Bowers was a junkie.

It wasn't alcohol, marijuana, cocaine or methamphetamine. He'd used them
all before, but he'd found something new.

This time it was a highly addictive narcotic - and legal. Bowers' name was
right there on the bottle.

His drug: OxyContin, a powerful painkiller his doctor prescribed for back pain.

Swallowed whole and taken as directed, OxyContin has been hailed as a
miracle drug for cancer patients and others who suffer chronic pain. But
when abused - usually by being crushed, then snorted or injected - it can
be deadly.

Shooting up OxyContin slammed 12 hours of pain medication into Bowers'
system in 20 minutes. It also killed him.

The Ash Grove native is one of up to eight people in southwest Missouri who
have died in the past 19 months while taking OxyContin. It has killed more
than 100 people nationwide.

Maine, Florida and Kentucky have been consumed by a criminal explosion
associated with "hillbilly heroin." It is enticing senior citizens with
legitimate prescriptions into surreal partnerships with street- drug
dealers. It's propelling addicts into robbing pharmacies and emergency
rooms. And in Maine alone, more than 30 pharmacists are under
investigation, accused of cutting distribution deals with pushers.

Locally, Ozarks law enforcement, physicians and pharmacists are on alert
for illicit sales and use.

Nationally, states are considering ways to control the sale of the drug.
The Food and Drug Administration, the Drug Enforcement Administration and
the drug's maker, Purdue Pharma, are scrambling for ways to stop the abuse.

The answers won't come easily - because the drug works. Extending a legacy
started by such drugs as morphine and heroin, OxyContin is hardly the first
effective painkiller to arrive on the market and promptly be exploited by
dealers and abusers. It's just the latest.

If OxyContin is taken off the market, people enduring severe pain will lose
a tool to soothe their misery. If it remains on the market, OxyContin will
continue to be abused.

And people - legitimate users who became abusers, as well as addicts who
snared the drug illegally - will continue to die.

Privacy laws make it unclear whether the drug's seven other local victims
were legitimate prescription patients or illicit users. The other Ozarks
deaths include two women, ages 25 and 49, two 35-year-old men and three men
in their 40s. Four of the deaths occurred in Greene County and one each in
Stone, Jasper, Douglas and Barry counties.

Their deaths indicate OxyContin has arrived in the Ozarks. So have
robberies and possession cases related to the drug, local authorities say.

Just as in other states, it's starting slowly. That won't last, local law
officers fear.

Brandon Bowers started slowly, too. But after months of using the drug,
Bowers, a diabetic, built up a tolerance and began injecting OxyContin with
his insulin needles.

On April 30, Bowers slipped into unconsciousness after shooting up. His
older brother, Michael Bowers, dragged him into the shower, trying in vain
to wake him.

He propped Brandon on the toilet, trying to snap him into consciousness.

Brandon crumbled onto the floor. Michael couldn't bring him back.

At 21, Brandon Bowers had overdosed on OxyContin.

OxyContin makes people feel good. Really good.

Some people truly need that feeling. Others simply covet the rush.

"It's just a real intense euphoria like any narcotic," said Mark Beas,
director of the Center of Addictions at Cox Health Systems. "It's a body
rush where it's a feeling kind of like warmth. At the same time, it's
excitation and euphoria. It's not like a stimulant. It's something like an
orgasmic-type feeling across the whole body."

Many doctors praise the drug because its time-release feature means
pain-stricken patients get a steady flow of relief from just one or two
doses a day, instead of the on-again-off-again numbing of pain from
frequent doses of other painkillers.

Christopher Long, director of toxicology at Saint Louis University, can see
why OxyContin has received such attention by users and abusers. Because
other time-release drugs are destroyed more rapidly in the body, their
effects are not as dramatic as OxyContin's, he said.

"It is more effective than if you were to take MSContin (another time-
release drug)," Long said. "So you get 80 percent of the bang for the buck.
If you take OxyContin, you get 110 or 120 percent more of an effect on the
same dose."

Long said OxyContin is so addictive because it stops the brain from
producing the natural chemicals that make the body feel good.

"You do develop a tolerance to all the opioids, which requires you to take
more," Long said. "It alters the brain chemistry so your brain doesn't
produce the endorphins and enkefalins. You get that feeling from the drug.
You want them to be replenished to make you feel better.

"Your body makes these things and now it doesn't need it," he said. "You're
supplying it externally so it doesn't make it anymore."

Theresa Gunderson has experienced OxyContin. She was prescribed the drug
after a biopsy. The 41-year-old woman suffered extreme pain with two
previous biopsies and her doctor gave her a 10-day supply of 10- milligram
pills.

"It was kind of like I took it, and I would start talking to (my sister)
and I'd start carrying on a conversation that was going on two hours ago,"
said Gunderson. "I would be laying there, watching TV, next thing I knew,
it was seven hours later."

She felt good. She was happy. She felt no pain.

"I felt really good," she said. "I guess you could say it was euphoric."

But Gunderson stopped taking it after four days and flushed the rest down
the toilet. As an inventory manager at St. John's Regional Health Center
who purchases medications for the hospital, she had heard of OxyContin
before. She knew the dangers.

"I was like, 'I'm taking OxyContin,'" Gunderson said. "It just kind of
surprised me. I was like, 'I don't think I want to take this anymore
because it makes me feel too doped up.' But I don't think I felt I was
going to get addicted."

OxyContin's abusers worry people in the medical field. They fear negative
publicity will force the drug off the market. Many prescription drugs are
abused, they contend, and OxyContin is just the latest.

"In what we do, this medication is very important," said Cindy Williams, a
patient-care supervisor for Community Hospices of America- Southwest Missouri.

Still, she knows that OxyContin abuse is possible. And addiction, too, even
for patients using it properly.

"There's an opportunity for it to be abused for all situations," she said.
"I can't guarantee it hasn't been abused in home situations that we've been
involved in. Nurses keep track of all narcotics. It's not something we hand
out and never look back. It's monitored every time a nurse goes into the home."

Williams said a significant amount of her patients take OxyContin. They do
build up a tolerance. Some become addicted. But without it, their lives
would be unbearable.

"It's not a pain that goes away," Williams said. "Any time you have pain,
you have a side effect of addiction. We deal with that."

Williams said the drug, like all medicine, should be taken as directed.
Patients need to make sure family members don't abuse medication and that
they are always open with their physicians and nurses.

"This medication would be greatly missed in our industry because it is a
very effective form of pain management," said Jan Badgett, vice president
of community services at Community Hospices of America- Southwest Missouri.
"(Our hospice has) a high regard for people's pain. We strive to get that
pain under control so they can have quality of life, or what life they have
that's left."

For the terminally ill patients in the latter stages of their disease,
OxyContin soothes their lives. It relieves when nothing else will.

"You can take the drug and you will feel good," Long said. "You do. The
pain goes away. All your cares and worries go away."

Long said the people who use OxyContin legitimately don't feel the rush
that abusers seek. They need the drug just to feel normal.

"Will you get some of it? Yes," Long said. "It will be dose-dependent. The
first thing they notice is pain relief, which in itself is euphoria when
you're in a lot of pain and all of a sudden it's gone."

As the director of pharmacy at St. John's, CW Powell was prescribed
OxyContin after two hip replacement surgeries. After the second, he was
first prescribed a short-term drug, one that couldn't compare to the relief
provided by OxyContin.

"Every two hours I would have pain and have to be redosed again," Powell
said. "I was fatigued. The pain was there every two hours. Once I was
prescribed OxyContin, I was fine. I could sleep. I wasn't doped out. I was
relaxed and pain-free."

Powell was even able to work from home while he was taking OxyContin. He
didn't experience euphoria or any adverse side effects. After about a month
of taking OxyContin, he began to wean himself from it.

"The only reason I phased it down wasn't to prevent addiction, it was
because I didn't need it," Powell said.

Like other medical experts, Powell and Gunderson believe OxyContin should
stay on the market.

"If people make the decision to abuse, they may get injured," Powell said.
"I don't know that the manufacturer needs to be punished for people who
abuse it."

Purdue Pharma has been working to correct what has become a public-
relations nightmare.

Company officials dispute that their drug is solely to blame for more than
100 deaths. They've launched their own investigation, scrutinizing autopsy
reports to see if victims mixed OxyContin with alcohol or other drugs.

This work is costing Purdue Pharma plenty. But not nearly as much as the
drug has made for the company.

A company that has been around for almost 100 years, Purdue Pharma took in
$1.5 billion in sales in 2000. More than $1 billion of that was from OxyContin.

From 1996 to 2000, the number of prescriptions dispensed for similar drugs
increased 23 percent. For OxyContin, the number rose 1800 percent.

"The success of OxyContin has definitely made the company grow," said Merle
Spiegel, associate director of corporate communications for Purdue Pharma.
"We've doubled in size in the past few years - partly due to the success of
OxyContin."

OxyContin has ignited profits on the street, too.

Because of his medical insurance, Brandon Bowers was only prescribed 21
20-milligram OxyContin pills at a time. The Bowerses said their son's
friends were prescribed 80-milligram pills by the same doctor. They paid $6
per pill through Medicaid and sold them for $60 to $80 each - a profit
margin that tops 1000 percent.

When Bowers ran out, he went searching for his friends.

"That drug has so much of a hold on you," Jim Bowers said.

That's how OxyContin finds its way to the street and into the hands of
people who abuse it. Doctors misprescribe it. Drug dealers and addicts rob
pharmacies to get it.

This year, Greene County has seen three or four cases of illegal possession
of OxyContin, said Sgt. Jim Farrell, who heads the drug enforcement unit of
the Greene County Sheriff's Department.

"Some of them are buying it from people who have prescriptions for
OxyContin," Farrell said. "Some are stealing it from people who have
OxyContin prescriptions. Some are stealing prescriptions from doctors."

"A lot of people who I knew to be methamphetamine users are turning to
(OxyContin)," said Springfield Police Department Sgt. Mark Deeds. Some
forge prescriptions, leaving the state to get them filled and returning to
Springfield to sell the drug, Deeds said.

Special Agent Shirley Armstead, public information officer for the DEA's
St. Louis office, said there has been one confirmed death in St. Louis and
four cases of fraudulent OxyContin prescriptions. A physician was arrested
for prescribing the drug illegally, she said, while another was arrested
for abusing OxyContin and illegally prescribing it to others.

In Stone County, Sheriff Richard Hill said a 41-year-old man had been
prescribed the drug legally, but chewed it up instead of swallowing it.

Citing the man's medical history, Hill said no in-depth investigation was
needed. "He just misused the prescription."

Pulaski County Sheriff J.T. Roberts said a 24-year-old man died last month
in a case that could be linked to the drug. But, because alcohol and
morphine could also be involved and no formal cause of death has been
issued, it is not yet considered an OxyContin-related death.

"Where concern really comes into play is where they start mixing it with
other things they may be taking," said Jasper County Sheriff's Department
Capt. Tony Coleman. "Whether it's alcohol or it's meth, it intensifies the
effects."

OxyContin was evaluated and tested for nine years and subsequently declared
one of the most effective methods available for treating extreme chronic
pain. But now the drug is the subject of re- examination by not only its
manufacturer, but also the FDA and the Substance Abuse and Mental Health
Services Administration.

Task forces have emerged to investigate expanding abuse of the drug. The
DEA has initiated unprecedented research - including contacting the Greene
County Medical Examiner's office and other regional agencies - to chart
abuse of the drug.

The FDA and Purdue Pharma have come together to craft changes. They've
joined forces to evaluate who was using OxyContin and for what purpose. The
FDA is working with sponsors to develop educational programs to stress the
dangers of the drug.

"We've been working at intra-agency meetings for many months to try to
evaluate the problem," said Dr. Cynthia McCormick, director of the FDA's
Division of Anesthetics, Critical Care and Addiction Drug Products. "Each
agency has taken part in its own way to use its authority to reduce the
problem as much as we can."

Purdue Pharma changed the drug's package inserts to present warnings in a
bold black box that can be clearly seen.

The company is also working to reformulate the drug with an antagonist
agent that would make it ineffective if it were injected intravenously.
Spiegel said Purdue Pharma, which typically spends $50 million a year on
research, has laid out "tens of millions of dollars" for clinical trials to
speed the change along. Still, the process takes time.

"They have to be tested first in the lab, on animals, on humans and then
submitted to the FDA," Spiegel said. "We're doing everything in our power
to speed it up and send it to the FDA. There's no way we can predict how
long it would take."

The pharmaceutical company also wrote letters to 800,000 doctors across the
country informing them of the new labeling and encouraging them to discuss
the dangers with patients.

Neither Purdue Pharma nor the FDA is considering pulling the drug from the
market.

"Not at this point," McCormick said. "If things became much worse we would
need to reconsider all options."

For now, the drug remains. So will the relief for pain-stricken thousands.
So, too, will the abuse.

Some blame Purdue Pharma's aggressive marketing campaign for both the
drug's legal and illegal expansion. Purdue Pharma says it wasn't overly
aggressive.

Some blame doctors who illegally prescribed the drug to those who didn't
really need it.

But old-fashioned word-of-mouth spread the news, too. The news of a high
like no other. A legal one, to boot.

And in reference to another legitimate painkiller turned to illicit uses
long ago, OxyContin picked up names that reflected its power: Appalachian
heroin, hillbilly heroin.

Whatever it's called, it killed Jim and Elaine Bowers' son.

They knew their son was on pain medication for his aching back. It wasn't
until they saw media reports about the drug that they began to question
their son's use of it.

"I never dreamed OxyContin would kill him," Elaine Bowers said. "I knew it
was addictive, but I didn't think it was something that would kill you. I
thought heroin and cocaine would kill you."

They sat down with their son and talked to him about OxyContin. He seemed
to listen.

Not long after that, they discovered Brandon was injecting OxyContin into
his arm with his insulin needles.

"I don't think he knew it was that addictive," Elaine Bowers said. "We
didn't. This is so addictive. This is killing people."

The Bowerses don't understand why, with his history of addiction, Brandon
was prescribed OxyContin in the first place.

"Terminally ill patients in severe pain I can understand," Elaine Bowers
said. "But why would a doctor prescribe a highly addictive pill to a
21-year-old with a history of addiction? Why did he give him that drug?"

The Bowerses won't reveal the name of the doctor who prescribed Brandon's
OxyContin.

"I'm not bitter and I'm not mad at anybody," Elaine said. "Brandon made a
choice. Nobody forced him."

Jim Bowers feels differently: "I'm bitter with his friends that knew he had
problems that would still sell it and give him stuff."

Brandon's bedroom is just as he left it. Stacks of baseball cards he
ordered online a few days before he died sit in a bookcase. The same blue
bedspread is still on the bed, neatly made. His wallet is still in the top
dresser drawer.

His Siamese cat, Pixie, has had kittens. His brother's son is now eight
months old.

Jim Bowers stares out Brandon's window, a view of green Ash Grove fields.
It was a view Brandon loved.

Jim and Elaine remember the kid who loved to read, who knew everything
about computers and drank a gallon of milk a day.

"I just think about him all the time," Jim Bowers said. "Every minute,
every second, really. We miss him a lot."

(SIDEBAR)

About OxyContin

- -The drug: OxyContin humbles the brain's ability to send pain "messages" to
the body. Some feel it's ideal for terminal cancer patients and others
shackled with chronic pain.

- -Why it's popular: Rather than ease pain in waves via multiple doses, its
time-release feature offers a steady flow of relief.

- -Why it's abused: Oxycodone, the active ingredient, floods the brain and
produces an intense rush.

- -How it's abused: The tablets are crushed, defeating its time-release
feature, then swallowed, snorted or injected.

- -The impact: Dozens of deaths nationwide have been linked to abuse of the drug.