KILLER DRUG

Abuse Of Painkiller OxyContin -- 'Hillbilly Heroin' In Appalachia --
Is Shattering Lives And Communities

GILBERT, W.Va. -- Kristen Rutledge had watched friends slowly kill
themselves with OxyContin. Her own cousin, just 18, shot herself in
the head when she couldn't get more of the drug. Girlfriends were
prostituting themselves for another fix.

Still, when someone offered her a yellowish 40-milligram pill, she
took it, chopped it up and snorted it. It was the start of a
three-day binge, and she was hooked.

"It's not like any other drug I've ever done," the 20-year-old says
as she takes a drag off her umpteenth cigarette.

During the next year, her habit grew until she was taking up to eight
"40s" a day, she says. When her dad, a school board member and former
mayor, found out, she tricked him into giving her more money by
saying she was being threatened by drug dealers.

The cash drain contributed to Tim Rutledge's loss of his grocery
franchise. But Kristen didn't care.

"When I got down to two, I started panicking," she says. "I had to
get out and buy some more."

Many in Appalachia call OxyContin "hillbilly heroin." Its abuse may
not have started in the mountains, but it exploded here.

Across the region, people have overdosed on the powerful prescription
painkiller and robbed pharmacies and family members to feed their
habits.

"If this was an infectious disease, the Centers for Disease Control
would be in here in white vans," says Tim Rutledge. "There's no doubt
it's very much a plague."

To cancer patients and chronic pain sufferers, OxyContin is a wonder
drug that can restore a semblance of normal life.

Dr. Michael Levy, director of pain management at the Fox Chase Cancer
Center in Philadelphia, calls Oxy "close to an ideal opiate." While
most strong pain medicines last only about four hours and take an
hour or so to work, patients on Oxy get a steady 12-hour release of
pain medicine with fewer side effects and less risk of liver damage.

"This product is better than anyone thought it would be when it was
released five years ago," he says. "This is a drug we need to
protect, because it really helps patients."

To addicts, however, Oxy produces a heroinlike high.

Purdue Pharma, the drug's maker, is willing to concede that Oxy abuse
has led to "somewhere between dozens and hundreds" of deaths in the
past two years, says David Haddox, Purdue Pharma's medical director.

"I am sure it has caused some deaths," he says, "but my feeling is
there is a magnification of this in the media."

In May, the state of West Virginia sued the drug's maker, accusing it
of pressuring and enticing doctors to overprescribe Oxy and of
failing to adequately warn of potential abuse. Purdue Pharma called
the suit's claims "completely baseless."

The company has taken steps to limit the damage. It has stopped
shipping its 160-milligram pills and has suspended shipment of 40s to
Mexico because too many were finding their way back across the
border. The firm has offered tamper-resistant prescription pads in
Maine and other states, and it expects to help pay for a federal
pilot program to track narcotics prescriptions in Florida,
Mississippi, Ohio, Virginia and West Virginia. Purdue Pharma sent a
representative to Gilbert in January to address concerns, and it is
running public service announcements on local radio to warn against
abuse.

Law enforcement officials insist the problems have not been
overblown. At least one dealer in Virginia has been charged with
murder, and manslaughter charges were filed in an Oxy death in
Florida. Several Virginia doctors have been convicted of illegally
dispensing the drug. Breaking and entering and armed robbery charges
related to Oxy have been filed from Maine to Mississippi.

Laying Waste

Michael Pratt, a prosecutor focusing on drug crimes in Kentucky,
Tennessee and West Virginia, sees reasons why OxyContin hit
Appalachia especially hard.

The Appalachian economy has long been dependent on coal and timber.
Those are industries that produce serious injuries, so there are
large numbers of people on painkillers.

"A lot of places, you got a headache, you'll tough it out," Pratt
says. "Down here it's like, 'Well, my grandfather's got some drugs.
I'll take that, and it'll go away.' And it just escalates."

In addition, OxyContin sells on the street for $1 a milligram -- up
to $160 for the highest-dosage pill, by some estimates. In an area
with chronic unemployment, that kind of money is hard to turn down.

For years, prescription fraud for Valium and other drugs has been a
problem. "But," Pratt says, "we've never come upon something that
kills people so much. I mean, if it killed them, they really had to
work at it.

"Oxy rolls in. It's so powerful, it just lays waste."

"This is a nuclear bomb," says Gregory Wood, a health fraud
investigator with the U.S. attorney's office in Roanoke, Va. "I was a
cop in Detroit and saw crack come through the ghettos, and I've never
seen anything like this."

Neither had the tiny town of Gilbert.

Like many coal towns, Gilbert, population 417, winds like a centipede
along the riverbank, pushing leglike hollows out into the surrounding
hills near the Kentucky line.

OxyContin found its way here about five years ago. What started as a
gentle rain soon turned into a flash flood.

Police Chief Greg Cline blames the drug for at least four deaths in
town, and state police Sgt. J.J. Miller put the number at about a
dozen for the entire county. But that number includes people who may
have been abusing other drugs, too.

A mental health counselor tells of a man who was having his teeth
pulled two at a time, because each visit meant a new Oxy
prescription. Kristen Rutledge has known people to shoot themselves
for a prescription. Cline has talked to cancer patients who were
selling some of their pills.

"It seems like if you're around people who are doing it, you catch
it," says Judy Compton, manager of the Compton Inn. "It's contagious."

She knows all too well. Her sister caught it, too.

All Gone

Jeanie Compton was spoiled. Her mother gave her a red convertible BMW
before she could even drive and a trailer home to live in. When she
wanted to get married at 15, her mother drove her across the Tug
River into Kentucky.

Now it's all gone. The BMW? Traded for OxyContin. The trailer? Sold
for a few thousand dollars' worth of pills. The husband? Found
slumped over in the bathroom with a needle nearby, dead of a
suspected Oxy overdose.

Jeanie's troubles began around 1991, after her adoring father died
suddenly at age 50. She started experimenting with drugs. Along came
Oxy.

At one point, Joyce Compton says, her daughter was raiding the
family's motel for televisions, microwaves and mattresses to supply
her habit. Judy Compton stopped letting her come to her house.

"She'd get up to leave, and my stuff would fall out of her pantlegs," she says.

On more than one occasion, Judy has found her sister slumped in a
chair, her head lolled over.

From a jail cell in nearby Logan, where she is serving time for
violating home confinement to seek drugs, Jeanie says she thinks
she's ready to get serious about kicking Oxy.

"I've said I'm either going to end up in jail or dead," she says.
"Well, I made it to the jail. I can't come back from the grave."

The Road To Ruin

Locals have a nickname for the road: Pill Hollow.

"On one occasion I timed them, and in 30 minutes we had 45 cars
coming to one house," says Clyde Lester, a local school board member.
Of the 20 or so homes wedged into the mountains around him, he says,
four were occupied by dealers.

People are starting to lock their doors and establishing community
watches. Isolation, long an obstacle for Appalachia, has become
something people miss.

"A lot of those troubles that used to be in the cities have really
come home to plague this community," says the Rev. Denny May, whose
19-year-old daughter, Shanda, killed herself in 1999 shortly after
getting involved with Oxy.

When Pastor Clayton Cline asked his Baisden Community Church
congregation who had been affected by OxyContin, he says, "Almost
everyone raised their hands."

One hand was his own.

About a year and a half ago, his daughter became addicted to
OxyContin after her husband received a prescription for an accidental
gunshot. For the past six months, Cline's daughter and son-in-law
have been attending a church-based methadone program in Georgia.

Cline is a coal operator and has the means to get his daughter
treatment. He has paid for some others to receive methadone at a
clinic in Charleston, the only one in the state.

"It's no disgrace to have a problem. What's the disgrace is when you
try to hide it," he says. "You can't hide this OxyContin. I've found
that out."

"A Huge Forest Fire"

Debbie Trent sits in a middle school auditorium in Bluefield, Va.,
and listens. She is a mental health counselor from Gilbert, where she
is a member of a new drug-awareness group called STOP -- Strong
Through Our Plan. She has driven two hours along mountain roads to
see what folks in southwestern Virginia are doing to battle OxyContin.

A self-described abuser named Mary tells the group, "Addiction stands
on a mountaintop and throws down commandments: 'Thou shalt not
abandon me. Thou shalt put no one or nothing before me.' " She says
she lost her job and committed prescription fraud because of
OxyContin.

Another recovering addict, a 38-year-old mother of two identified as
Cindy, shifts from one foot to the other as she tells how she took
320 milligrams in the morning before she had the strength to take her
boys to school. Friends thought she had cancer.

For two hours, people talk about the problem. Dennis Lee, Tazewell
County's top prosecutor, says 80 percent of the crime in his
jurisdiction is related to OxyContin.

Sheriff H.S. Caudill says efforts to get a statewide prescription
tracking system failed in the Legislature this past year. Just as
local firefighting is done by volunteers, Caudill tells the crowd,
much of the burden of stopping Oxy abuse will fall on them.

"I look at OxyContin as a huge forest fire," he says. "It's burning
everywhere in Tazewell County. . . . There's not enough of us, ladies
and gentlemen. We need you."

Kristen Rutledge has three tattoos she doesn't remember getting. She
went through physical problems -- not menstruating for months,
constipated for weeks. She stopped writing in her journal.

When she finally decided to quit Oxy, she did it cold turkey. The
withdrawal lasted three days, the same as her first Oxy binge.

"I'd rather have died," she says, drawing her knees up to her chest.
"I was vomiting. I could hear things and see things. I had pain all
over my body, all over me."

Her habit cost her father tens of thousands of dollars. OxyContin is
still costing Tim Rutledge: Now, he's giving the cash-strapped Police
Department money for undercover drug buys and taking out full-page
newspaper ads warning others about drugs.

Kristen says she's been clean for a month. But she's not kidding herself.

"I'm still addicted," she says. "I'm just not using."