What Is Oxycontin?

OxyContin, the brand name for oxycodone hydrochloride, is a legal narcotic
prescribed for cancer patients and the terminally ill. The 12-hour
time-release pain-management medication is designed to be swallowed whole.
Abusers cripple the tablet's protective coating by chewing, crushing,
snorting or injecting. Possible side effects of OxyContin abuse: watery
eyes, dizziness, sleepiness, sweating, vomiting, addiction, respiratory
arrest, death.

Illicit Use Of Painkiller Takes Heavy Toll In Mississippi

In the past six months, abuse of the powerful prescription painkiller
OxyContin has led to the fatal overdoses of at least six people in the tiny
towns of Magee, Mendenhall and Picayune.

Ruth Fleming of Picayune has learned firsthand about this frightening new
drug trend. Two of her family members are addicted to OxyContin.

They can no longer find doctors willing to write them prescriptions. But
street dealers illegally trafficking in the 10-, 20-, 40- and 80-milligram
dosages sell Fleming's relatives the round coated tablets for 50 cents to
$1 per milligram.

"They don't have any friends that are not drug people," Fleming said.
"Their days are spent chasing the pills. It's the most tragic thing I've
ever seen. This drug is so addictive."

OxyContin's illicit use has been growing not only in places like Picayune,
where authorities suspect OxyContin overdoses in eight more deaths, but
traveling at an alarming pace across the Southeast. Since January 1999 at
least 12 people in northeast Alabama, 39 in Virginia and 59 in eastern
Kentucky died from OxyContin overdoses, according to the Regional Organized
Crime Information Center in Nashville.

OxyContin, introduced in December 1995, is a time-release pain medication
for patients suffering chronic pain. "It is a tremendously beneficial drug
for cancer patients," said Tim Rutledge, agent-in-charge of the Mississippi
Bureau of Narcotics' diversion investigation. "For them, it's a godsend.
It's the abuse of the drug that is a problem."

Abusers cripple the time release by chewing, crushing, snorting or
injecting the drug.

Possible Epidemic

Without computerized monitoring systems in pharmacies, law enforcement
authorities in Mississippi and 33 other states have a hard time telling if
they have an epidemic at hand. In 1996, federal data show doctors wrote
316,000 OxyContin prescriptions nationally. By 2000, the number increased
850 percent to 5,848,000, said Mike Hargroder, a diversion investigator in
Mississippi for the U.S. Drug Enforcement Administration.

"It's getting to be a very serious problem nationwide," Hargroder said.
"It's spreading more in rural than urban areas, with the majority of
OxyContin abusers tending to be white males and white females ranging from
25 to 40 years old."

The Drug Abuse Warning Network reported drug overdoses related to
oxycodone, the generic name for OxyContin, almost doubled nationally, with
hospital emergency department visits soaring from 3,395 in 1993 to 6,429 in
1999. At the University of Mississippi Medical Center in Jackson, Dr.
Robert Galli, chairman of the Emergency Department, has not seen increases
in OxyContin-related visits.

"You get a good, quick buzz from OxyContin," said Galli, trained in medical
toxicology. "Then you really do crash. Nodding out is a fairly common
reaction. It becomes dangerous when the envelope of relaxation turns into
respiratory arrest. People think you can sleep it off. But you can't."

Reluctance to get help for fear of reprisal can be fatal, Galli said.

"I think what's perhaps tragic about OxyContin deaths is that they are
unnecessary," Galli said. "This is really a drug where we have a specific
reversal agent. We use it for heroin overdoses, and all other opiate
overdoses. In 30 seconds, the person is wide awake and absolutely fine."

Warning Signs

In late 2000, the Bureau of Narcotics began fielding complaints about
OxyContin abuse, Rutledge said. The precipitous rise in seizures of the
drug in Mississippi gave him even more reason to worry. In 1999, the state
Crime Lab confirmed 25 cases where the controlled substance turned out to
be OxyContin. By 2000, the number more than tripled to 79 cases. In the
first quarter of 2001, 32 cases have been verified, said Sam Howell, the
lab's director of analysis.

"It's just like heroin," Rutledge said. "The pleasure takes over and
addicts have to do it every few hours. As long as they have a legitimate
supply, everything's fine. The minute the supply is exhausted, addicts
start forging prescriptions, stealing it from pharmacies and buying it on
the street."

From April 1, 2000, to March 30, 2001, the state Division of Medicaid paid
out $4,422,044.93 to dispense 1,341,300 tablets of OxyContin, Rutledge
said. "In Medicaid's defense, the bulk of their patients are not abusing
the OxyContin prescriptions," Rutledge said. "But we are seeing patterns of
abuse with some."

Monitoring Abuse

The DEA asked Purdue Pharma, the Connecticut-based maker of OxyContin, to
limit how it distributes and markets the drug. In April, the company
temporarily suspended shipments of its 160-milligram dosage tablets. But
Rutledge says drug intelligence shows the 160-milligram tablets are not a
problem in Mississippi.

A recent New York Times story said the U.S. Food and Drug Administration
acknowledged it failed to research all the ways abusers could tamper with
OxyContin. "We are trying to create a drug where once it's compromised, you
either get no effect or you might get slightly ill discouraging the abuse,"
said Jim Heins, Purdue Pharma's public relations director, who says
OxyContin is the company's top sales product. "It's the Holy Grail for our
research and development efforts."

Heins said FDA clinical trials will take at least three years, making an
overnight change in OxyContin's chemistry unlikely. Purdue Pharma recently
funded a $100,000 study to find a model prescription monitoring program to
prevent patients from doctor shopping to get multiple prescriptions, Heins
said. He said Purdue hopes to identify a monitoring system that surpasses
the Kentucky All Schedule Prescription Electronic Reporting (KASPER)
computer database used to track all dispensed controlled drugs.

"In Kentucky, there's a 30-day lag time in getting information," Heins
said. "What we are doing in our study is finding out the best system for
real-time results. We're trying to find a way for doctors, law enforcement
and pharmacists to share information state-to-state."

At present, Mississippi has no prescription monitoring system, said Harold
Stamps, the state Board of Pharmacy's director of compliance. "What
surprised everybody was the short length of time it took OxyContin to
become known on the street level," Stamps said. "We've been working with
the Mississippi Bureau of Narcotics to create a monitoring system. I think
it would be a great tool for enforcement. Right now, we rely on
old-fashioned footwork."

In 1997, Dr. Rice Leach, commissioner of Kentucky's Department of Public
Health, headed a task force to change his state's laws regarding diversion
of controlled substances. The task force asked for funds to install the
software and hardware needed to monitor dispensed prescriptions at a state
level. In 1998, Kentucky's governor and legislature appropriated $400,000
to turn on the system.

"The amount of time it takes to do an investigation has dropped from six
months to 20 to 30 days," Leach said. "Nobody in the United States has an
online system that is real-time. That's where we want to go."

Nationally, 16 states have prescription monitoring systems, but only two,
Kentucky and Utah, are computerized, said Danna Droz, chief of the Drug
Control Branch at the Kentucky Department of Public Health and Cabinet for
Health Services.

"The biggest problem we face with people is they don't understand
prescription drugs can hurt them if they are abused," Droz said. "They say,
'If a doctor gave it to me, I'll be OK.' It's a misconception that's very
hard to overcome. OxyContin has made people realize some prescription drugs
are dangerous."