PEOPLE IN PAIN FEAR OXYCONTIN BACKLASH

Clampdowns On The Painkiller Because Of Abuse Makes It Harder To Get
Prescriptions, Some Patients Say

In one short year, OxyContin has become the dastardly villain in the war on
drugs, engendering the ire of prosecutors and federal regulators while
being blamed for dozens of deaths from New England to Florida.

Nervous physicians are on the lookout for addicts faking injuries to con
prescriptions. The government is considering restricting distribution.

But OxyContin is also the drug that lets Ed Madonia, 74, who suffers from a
diseased spinal column, teach a Tuesday night self-improvement class at
Palm Harbor Unity Church. It lets Liz Constable, who suffers from
fibromyalgia, resume some semblance of a normal life after nearly a decade
of debilitating pain.

As law enforcement tries to battle the illegal use of OxyContin, a powerful
prescription pain reliever that has become a hot new street drug, some
patients and pain management groups worry they'll be the ones to suffer.

Already some doctors are blanching at prescribing it, they say, and
advocacy groups fear new government restrictions that will make it more
difficult for people who need it to get it.

"I had to literally go beg doctors to give me a prescription because
everybody is so paranoid," said Constable, who read about the benefits of
OxyContin in a fibromyalgia newsletter, then visited three doctors before
one agreed to let her try it.

"I'm a 51-year-old retired schoolteacher," she said, exasperated. "The last
thing I'm going to do is sell a drug on the street."

Dr. Russell K. Portenoy, a member of the board of the American Pain
Foundation and chairman of pain management and palliative care at Beth
Israel Medical Center in New York, blames media hype and government
overreaction for having a "chilling effect" on some doctors.

Portenoy, a national leader in the field of pain management, has been asked
to serve as a consultant to a U.S. Food and Drug Administration panel that
will meet in the fall to consider whether oxycodone, the generic name for
OxyContin, and other opioids need more restrictions.

He says patients have reason to worry.

"Because of the pervasive fear of these drugs in this country, what I would
call the stigmatism of these drugs, stories about (misuse) may drive
regulators and those in law enforcement to take actions that are not
warranted and would have the unintended effect of reducing access to
patients who need them," Portenoy said.

Maggie Tucker, 39, who has lesions on her spine from multiple sclerosis,
had been on several drugs that left her groggy and in pain before she
mentioned OxyContin to her physician.

He agreed it could help but didn't want to be the one to prescribe it, she
said. She got it from a pain specialist four months ago.

"He was afraid just because the DEA would come down on him, because he's a
family practitioner," said Tucker of Palm Harbor, an insurance agent who
has been unable to work. "He said I need somebody to back me on this. Your
best bet is to go see (a specialist)."

Since being approved in 1995, OxyContin has become one of America's
most-prescribed medicines for chronic pain, reportedly with sales of
$1-billion last year. Its popularity rose as family doctors, who long
resisted giving opioids to people with non-fatal diseases, have become more
comfortable with stronger drugs.

Several Tampa Bay-area residents suffering from chronic pain say they tried
other medications, but they made them feel sleepy or didn't work as well.

"For the first time in 15 years, I've had days where I've been able to
function. And that's been a blessing," said Madonia, who took Percodan for
a decade before switching to OxyContin early this year.

OxyContin is a synthetic morphine, an opioid like Percocet or Vicodin. Dr.
Ron Schonwetter, medical director of Lifepath Hospice in Tampa and chief of
the geriatrics program at the University of South Florida, said OxyContin
provides sustained relief and has few side effects.

The key to OxyContin is its timed-release formula, in which small amounts
of painkiller are released into the bloodstream gradually, usually over 12
hours. Most opioids ease persistent pain for a couple hours, then wear off.

But when used illegally, the pill is often crushed and snorted, or mixed
with water and injected, or chewed. This delivers all the drug at once,
producing an intense high that also can kill.

Oxycodone and hydrocodone, another morphine-like drug, were blamed for 152
overdose deaths in Florida in the last six months of 2000, state medical
examiners report.

Addicts and dealers typically steal it from pharmacies or patients, or buy
prescriptions from unscrupulous doctors. Or they concoct elaborate ruses in
hopes of persuading a physician to prescribe it.

Dr. Lynne Carr Columbus, a pain management specialist now treating Madonia
and Tucker, said she was duped into writing a prescription for OxyContin
for a man claiming to have bladder cancer.

He sported bogus medical records and a wheelchair, and she had no reason to
doubt him. A pharmacist got suspicious, and police were alerted.

Two weeks ago, Tarpon Springs police arrested a 36-year-old Michigan man
for fraud after he allegedly used false "claims of injuries and illnesses"
to obtain prescriptions for OxyContin and other pain relievers from 18 area
physicians, clinics and emergency rooms, the police report said.

In Florida, the DEA is working with police to stop the spread.
Investigators may audit any pharmacy or doctor at any time, and OxyContin
has taken priority, said Special Agent Joe Kilmer.

"There are many, many investigations that are in progress right now," he said.

OxyContin's manufacturer, Purdue Pharma, has met with officials in several
states, including Florida, to discuss ways to control distribution, and it
recently sent brochures to 400,000 doctors.

Purdue says it has marketed OxyContin responsibly, although some doctors
complain it was pitched as benign. Portenoy, from the American Pain
Foundation, said it was marketed to general practitioners just as opioids
have been marketed to cancer specialists in the past -- but general
practitioners often aren't as well-trained in managing narcotics or addiction.

"It was almost preordained that, with that increased use and the vast
amounts of it on the market, this would happen," Portenoy said.

Columbus said physicians can take steps to reduce the chances drugs they
prescribe will be misused. Her clinic, Gulf Coast Pain Management in Palm
Harbor, requires patients to present photo identification to pick up a
prescription for OxyContin, and patients must keep a "pain dairy" that
charts their pain and keeps track of every pill.

Many patients also are given urine tests to ensure they're taking the drug,
not selling it, she said.

Columbus said she has several new patients whose doctors refused to
prescribe OxyContin.

"I think that there's definitely been fear put in the doctors about the
medication, and I've had a lot of patients come to me and say they're being
told by their primary care physicians that they can't prescribe it, that
they don't have the expertise," she said.

"There's a risk we could lose our license over issues with this. It is
scary. I worry about it every day."

OxyContin
Generic: controlled release oxycodone. It has no generic equivalent.
Availablity: 10-, 20-, 40- and 80-milligram pills. Prescription only.
Cost: $278 for 60 40-mg pills.
Street value: About $40 per pill.