POLICE SAY ABUSE OF POWERFUL PRESCRIPTION DRUG OXYCONTIN ON RISE

Patients Suffering?

The reaction to OxyContin abuse also has many physicians worried about
the effects on legitimate patients who suffer from pain every day.

The medical community nationwide finally is beginning to understand that
pain has been undertreated in many patients, pain specialists say. Now,
some physicians are treating pain more aggressively, even as a disease
unto itself, and new drugs such as OxyContin are making a normal life
possible again for thousands of people, some doctors say.

But because of law enforcement's concern over abuse of OxyContin, some
physicians and pharmacies are shying away from it, said Dr. Dennis
Doherty, a pain specialist.

"It would truly be a tragedy if public sentiment is allowed to run wild
on this," Doherty said last month at a geriatric health conference in
San Destin, Fla. Doherty runs a pain management clinic in Stone
Mountain, Ga., and is paid by Purdue to speak at seminars.

Doherty said that at a meeting of the Etowah County Medical Society
earlier this year, a police officer urged doctors not to prescribe
OxyContin.

Bishop, who is assigned to the Etowah County Narcotics Task Force out of
the sheriff's department, said he knows of no such plea being made by
law enforcement there, but extensive publicity may have led some
physicians to cut back.

"I think in a roundabout way, they got the message," Bishop said.

Some Mobile-area doctors said law enforcement officers would be wasting
their time meddling in medical practice.

"I just wouldn't do it," if local police asked him to stop writing
OxyContin prescriptions, said Dr. Michael Meshad, a cancer specialist
who practices with the Oncology Group at Providence Hospital in west
Mobile. "I would continue to use it, because if it's not this one that's
being abused, it's another drug. If a patient has a terminal disease,
it's our job to prevent suffering, and this drug is very good at that."

"I see patients of all ages, who are disabled from pain, who are now
able to live the life they want, because of this," said Dr. John
Rothrock, a neurologist and professor at the University of South Alabama
College of Medicine, who has done extensive research in pain disorders.

Pure And Powerful

OxyContin, introduced in 1995, is so craved by abusers and addicts - and
so dangerous - experts say, because of its particular design. Each tiny
pill, marked with an "OC" on one side, has a coating that keeps the
medicine from breaking down too quickly in the stomach, allowing it to
be time-released over eight hours or more.

But abusers quickly found that they could crush the pills and snort the
powder or dissolve them in water and inject the solution, bypassing the
time-release coating altogether. That pumps the entire 8-hour dose into
a person's nervous system at once, creating the intense high that
addicts crave so much, said Dr. Patrick Couch, a Mobile pain specialist.

OxyContin also is a respiratory depressant, though, and so much of it at
one time can easily cause an overdose, doctors say. Oxycodone, an opiate
derivative, is found in other drugs, such as Percodan, Percocet and
Tylox, which also are frequently abused, police say.

Lortab, which narcotics agents say is one of the most widely abused
prescription drugs, contains a similar painkilling ingredient:
hydrocodone.

But all of those drugs also contain much more acetaminophen or aspirin,
which dilutes the high, and also can damage the liver and stomach when
taken in the large doses that abusers crave. OxyContin is pure and
powerful, said Lt. Kay Taylor, a narcotics officer with the Mobile
Police Department.

Abusers often obtain the drug by what's known as doctor shopping,
officers say. They'll go to several doctors or get cohorts to do so, to
obtain several prescriptions for the same drug. Others have stolen
prescription pads and forged their own prescriptions.

Pharmacies often catch abusers when they come in for refills too soon or
if a written prescription looks suspicious, said Gerald Moore, executive
director of the Alabama Pharmacy Association, a lobbying group based in
Montgomery.

Chain pharmacies, such as Rite Aid or CVS, also can check a company
database to see if a customer has obtained the same prescription at
another company store. But pharmacies have no way of cross-checking with
other companies' stores, pharmacists say.

"The best thing is to make sure you know the patient and you know the
doctor," said Marshall Waters, pharmacist at The Medicine Shoppe on
Airport Boulevard in Mobile.

Local doctors agree that knowing the patients, counseling them on the
dangers and watching for patients' escalating demands for more drugs is
the best approach to limiting abuse. Many pain specialists now require
non-cancer patients to sign contracts, in which they agree not to sell
or give their OxyContin to others, and that they will be subject to
periodic urine tests to see if they are abusing the drug, Couch said.

Different Approaches

The debate over OxyContin also highlights the ongoing debate over the
treatment of pain. A growing number of physicians now subscribe to the
idea that severe, chronic pain, especially for terminally ill or cancer
patients, must be treated with strong medicine to relieve suffering.

Severe, long-term pain can even lead to nerve disorders or changes in
the immune system, Doherty said.

But other doctors believe treating pain with narcotics can lead to
addiction and further complications.

"OxyContin is being used by everybody because the drug makers who push
it are saying how wonderful it is," said Dr. David Walsh of Mobile, an
anesthesiologist and pain specialist. "But it's a narcotic, and it's as
addictive as it can be."

Walsh prefers to attack the root cause of the pain or deadening nerves
with a local injection whenever possible instead of prescribing
narcotics.

He said he's had to try to take several patients off of OxyContin,
because they kept wanting higher and higher doses. "But you can't just
get them off of it."