ABUSE TAINTS DRUG'S REPUTATION

Medical Workers, Patients Praise Pain Reliever

Jill Berger said she was "shocked" to hear that OxyContin, a narcotic
that eased the pain of her herniated disc, had become "the street drug
of choice" in Eastern Kentucky.

"I'm disappointed that this has happened," Berger said, "because it
means some people might not get the help they need" from the powerful
pain reliever that can be addictive -- but can also help people with
everything from cancer to back pain.

Berger, who is coordinator for the Center for Pain Management at
Baptist Hospital East in Louisville, said she and others there first
heard late last summer that OxyContin, a time-release medicine
designed to provide pain relief for 12 hours, was being abused.

Earlier this week, U.S. Attorney Joseph Famularo announced that
overdoses of OxyContin had killed 59 Kentuckians in the past 13
months, and that more than 200 people had been indicted in an
investigation of trafficking in the drug.

Among other practices, people reportedly were chewing the prescription
drug to get high from it quickly. The manufacturer, Purdue Pharma of
Norwalk, Conn., warns that chewing the tablets could lead to "rapid
release" of a "potentially toxic dose" of OxyContin.

Berger said yesterday that she feared the publicity about the abuse of
the drug might make some doctors reluctant to prescribe it, fearing
they would risk investigation if they did.

Leaders of the new Appalachian Pain Foundation made a similar point at
a news conference yesterday. They said news articles about illegal
traffic in OxyContin and similar drugs will make it harder to provide
adequate pain treatment.

Purdue Pharma, which makes OxyContin, has given a $25,000 a challenge
grant to help finance the operations of the pain foundation, based in
Huntington, W.Va.

Stories about the abuse of OxyContin and other painkillers make some
patients reluctant to take the drugs, Dr. J. David Haddoz, who is
Purdue Pharma's medical director, said at the news conference.

Berger and several physicians who prescribe OxyContin agreed that the
medication can help patients deal with cancer and other forms of pain
that can be difficult to manage.

It helped her last July, Berger said, when a herniated disc left her
in agony. Quick-acting pain relievers made her comfortable for a
while, but "they didn't last the night, and I'd wake up with my back
hurting like crazy," Berger said.

She talked to her pain doctors, they prescribed OxyContin, and she
took 10 milligram doses for about three weeks.

"It got the pain under control, and kept it there," Berger said. "It
gave nice, even, steady relief, and it didn't make me sleepy or dopey."

She was able to ride to Florida for a vacation with her husband, Bob,
and their two children. She tapered off and stopped taking the
medicine as her pain eased.

"I am sold on it," Berger said.

So are some doctors who treat cancer patients.

"It's probably the No. 1 medicine we prescribe for cancer pain," said
Dr. Charles Louis Dannaher, a hematologist who practices with eight
other physicians in Louisville's East End.

"We prescribe a lot of it," Dannaher said, adding that he came to rely
on OxyContin after patients told him it made them comfortable, and
reduced the nausea and constipation associated with other powerful
painkillers like morphine.

"This is a good medicine," Dannaher said.

Dr. Joseph Rotella, medical director for Hospice and Palliative Care
of Louisville, which cares for people with terminal illnesses and
their families, said he, too, prescribes OxyContin for some patients,
but it is not his first choice.

"Used properly, it's about as effective and safe as using morphine,"
Rotella said.

But he typically prescribes morphine first because it is available in
so many forms -- liquid, pill, time-release tablet and injection --
and because its effectiveness has been established by many studies.

Besides, Rotella said, OxyContin, which came on the market about five
years ago, is much more expensive.

A 30-day supply of time-release, 30-milligram morphine, for example,
costs about $75 at one Louisville pharmacy, while a similar dose of
OxyContin that would last only 15 days was about $155.

He would prescribe OxyContin, Rotella said, to see if it helped
patients who couldn't tolerate the side effects of morphine, such as
nausea and constipation, or who reported it wasn't controlling their
pain.

Doctors who treat patients for a broader range of problems --
everything from cancer to sore backs and limbs -- say OxyContin has a
place in their practices as well.

Dr. Kevin O'Keefe, an anesthesiologist at Baptist East's pain center,
said "we are very selective about who gets it" because "it can be
habit-forming" and there are often ways to relieve back pain and other
problems without using such powerful drugs.

Dr. Kunnathu Geeverghese, an anesthesiologist who treats pain patients
at Caritas Medical Center, said that while some doctors prescribe
OxyContin commonly, he tends to use it only when other medications or
treatments don't work.

"This medication is not for the first line of treatment, but it can
really help people when they have nowhere else to go," Geeverghese
said. Dr. Jeffrey Berg, an anesthesiologist at Norton Audubon
Hospital's Pain Management Center, agreed. He said OxyContin can be
excellent for cancer pain, and for some other patients.

"But personally I much prefer using shorter-acting pills," Berg said.
He fears the timed-release drug, which stays in the bloodstream
longer, may tend to make some patients more dependent on it than other
medicines.

"I do have patients on OxyContin," Berg said, including a woman in her
80s with severe pelvic pain. "It gives her a little relief," Berg
said. "She has no quality of life without it."