OXYCONTIN: PAIN DRUG BECOMES THE 'HEROIN OF THE MIDWEST'

Traffickers' And Abusers' First Choice

One of medicine's newest, most promising pain fighters has become the drug
of choice for pharmaceutical abusers in the Tristate, making a leap in
popularity unlike anything police have seen in years.

OxyContin, a potent narcotic, has been hailed as a miracle drug for people
with chronic pain and cancer. But police around Greater Cincinnati have
given it a more sinister nickname: "the heroin of the Midwest."

"It's like the purest form of heroin I've ever done," said Rob Ramundo, a
former Cincinnatian whose addiction to the drug led to a spree of drugstore
robberies last year - and to prison. "Absolutely it was just as addictive."

Since it popped up on the illicit market about a year ago, Tristate police
have confiscated more than 13,000 doses of OxyContin.

That's amazing for a drug that was almost unheard of on the illegal market
in 1999, authorities said. Only oxycodone, its sister drug, and the popular
painkiller Vicodin were taken off the streets in larger amounts last year.

Arrests related to OxyContin are soaring. Last year, of 140 arrests by the
Cincinnati Police Division's Pharmaceutical Diversion Squad for illegal
possession or trafficking in pharmaceuticals, 32 were for OxyContin.

"It's the prescription drug of choice (for abuse) from Greater Cincinnati
to rural Ohio," said Sgt. Kerry Rowland, diversion squad commander.

What is happening in the Tristate is unfolding across the nation. From tiny
towns in Maine to the hollows of Kentucky to the suburbs of New Orleans,
reports of theft and abuse are rampant.

"They'll kick a bag of cocaine out of the way to get to "Oxy,'" said
Detective Roger Hall of the Harlan County Sheriff's Department in Kentucky.
"We did a drug roundup back in September. We arrested 76 people, and 45
were trafficking in OxyContin."

Pill is unique The appeal of OxyContin, introduced in 1995, lies within a
patented substance that bonds with its main ingredient, oxycodone, a widely
used compound derived from opium.

The bonding agent can actually measure the level of oxycodone in the blood,
then release more or less pain-killer over a 12-hour period.

Cancer patients, in particular, praise the drug because it gives them
enough relief from pain that they can resume nearly normal lives.

"It's the best," said Roberta, 57, of West Chester. "I can't drive but,
other than that, I'm totally functional. My quality of life has improved so
much, and there are no side effects."

It is because the drug works so well that Roberta asked that her last name
not be published. Around the nation, legal users of OxyContin have been
accosted in drugstore parking lots and had their homes burglarized by users
and dealers desperate for the drug. Roberta said she does not want
criminals to know she has OxyContin in her home.

OxyContin's potency - and the fact it is considered safer than street drugs
because it is lab-produced - are what make it appeal to criminals and
abusers. Its time-release properties mean more oxycodone - up to 160
milligrams - can be packed into each pill.

It's also an expensive high.

Pills are sold on the street for up to $1 per milligram, so a 40-mg tablet
- the most commonly prescribed - fetches up to $40. (In a prescription,
that pill would cost about $4).

Abusers crush the pills and sniff them, or extract the oxycodone, then
inject it. That defeats the pill's time-release substance, unleashing all
the oxycodone for an intense - and highly addictive - rush.

Why it's big here Drug experts say Cincinnati's location, and its
reputation as a "pill town" with a large medical and pharmaceutical
community, are part of the reason for the drug's rapid rise here.

"Cincinnati is a long way from the supply centers for drugs such as heroin
or cocaine," said Dr. Don E. Nelson, associate director of the Drug and
Poison Information Center in Corryville,

Those drugs often are "cut" - or diluted - significantly before reaching
the streets here, so hard-core drug abusers turn to prescription drugs.
Also, because Cincinnati has numerous hospitals and doctors' offices,
abusers have more opportunities for theft and fraud, officials said.

Local authorities have not seen any fatal overdoses yet involving
OxyContin, and abusers, they say, don't fit into common stereotypes.

"OxyContin can appeal to anyone - teen to senior citizen" said Sgt. Tom
McGrath, coordinator of the countywide Drug Abuse Resistance Task Force
(DART). "You can find it anywhere - Over-the-Rhine to West Chester."

No escape for addict Mr. Ramundo knows well the dark side of OxyContin.

The Cincinnati native is serving a four-year term at the Chillicothe
Correctional Institution for robbing six pharmacies in suburban Hamilton
County and Clermont County last spring.

OxyContin was the only thing he demanded.

"It produced the same feelings heroin did," said Mr. Ramundo, 29, once a
successful photographer for a Chicago-based men's magazine.

Mr. Ramundo said he tried OxyContin because the quality of heroin he could
find in Cincinnati was poor. If abused, OxyContin is as addictive as
heroin, he said.

And like quitting heroin, quitting OxyContin was hellish, he said.

"You feel the same withdrawal symptoms ... the worst flu you ever had. You
sweat. You vomit. You can't control your bowels and you shake and you wish
you would die. The only relief is more."

When he ran out of money, he began holding up drugstores.

"Because of my history (with heroin), mom and pop would not give me any
money," he said.

Ruses, thefts feed habit While robbery sprees like Mr. Ramundo's are
uncommon, people addicted to OxyContin, or those who simply want to cash in
on the hot market for it, will go to extraordinary lengths to obtain it.

Sgt. McGrath said some abusers try "doctor shopping" - visiting a number of
physicians and complaining of pain to collect several prescriptions. Others
alter their prescriptions, or steal the drug from relatives or friends.

Evidence abounds of OxyContin's infiltration in the Tristate:

. On Monday, the Butler County grand jury indicted two Kentucky men on
aggravated trafficking in drugs and weapons charges. They were arrested
Jan. 28 in Fairfield after the Butler County sheriff's drug and vice unit
purchased 600 tablets of OxyContin. It was the largest bust involving
OxyContin in Butler County.

. DART recovered 1,200 OxyContin tablets last year that had been diverted
from a mail-order pharmaceutical company.

. Agents arrested a Madisonville medical assistant in December, accusing
her of taking prescription blanks and filling them out for OxyContin for
herself.

. Police are still seeking a man in his early 20s who robbed an Amelia
pharmacy of an undetermined amount of OxyContin on Jan. 12.

Mr. McGrath said authorities are taking measures to quell the problem. DART
has sent advisories. It also has featured the drug in its monthly
newsletter, distributed to health-care professionals, describing common
methods abusers are using to forge or alter prescriptions, he said.

Drug has defenders Those who dispense the drug for patients with chronic
pain say there's nothing else quite like it on the market.

Dr. Rebecca Bechhold, medical director of Hospice of Cincinnati and an
oncologist, is one of OxyContin's biggest advocates. She sees the changes
it brings in patients every day.

"I probably prescribe more of it than any other (doctor) in this area," she
said.

The drug's patented formula means it needs to be taken only once or twice a
day. Patients also experience few side effects.

"It is a narcotic and it is very similar to morphine," Dr. Bechhold said.
"But it does not have the side effects of morphine," such as hallucinations.

Dr. J. David Haddox, medical director of Purdue Pharma, the Stamford.
Conn.-based developer of the drug, said OxyContin is getting a bad rap in
the media, with too much attention focused on its abuse rather than its
pain-relieving abilities.

"We have to make sure physicians and law enforcement and pharmacists ...
are aware, and make sure we do all we can to minimize drug abuse," he said.
"At the same time, we need to do all we can to make the drug available to
patients who have legitimate needs."

Purdue Pharma conducts seminars and distributes literature about the drug's
benefits, and its dangers if abused, he said.

Sitting in prison in Chillicothe, Rob Ramundo prays he can turn his life
around. Prison and law enforcement officials said he has a good chance at
rehabilitation based on a strong and supportive family and his will to
straighten out his life.

Still, he's plagued with regret over "the pain I've caused my family," he said.

"That's the hardest part of all of this. They still support me, but when I
get out, there will be a trust issue.

"Put it this way: OxyContin can consume your life. It's nothing to play
with. It's fire."