NORTHERN N.M. BLACK MARKET IS AWASH IN PAINkILLERS

Kayla used to take prescription pain pills by the handful. The pills were her way of coping with the death of her mother, her health problems and the gruesome murder of a close friend.

For the past year and a half, she has been receiving methadone and counseling at the Ayudantes program in Santa Fe.

Back in her pill-taking days, Kayla, not her real name, decided to inject heroin just one time "to see what the hoopla was all about."

"It was exactly the same as taking Vicodin (a prescription painkiller)" she says. "It just hit faster."

Kayla's reaction to heroin is typical among those who abuse prescription narcotics. Many say heroin is just another drug in the medicine chest - along with prescription painkillers such as Percocet, Dilaudid, Lortab and Vicodin. Methadone, a heroin substitute used to break addiction, also is sold on the street.

All the drugs are opiates and do basically the same thing: kill pain. But while heroin is illegal, the pills are available by prescription, and at clinics methadone is available to addicts as a substitute for heroin.

The pills also are available on the street, but the price might be higher than heroin. In Espa=F1ola, Percocets sell on the street for $5 a piece. Most addicts say they need at least seven or eight pills a day. Heroin, at $20 a dose, is comparatively cheaper.

"A lot of addicts like these prescription products because the purity is guaranteed," says Jerry Montoya, a former state narcotics agent who is now acting director of the New Mexico Board of Pharmacy. "They also like them because if they have a (Medicaid) prescription card, they can often get them for free."

The availability of prescription narcotics on the street raises the question of whether doctors are fueling a black market in pills. It also raises the question of whether some people are turning to illicit narcotics because they're unable to get relief from physical pain.

Debbie Borrego, a recovering heroin addict who now takes methadone, says her doctor gave her Percocets for more than a year after she suffered an accident at work. After the doctor cut her off, Borrego bought Percocets on the street, then turned to heroin because it was cheaper.

"I'd go to the doctor and tell him about my pain, and he'd just prescribe more and more," Borrego says. "I wish I had known how addicting they were."

Dr. Erv Hinds, medical director of the New Mexico Pain and Wellness Center in Albuquerque, commonly sees patients referred to him from Northern New Mexico who were given Percocets and other narcotics inappropriately.

Hinds thinks regulatory action against a handful of physicians in recent years has helped limit the black market in pills.

"Doctors are paranoid because of the regulatory framework," Hinds says. "They are undertreating people for pain far more than they are overtreating it."

New theories of pain management suggest that the way painkillers have been traditionally dispensed might inadvertently lead to dependency, says Bill Harvey, a drug inspector for the pharmacy board. Doctors have commonly told patients who have acute pain - after surgery for example - to take painkillers as needed.

"Doctors would say, 'Take aspirin, but if it gets really bad take these,' " Harvey says. "For a lot of people that works just fine. But for some percentage, that sets up a cycle of drug-seeking behavior."

Montoya thinks much of the black market in prescription painkillers stems from patients who dupe their doctors into giving them painkillers.

But in small communities, a few doctors can have a big impact. In the past five years, the state medical board has brought cases against three doctors in Northern New Mexico for overprescribing narcotics. Dr. Lindy Akes, who practiced in Tierra Amarilla, was suspended for six months. The state medical board found Akes prescribed 30,000 doses of narcotics for a single patient in the course of a year. Akes is back in practice in Espa=F1ola but has been permanently prohibited from prescribing narcotics.

In 1994, the medical board revoked the license of Dr. Charles Novosad, a Nambe physician, after it concluded he overprescribed narcotics. In one case, Novosad prescribed 500 Percocets each month to a patient for more than three years.

"What we find is that patients just move on to the next doctor," Montoya says. "So once Novosad was shut down, his patients went to Akes."

Harvey said share of that kind of prescriber."

"But in a small community, what appears to be a trend may just be a couple of bad actors," he says.

In 1997 the board suspended the license of Santa Fe psychiatrist Dr. Joel S. Hochman. Hochman also was charged with writing unauthorized prescriptions for narcotics. He later voluntarily surrendered his license.