THE PAIN OF FENTANYL

FARMINGTON, Mo. -- Justin Knox probably spent the last few minutes of
his life struggling to breathe.

The fentanyl pain patch he chewed up March 11 released three days'
worth of pain medication into his body in a matter of hours. The
fentanyl -- 80 times more powerful than morphine -- shut down the
22-year-old Farmington man's respiratory system.

It's been more than three months since Knox died, and his mother,
Rose Marler, said it's difficult for her to understand her son's death.

"I just don't know where Justin got the idea to do something like
this. If he was aware of what it can do, why would he do it?" Marler
said about the fentanyl patch. "It's a new-generation drug, and most
aren't living to tell about it."

Fentanyl is a synthetic opiate used to treat patients with severe or
chronic pain, and a number of people have died abusing the
prescription pain patch. The Food and Drug Administration reports at
least seven people have died in Indiana and four in South Carolina
since 2005. More than 100 deaths in Florida in 2004 were blamed on
pain patch abuse.

About 8,000 emergency room visits were due to people misusing the
fentanyl patch in 2004, according to figures from the Substance Abuse
and Mental Health Services Administration, a division of the
Department of Health and Human Services. Earlier this month, the
department released a warning about the drug-related deaths to public
health officials.

The increase in fentanyl abuse is a concern for local health and law
enforcement officials, but they don't see the national trend
occurring in Cape Girardeau County.

"Thank goodness we haven't had this problem here," said Coroner John
Clifton. He said there have been no fatal fentanyl-related overdoses
in the county.

About 3 percent of the patients at Gibson Recovery Center, a drug and
alcohol rehabilitation center in Cape Girardeau, are addicted to
opiates, including fentanyl. Despite that small percentage, assistant
director Scott Doty said the number of people abusing pain
medications has increased within the past few years.

"Opiates, including the pain medicines and heroin, are very difficult
to get off of. It's like having a bad case of the flu for about three
weeks, and the cravings are intense," Doty said.

Despite the addictiveness of the drug, local law enforcement
officials said they haven't experienced many fentanyl-related cases.
"I don't want to say it's never happened here, but it's not a
reoccurring problem. We don't run into it much," said Cape Girardeau
police spokesman Jason Selzer.

Lt. David James of the Cape Girardeau County Sheriff's Department
said that a few years ago an inmate chewed up a used morphine patch,
similar to the fentanyl patch, and was taken to the hospital for an
accidental overdose.

A local recreational fentanyl user, who wished to remain anonymous,
describes the drug's effect as "euphoric." Depending on the dosage
amount, fentanyl patches sold on the street can cost from $15 to $100.

Marler said her son had been released from a drug rehabilitation
center two weeks before he died. Knox had been abusing pain
medication for almost six months before he sought treatment. "I knew
he had some problems with pain medicine -- he knew that, too," she said.

The day Knox died, Marler said, he called her that afternoon when he
got off work. "Everything seemed fine. He was just going to spend the
night at his friend's house," she said.

Marler said that night, Knox and his friend purchased fentanyl
patches from Potosi, Mo., resident Burl Washington. The next morning,
Knox's friend found him dead. Washington has been charged with
second-degree murder.

"It's been so hard without him here. I keep expecting him to walk in
the door," Marler said about her son.

A week after Knox's death, another St. Francois County man was
prescribed the patch legally and died after injecting himself with
the gel that he scraped from it.

Prescription sales of the fentanyl pain patch reached the billions
last year. More than 5.7 million prescriptions were filled in 2003
for the brand name Duragesic patch, according to IMS Health, a
consulting services for the pharmaceutical and health-care industries.

The Food and Drug Administration has an ongoing investigation into
deaths and overdoses related to both Duragesic and generic fentanyl patches.

Dr. Harry George, a Cape Girardeau physician, said he prescribes
fentanyl patches about three times a week.

"Doctors know when patients need the medication for pain. And we're
aware of those people who come in wanting pain medication for
recreational purposes," George said. "Some people think we're stupid."

George, in practice for more than two decades, has seen the abuse of
fentanyl increase in the past few years.

Recently, a woman, who is now no longer George's patient, was
prescribed the fentanyl patch. The woman's boyfriend took one of her
patches, scraped off the gel and injected it into himself and the
woman. Both ended up in the emergency room from an overdose.

"People abusing fentanyl are messing with fire. The risk is too great
to use them for recreational purposes," George said. "They're going
to end up in the funeral home."

Medicap Pharmacy pharmacist Ben Tally agrees.

"It's crazy to abuse them. I can't imagine wanting to because it's
very dangerous," Tally said.

Marler can't understand why her son abused fentanyl, either. "If it
had been a car accident, it would have been more understandable," she
said. "But this was just an unnecessary death."

The Associated Press contributed to this report.