PAIN PATCH ABUSE LINKED TO DEATHS

Addicts Misusing Powerful Drug For Cancer Patients

ST. LOUIS -- Justin Knox bit down on the bitter-tasting patch,
instantly releasing three days' worth of a drug more powerful than
morphine. He was dead before he even got to the hospital.

The 22-year-old construction worker and addict was another victim in
an apparent surge in U.S. overdoses blamed on abuse of the fentanyl
patch, a prescription-only product that is intended for cancer
patients and others with chronic pain and is designed to dispense the
medicine slowly through the skin.

"I cannot tell you the amount of people I've seen and the creative
ways they abuse this drug," said Dr. Scott Teitelbaum, director of
the Florida Recovery Center in Gainesville, Fla. "Fentanyl has been
abused for years. But recently there has been an increase. I've seen
more chewing, squeezing of the drug off the patch and shooting it up."

Fentanyl, a synthetic narcotic, was introduced in the 1960s, but it
was not until the early 1990s that it became available in patch form.
Last year, the first generic versions of the patch hit the market.

At least seven deaths in Indiana and four in South Carolina since
2005 have been blamed on abuse of the fentanyl patch, along with more
than 100 deaths in Florida in 2004. About a week after Knox's death
in Farmington, Mo., in March, a second man in the same county was
prescribed the patch legally and died after injecting himself with
gel that he had scraped from it.

Emergency-room visits by people misusing fentanyl shot up nearly
14-fold to 8,000 nationwide between 2000 and 2004, according to the
U.S. Department of Health and Human Services. The figures do not
indicate how many of those ER visits were because of the patch.

The same overdose trend isn't apparent in Washington, experts say.
However, the drug is more widely available. Between 1997 and 2003 in
King County, for example, sales of fentanyl to hospitals and
pharmacies increased 174 percent.

(In recent months, more than 100 deaths have been reported from
Chicago and Detroit to Philadelphia among drug addicts who overdosed
on heroin mixed with fentanyl. That doesn't seem to be happening much
in the Northwest, where the predominant black tar heroin doesn't mix
well, health experts say.)

The first fentanyl patch was Duragesic, made by Johnson & Johnson.
Sales more than tripled from 2000 to 2004, according to the Pacific
Law Center in La Jolla, Calif. Worldwide sales were more than $2
billion in 2004, and half of that was in the U.S., according to the
J&J's Web site. More than 5.7 million prescriptions were written in
2003 for the Duragesic patch, according to IMS Health.

Mark Wolfe, spokesman for PriCari, the J&J unit that oversees
Duragesic, said the product comes with strong "black box" warnings
about the dangers of abusing Duragesic.

One theory is that addicts are turning to the fentanyl patch because
of a government crackdown on abuse of another powerful prescription
painkiller, OxyContin, or oxycodone.

"The abuse of oxycodone and the fear of litigation is enough to scare
doctors from prescribing it. Duragesic is in vogue, as we've seen
over the last year and a half and two years," said Dr. John Brandt, a
chronic-pain specialist at the University of Florida.

In Missouri, the man accused of illegally selling the fentanyl patch
to Knox has been charged with murder.

"The awareness is just not out there. I had never heard of this
patch," said Knox's mother, Rose Marler.

"There's a new generation of drugs and people just need to be aware."