THE NEWEST WAR ON DRUGS

When Anne's grandmother was hospitalized two years ago with chest pains,
she couldn't remember what medications she was on. So doctors sent Anne to
the woman's home in eastern Washington State to look in her cabinets. What
they found shocked both the family and the doctors. In the basement, the
woman had several copies of the Physician's Desk Reference, scales for
weighing pills, and a cupboard chock-full of both prescription and
over-the-counter medications. All in all, doctors told the family later,
she had 11 types of prescription medications, including at least 400 Valium
pills. Her medications, doctors said, would probably fetch about $15,000 on
the street. "When I went down there," says Anne, "I thought, 'Oh my God, it
looks like a pharmacy in here.' "

To get pills, Anne's grandmother would go from doctor to doctor complaining
of anxiety, asking each for a prescription so that, unbeknownst to the
doctors, she racked up a huge stockpile of drugs. The practice is known as
"doctor shopping," and it's one of the most common ways that prescription
pills are obtained illegally. Figuring out how to stop the practice, along
with other strategies people use to obtain prescription drugs illegally, is
a major challenge facing law enforcement, the medical profession, and
government agencies.

Though use of illicit drugs has held relatively stable, prescription-drug
abuse has risen dramatically in the past few years. Indeed, only the
illegal use of marijuana is more prevalent today. Although abuse is rising
among all age groups, officials are especially concerned about abuse among
teenagers: One in 10 high school seniors has tried the painkiller Vicodin
without a prescription, and 1 in 20 has taken the potent pill OxyContin.

Local, state, and some federal agencies have been combating this problem
for decades. But the issue started getting widespread attention just last
year, when the Bush administration released its first-ever plan targeting
prescription-drug abuse. The White House set up new federal
programs--including increased physician education and support for state
prescription monitoring efforts that can catch people with multiple
prescriptions for the same drug. In addition, two members of Congress
introduced the Prescription Drug Abuse Elimination Act, some provisions of
which passed as part of another bill. And outside the government, the
Partnership for a Drug-Free America recently completed a study of
adolescent attitudes on prescription drugs and will most likely release an
ad campaign later this year warning of the dangers of popping pills. As
these efforts gear up, experts at all levels are realizing that fighting
the war on prescription drugs may be unlike anything they've done before.

"Kiddie Dope."

"We are faced here with a different kind of threat," says John Walters, the
U.S. drug czar. "With most illegal drugs, such as cocaine, production and
distribution are illegal activities. In this case, this is a diversion from
a legitimate source."

In contrast to other types of illicit drugs, fighting this threat takes
more finesse than force. Education is one of the main components--people
are still unaware that prescription drugs can be just as dangerous as
illegal drugs. There's an idea that because doctors recommend prescription
drugs for some uses, they must be safe. The perception even extends to law
enforcement, says John Burke, vice president of the National Association of
Drug Diversion Investigators. Federal agents and others refer to
prescription pills as "kiddie dope" and don't regard rounding up those who
sell it illegally as a top priority, he says.

This drug war also has different players: medical professionals, patients,
and pharmaceutical companies, all of whom have legitimate uses for the
drug--and lobbyists in Washington to make sure their interests have a
voice. The word balance is often used to describe the complex task of
keeping these groups happy while preventing the drugs from falling into the
hands of illicit users and criminals. The most delicate relationship right
now is between law enforcement and doctors, who want to be able to
prescribe medication as they see fit without evoking suspicion of drug
trafficking--a fact not lost on the Drug Enforcement Administration. Says
William Walker, head of the agency's Office of Diversion Control: "The DEA
in no way attempts to hinder any medical practitioners who are legitimately
prescribing and administering controlled substances to their patients."

Anxiety and Pain.

Haley Bruns knows firsthand how dangerous prescription drugs can be. She
became addicted to the anxiety medications Xanax and Ativan but has been
sober for about five years now. When she had knee surgery last month,
however, and was prescribed the painkillers Percocet and OxyContin, she was
wary. Even though she's never been addicted to those drugs, she says: "I
didn't want to tempt myself." She solved the problem by getting only a few
pills at a time from the pharmacist, even though it meant going into the
store every day. "The first time I did it, the pharmacist was like 'you're
nuts,' " she says. "I think it's a great way of doing it."

Painkillers like Vicodin, Percocet, and OxyContin, derived from opiates,
technically known as narcotic analgesics, are the biggest concern among
policymakers and experts because they can be very addictive. Even patients
who use them properly for pain can become addicted, though it happens
rarely. Abuse of these drugs is increasing "quite dramatically," says Nora
Volkow, director of the National Institute on Drug Abuse. More than 31
million Americans say that they have illicitly used narcotic analgesics,
and emergency room visits related to this type of drug have more than
doubled in the past decade, to 108,000 in 2002. People take the drugs
because they produce a sense of euphoria, similar to the high from heroin.
When taken improperly, these drugs can be fatal.

But the heavy focus on abuse of painkillers, along with several
high-profile court cases involving doctors, has had a chilling effect on
pain medicine, doctors contend. Millions of patients, they say, are
suffering because doctors are either underprescribing to avoid suspicion or
are leaving the field altogether. One woman in New York started a patient
advocacy organization, the Pain Relief Network, because of her husband's
chronic joint pain. "These people deteriorate because it hurts to move,"
says Siobhan Reynolds. "I can't even begin to explain the severity of the
repercussions on their lives."

Rift.

The Office of Diversion Control says it's not in the business of
prosecuting doctors who operate legitimate medical practices. The problem
is that there isn't an agreed-upon definition of what prescription
practices are legitimate. Diversion Control tried to address this problem
several years ago when a couple of its agents teamed up with four pain
specialists and spent two years writing a "Frequently Asked Questions"
document that addressed issues like how narcotic analgesics should be used
to manage pain and what federal regulations were involved with prescription
painkillers. The 32-page document was released in August 2004 and lauded in
the Journal of the American Medical Association. Shortly after, the DEA
pulled the FAQ off its website with no explanation, according to David
Joranson, the director of the Pain and Policy Studies Group at the
University of Wisconsin and a member of the drafting committee. "It was
just amazing to have that collaboration unilaterally ended," he says,
"without explanation."

If that rift is not mended, it could impede the war on prescription drugs,
which depends on cooperation between the medical community and law
enforcement. Ensuring such cooperation will require strategies new to drug
enforcement. But at least one person is optimistic. "Unlike street drugs,
people don't want to do the wrong thing here," says Walters. "The vast
majority of the people we're dealing with are committed to people's health
and welfare."