5 TOP PAINKILLERS SEE LARGE JUMP IN SALES

90% Increase Seen 1997- 05, Including OxyContin, Vicodin

WASHINGTON -- Retail sales of five leading painkillers nearly doubled
over an eight-year period, reflecting a surge in use by patients
nationwide who are living in pain, according to a new Associated
Press analysis of federal drug prescription data.

The analysis reveals that oxycodone usage is migrating out of
Appalachia to areas such as Columbus, Ohio, and Fort Lauderdale,
Fla., and significant numbers of codeine users are living in many
suburban neighborhoods around the country.

The amount of five major painkillers sold at retail establishments
rose 90 percent between 1997 and 2005, according to Drug Enforcement
Administration figures. More than 200,000 pounds of codeine,
morphine, oxycodone, hydrocodone and meperidine were purchased at
retail stores during 2005, the most recent year represented in the
data. That is enough to give more than 300 milligrams of painkillers
to every person in the country.

Oxycodone, the chemical used in OxyContin, is responsible for most of
the increase. Oxycodone use jumped nearly six-fold between 1997 and
2005. The world of pain extends beyond big cities and involves more
than oxycodone. In Appalachia, retail sales of hydrocodone -- sold
mostly as Vicodin -- are the highest in the U.S. Nine of the 10 areas
with the highest per-capita sales are in mostly rural parts of West
Virginia, Kentucky or Tennessee. Dr. Jeffrey Gordon, director of the
blood and cancer center at Day Kimball Hospital in Putnam, Conn.,
said Vicodin is a popular painkiller to give patients after surgery,
and many doctors are familiar with it. "Over the past 10 years, there
has been much better education in the medical community to ... ask if
people are having pain and to better diagnose and treat it," Gordon said.

Suburbs are not immune to the explosion. While retail sales of
codeine have fallen by one-quarter since 1997, some of the highest
rates of sales are around Kansas City, Mo., Nashville, Tenn., and
Long Island, N.Y. The DEA figures analyzed by the AP include
nationwide sales and distribution of drugs by hospitals, retail
pharmacies, doctors and teaching institutions. An AP investigation
found these reasons for the increase: The population is getting
older. As age increases, so does the need for pain medications. In
2000, there were 35 million people older than 65. By 2020, the Census
Bureau estimates the number of elderly in the U.S. will reach 54 million.

Drugmakers have embarked on unprecedented marketing campaigns.
Spending on drug marketing has zoomed from $11 billion in 1997 to
nearly $30 billion in 2005, congressional investigators found. Profit
margins among the leading companies routinely have been three and
four times higher than in other Fortune 500 industries.

A major change in pain management philosophy is now in its third
decade. Doctors who once said pain is part of the healing process
began reversing course in the early 1980s; most now see pain
management as an important ingredient in overcoming illness.

Retired Staff Sgt. James Fernandez, 54, of Fredericksburg, Va.,
survived two helicopter crashes and Gulf War Syndrome over 20 years
in the Marine Corps. He remains disabled from his service-related
injuries and takes the equivalent of nine painkillers containing
oxycodone every day. "It's made a difference," he said. "I still have
bad days, but it's under control." Such stories should hearten
longtime advocates of wider painkiller use, such as Russell Portenoy,
head of New York's Beth Israel pain management department. But they have not.

"I'm concerned and many people are concerned, that the pendulum is
swinging too far back," he said.

ON THE WEB: Pain Relief Network, www.painreliefnetwork.org Drug
Enforcement Administration, www.usdoj.gov/dea American Academy of
Pain Management, www.aapainmanage.org/

AP writers Dave Collins and Samira Jafari contributed.