THE CURSE AND THE CURE

Prescription Drug Abuse and the Fight to Keep Them Out of the Wrong
Hands

The basic thing nobody asks is why do people take drugs of any sort? I
mean, is there something wrong with society that's making us so
pressurized that we cannot live without guarding ourselves against
it? --John Lennon

When Jean snorted her first line of OxyContin at age 19, she knew
right away that there was a difference between doing drugs and getting
high. As Allen Ginsberg said, there was "no monster vibration, no
snake universe hallucination"--just a comfortable blanket, a cup of
ice and an unprecedented sense of warmth and well-being.

"All I remember is chewing on ice chips and laying in bed," says Jean,
whose name has been changed to protect her identity. "It wasn't like I
was floating, but I just felt extremely good. I didn't feel sick. I
wasn't worried about anything. I sat in the same spot for, like, four
hours."

So began her year-long tryst with the billion-dollar painkiller that, in
eight years, has gone from being hailed as a medical miracle to being
peddled on the streets under the nickname "hillbilly heroin." As New
York Times reporter Barry Meier notes in Pain Killer: A 'Wonder' Drug's
Trail of Addiction and Death, "At its birth, OxyContin had been a
pharmaceutical industry dream, a 'wonder' that heralded a sea change in
the treatment of pain." But in the end, it was the drug's biggest
asset--its revolutionary 12-hour, time-release coating--that would
become its biggest liability.

When taken in accordance with manufacturer instructions, OxyContin
gradually dissolves in the digestive system, slowly releasing moderate
doses of its narcotic agent--oxycodone--into the bloodstream. But when
crushed into a fine powder, OxyContin's protective coating does
nothing to prevent the rapid absorption of the drug, which can then
bring on a heroin-like high. As a result, the favored method of
consumption by abusers is chewing the tablets or sniffing them through
the nose. Jean chose the latter, although she was always bothered by
the "drip" that accompanied nasal ingestion.

"This is the only drug I've ever done," Jean says. "I never drank. I
never smoked pot. My friends did, but I was always the last kid to try
anything. I don't know how to explain it, I just really liked the way
OxyContin made me feel about myself and my life."

Supply and Demand

Jean's now-ex-boyfriend was the first to turn her on to painkillers. A
longtime user, he relied on a variety of sources to indulge his habit,
but he hit the mother lode when he hooked up with a heroin addict who
would sell him her entire monthly OxyContin prescription for $5 a pill.

"He'd buy maybe 150 or 200 40-milligram pills at a time," says Jean.
"Then he would sell half of them, make his money back and do the rest
for free."

According to estimates on the Drug Enforcement Administration website,
OxyContin obtained through conventional channels can cost anywhere
from $1.25 for a 10-mg pill to $6 for an 80-mg pill--the largest
single dose currently marketed by Purdue Pharma. When illegally sold,
however, "a 10-mg tablet of OxyContin can cost between $5 and $10" and
"an 80-mg tablet can cost between $65 and $80." But as Jean notes,
these estimates are slightly overblown for Clark County. "Normally,
you can get an 80-milligram Oxy for, like, $20 or $30. And a
40-milligram pill might be $15 or even $10." But even at these
discount rates, Jean still found herself with a habit that could cost
her upwards of $30 per day.

"It's a lot considering that I don't even remember how I was getting
all of that money," she says. "I was taking money out of my mom's bank
account and doing things that I normally wouldn't ever do."

But by that time, she didn't really have a choice. After six months of
three-times-daily use, she'd begun to suffer withdrawal symptoms,
including body aches, chills and sweats. On the worst days, she'd dry
heave; on the best, she'd be hopelessly depressed. Even if she had
wanted to quit, her body had developed a bond with the drug that her
will couldn't break. "I had to do a line in the morning just to feel
normal," she says. "Most of the time, I wasn't even getting high."

'Billion-Dollar Business'

"The availability of these drugs is incredible," says Dr. Michael
Levy, a private addiction recovery specialist who works with Jean and
a host of other Las Vegans struggling with prescription drug
dependence. "The patients that I take care of tell me that there has
been no decrease in the availability of these painkillers on the
street. If anything, it's increasing."

It's an observation echoed by Metro Detective Paul DeAngelis. "The
prescription problem in Nevada absolutely dwarfs that of illicit
drugs," says DeAngelis. "This is a billion-dollar business. It's a
major problem. For every one person who's out on the street abusing
cocaine or heroin, you probably have three that are abusing OxyContin,
Lortabs and things of that nature."

DeAngelis serves on the Southern Nevada Pharmaceutical Narcotics
Enforcement Team, a fledgling task force formed by Metro, the DEA and
the state Department of Public Safety Investigations Division. Its
charge: to contain the exploding underground prescription drug network
flourishing in Las Vegas.

"We're working with the Nevada State Board of Pharmacy to start
looking at people who are receiving large quantities of controlled
substances," DeAngelis says. "We have people in Las Vegas who are
receiving up to 1,000 OxyContin a month. It's incredible--especially
when the resale value on the street is anywhere from $25-$30 tablet."

And that's only the tip of the iceberg. Six to eight months ago, the
"Las Vegas cocktail" was a comparatively harmless blend of OxyContin
and Soma, a prescription muscle relaxant. Now it's a combination of
Soma, Viagra and Fentanyl--a raspberry-flavored lollipop that delivers
a narcotic commonly considered to be 80-100 times more powerful than
morphine. Add a little cocaine, and you have a potentially lethal
concoction that DeAngelis says will (a) "keep you up all night" and
(b) "probably make your heart explode." It was a version of this
cocktail mixed with alcohol that led to the recent death of Green
Valley Ranch Station executive Michael Tata, widely known for his
appearances on the reality television show "American Casino."

"I want to stress that we absolutely do not target people who require
legitimate pain management," says DeAngelis. "What we're targeting are
the large-scale trafficking organizations that do nothing but
manufacture fake prescriptions and send out people to fill them. We
have several of these loose-knit groups in Clark County that are no
different than your illicit drug organizations--people selling
methamphetamines, cocaine and heroin."

On the treatment end of the spectrum, Levy estimates at least 50
percent of his patients have prescription drug dependence issues.
While OxyContin isn't the only pharmaceutical that his patients abuse,
it belongs to a class of analgesic opioids--codeine, Vicodin,
Percocet, Lortab, etc.--that definitely stands out from the pack.

"I have young adults that are buying it off the street and not using
it for any reason other than recreation," Levy says. "I'm talking
about high school kids. They're not only getting into it, they're
dying from it."

And those who aren't dying are suffering through withdrawal symptoms
that make the most savage hangover look like the sniffles. "Just take
the worst flu you've ever had and multiply it by about 100," Levy says
before rattling off a laundry list of potential symptoms--nausea,
vomiting, diarrhea, body aches, abdominal cramping, muscle cramping,
irritability, insomnia, loss of appetite and craving.

"We're constantly bombarded with ads that suggest we can use these
products as a cure-all for our problems," says Levy. "It's the classic
case of better living through chemistry gone terribly wrong."

Drugdealers Com

Of the primary painkillers, Vicodin is without a doubt the most
prominent, snaring in its addictive web everyone from Green Bay
Packers quarterback Brett Favre to "Friends" TV star Matthew Perry to
perennially troubled rock starlet Courtney Love. No-brow rapper Eminem
has not only memorialized the drug in several of his songs, he's
tattooed it on his arm. And now, thanks to the wonders of e-commerce,
it's easier then ever to get--even in the absence of a
prescription.

A June report issued by the U.S. General Accounting Office revealed
that investigators had successfully obtained hydrocodone--essentially,
generic Vicodin--from eight domestic websites "without submitting a
prescription or undergoing an examination by a physician." All the
orders followed a similar, three-step pattern. The customer completed
an online questionnaire, spoke by phone to a physician's
representative and made a credit card payment to satisfy "the physical
examination requirement." Afterward, the customer was immediately
issued a 30-day hydrocodone prescription--at an average cost of $200.

It's a process that, until recently, was old hat to a handful of
unscrupulous drug distributors based in Las Vegas. According to a
story in the Washington Post, PrescriptionOnline.com--a now-defunct
Internet pharmacy formerly headquartered on Smoke Ranch Road--shipped
nearly 5 million doses of controlled substances to customers around
the country from July 2001 to January 2003. When PrescriptionOnline.com
was finally shut down, the dad-and-daughter operation accounted for 10
percent of all hydrocodone sold in Nevada.

But that all changed with the passage of state Sen. Valerie Wiener's
Senate Bill 397. Exalted as "the strongest Internet pharmacy bill in
the country," it targets unlicensed pharmacies that rely on Internet
consultations over appropriate practitioner reviews when dispensing
drugs. The legislation has proved remarkably effective--especially
considering Las Vegas' legacy of see-no-evil corporate oversight.

"We were seeing some substantial movement of corrupt Internet
pharmacies into the state," says Wiener. "The way the telemarketing
industry hit Nevada, we were ripe for Internet pharmacies to do the
same thing."

A lack of legislation also left Nevadans vulnerable to shysters and
pharmaceutical hustlers. As an example, Wiener tells of a Carson City
drug broker "who was going to Third World countries and buying up free
samples or expiring prescription meds that were donated to those
countries as humanitarian aid." Then he would return home and sell the
secondhand drugs online as if they were new. "You can't do that
anymore in Nevada," she says. "That's the kind of stuff we're watching
out for." Nevertheless, she concedes that her bill has been a source
of some controversy.

Wayne Stevens runs a Dallas website that guides interested parties
through the increasingly difficult process of ordering OxyContin and
other prescription painkillers online. In a lengthy e-mail, Stevens
notes that government regulations like Wiener's have made it much more
difficult for prescription drugs to be purchased via the web. "In the
government's eyes, the Internet pharmacy is an illegal drug source
that sells to anyone," he says. "This is simply not true."

Rather, Stevens argues that there are a number of legitimate reasons
for purchasing medications over the Internet. People far from care
facilities and without insurance often find it cheaper and easier to
shop for drugs online. Stevens also points out that cautious doctors
may be afraid to prescribe adequate amounts of pain medication--even
for patients with severe ailments and injuries.

A 2002 story on Salon.com reached a similar conclusion: "Cancer
patients and sufferers of debilitating diseases report that they are
getting ineffective dosages of OxyContin, running out of places to
fill legal prescriptions for it, or finding themselves without
doctors, many of whom choose to avoid OxyContin headaches by sending
patients to overwhelmed pain specialists struggling with the same
regulations."

Says Wiener: "I want to underscore this: This legislation does not
deprive people of the right to go online and find the best deal on
medication. It simply protects them from being harmed. The legitimate
sites are out there. There are plenty that are playing by the rules."

Recovery Redux

Ironically, it's an opiate that more and more people are relying on to
help overcome their prescription drug problems. Like Methadone,
Subutex is a prescription painkiller that acts as a less-addictive
bridge to recovery. "It's very, very effective as part of a complete
treatment program," Levy says. "It's basically like an opiate that you
don't get high on. As a result, it has much less abuse potential. My
patients describe it as a miracle drug."

Levy put Jean on a one-month supply when she first came to him for
treatment. "I love it," she says. "It works so well."

Not always well enough, though. A month ago, Jean succumbed to
temptation and went on a brief OxyContin binge. This time, Levy
prescribed her a significantly smaller allotment of Subutex--a
decision that forced her to tough out some unpleasant withdrawal symptoms.

"I'm so stupid," she says in retrospect. "I had been good for, like,
three months. I don't care what anyone says, I honestly think
OxyContin's the worst drug out there. I hear people talk about speed,
but this drug actually makes people go insane. I was getting pretty
crazy on it, too--like violent and stuff. It can be intense, man."