A PRESCRIPTION FOR RUIN

Illicit Trade in the Painkiller OxyContin Is Bringing Crime, Addiction -
and Death - to the Atlantic Provinces

THE 10-MINUTE TRIP from Donkin, N.S., to downtown Glace Bay is the
kind even locals seldom tire of driving.

The narrow, seaside highway winds through one of those postcard
stretches of coastal Cape Breton, among churches and cemeteries and
shoebox houses that seem to cling to the hills above the water.

But when Morley Prendergast drove it during his last year of high
school, he rarely noticed the sights.

By then, the route had dimmed in his mind to a single, vital line --
his sole link to the potent prescription painkiller OxyContin. "The
only thing I cared about was getting into town and finding a dealer,"
recalls Prendergast, now 20. "Sometimes I'd have to pull over and
throw up, because you get sick if you stop taking it. I'd just close
the door and keep going. I needed it just to feel normal."

We're seated in the den of Prendergast's home in Donkin, where he's
under two years' house arrest for holding up a convenience store, a
crime committed so he could illicitly buy more OxyContin. He's a
laughable excuse for a robber -- soft-featured and thin, with a kitten
named Mia to keep him company during his sentence.

His crime, he explains, marked the end of a descent into addiction
that started in Grade 11, when he began snorting ground-up tablets
with schoolmates whenever he got the chance. "I could run into the
washroom," he says, "crush up a pill on the back of the toilet and
take it right there." Within months, the former honour-roll student
was injecting the drug in liquid form, relying on OxyContin to get him
through his weekend shifts at a theatre in Sydney, stealing cheques
from his parents to pay for it. Then, two winters ago, having lost his
job and exhausted all sources of cash, he made a clumsy attempt to rob
the store. "There were times when I was spending $200 a day," says
Prendergast, who's been clean since his arrest. "I spent all my
savings, and I still owe my parents about $2,000. It takes over your
whole life."

Or, in some cases, your whole town. Communities in Cape Breton and
other pockets of Atlantic Canada have become veritable fonts of such
tales in recent months, as a drug that has already wreaked havoc in
rural areas of the eastern U.S. cuts a swath north.

There are the two Glace Bay brothers who received last rites in one
12-hour period after overdosing last February. Or the 65-year-old
grandmother in New Waterford, N.S., who was ordered to jail for
selling OxyContin pills from her purse.

She cried upon sentencing, but got a scolding from the judge for
trying to make "easy money." Or the former Glace Bay coal miner who'd
been legally prescribed OxyContin for eight years, yet went into shock
during a routine hospital visit when staff administered his "usual"
dosage.

He survived, but it turned out he'd been selling off his pills all
along, and had no tolerance for the drug.

All this, and a startling spike in fatality statistics. Cape Breton
Regional Police attribute eight of 20 sudden deaths in the last 18
months directly to OxyContin abuse, while the number of prescription
opiate addicts reporting to Sydney's detoxification unit has more than
doubled in the last four years.

Authorities in other Atlantic provinces report similar grief: a task
force into the issue in Newfoundland and Labrador recently linked the
painkiller to six overdose deaths there since 2001, while police in
New Brunswick and Prince Edward Island also report misuse of the drug.
Anti-drug units are quickly retrenching, shifting their attention from
old bogeymen like pot and liquor to one that lives in the cabinet of
their local pharmacy. "We got used to seeing the town wino standing on
the corner," says Sgt. Doug Lawrence of the Cape Breton regional
police street crime and drug unit. "Now the concern is some guy
selling pills."

THIS WASN'T SUPPOSED to happen to OxyContin, a drug once heralded as a
godsend for cancer and palliative-care patients.

Developed by chemists at Connecticut-based Purdue Pharma LP, the drug
was designed to treat severe, long-term pain. Its genius was in a
"controlled-release" system preventing all of the opiate in each pill
- - in this case, a morphine-like compound called oxycodone - from
taking effect at once. That allowed its maker to pack more of the
feel-good stuff into each tablet.

Instead of giving patients dozens of pills per day, doctors could now
prescribe one or two. Within five years, OxyContin accounted for 90
per cent of Purdue's U.S. prescription sales, raking in more than US$1
billion for the company annually.

Trouble was, abusers soon learned that grinding up the pills broke
down that control mechanism, unleashing the drug's full force.
Snorting OxyContin in powder form, or injecting it in a water-based
solution, produces a euphoria rivalling that of heroin, say those
who've tried it. "Three days of being on it, and you become addicted,"
one Cape Breton user told Maclean's. "It's a very, very powerful
drug." And potential abusers didn't have to look very far for mixing
instructions: Purdue was required by law to include a warning on its
label reminding users that breaking, chewing or crushing the tablets
"leads to rapid release and absorption of a potentially fatal dose of
oxycodone."

For these reasons, and because of its widespread availability,
OxyContin became known as "hillbilly heroin" -- a high-powered opiate
readily obtainable in the woods of rural America. After its
introduction in 1996, an illicit trade of OxyContin swept West
Virginia and Virginia, along with parts of Ohio, Pennsylvania and
rural Maine. Patients were caught double-doctoring, then selling off
their extra prescriptions, while pharmacies began reporting increased
numbers of break-ins for OxyContin. In 2000 and 2001, the U.S. Drug
Enforcement Administration linked 146 deaths to OxyContin abuse,
lamenting the drug as a "significant problem for law enforcement
authorities throughout the United States."

THE TRADE WAS slower to take root in Canada, but has proven no less
insidious. On a recent evening in Glace Bay, Sgt. Lawrence and his
partner, Const. Shaun McLean, cruise the city of 20,000 in an unmarked
vehicle, pointing out some of the 14 homes where they believe
OxyContin is for sale. "The dealers use cellphones and pagers,"
explains McLean. "They give their customers passwords." He parks on a
side street, not far from a rundown, two-storey home, and settles
lower in his seat. Within minutes, a white sedan rolls past the house,
letting out two men who quickly go inside. "This is a place we've been
watching for a while," McLean murmurs. "But we have to wait for the
right time." In the past, he explains, police have gotten wind that
dealers have obtained supplies of pills, "but in the few hours it
takes for us to go to a judge and get a warrant, they've sold it all
off." Wary of alerting these suspected dealers, McLean quietly starts
the vehicle and drives away.

Why Cape Breton became an epicentre of this market remains a matter of
heated debate.

Lawrence and McLean, both of whom grew up in the region, suspect pot
users and alcoholics are graduating to more serious stuff; the island,
they point out, has always had its share of substance abusers.

But a tour of withering communities around Glace Bay - Dominion, New
Waterford, Reserve - highlights socio-economic factors that may have
played a role, too. Like residents of West Virginia or Pennsylvania,
Cape Bretoners live amid the ruins of once-thriving coal mines and
steel mills, industries that have left a legacy of double-digit
unemployment and illness.

And while the average Cape Bretoner is likely to live two years less
than other Canadians, he's also likely to spend six more of those
years fighting some form of long-term disability. It's just the kind
of place for a miracle painkiller.

The result: OxyContin began turning up in medicine cabinets in Cape
Breton just as economic hardship made reselling it attractive. Between
2000 and 2003, the number of OxyContin prescriptions dispensed in Cape
Breton rose 270 per cent, to almost 4,000. People taking the drug were
averaging 15,200 mg per year -- fully 2,000 more than the provincial
average.

Some seniors took to calling it the "pension pill," because they could
hawk it to augment their incomes, says John Malcom, chief executive
officer of the island's regional health authority.

Brian Petite, a pharmacist who operates a dispensary in Glace Bay, saw
prescription holders who were obviously fronted by buyers who'd
followed them to the store. "I knew a couple of guys who wouldn't have
$10 in their pockets," he says. "All of a sudden, they're handing me
hundreds." He called authorizing doctors to double-check the
prescriptions, he says, but was instructed to fill them anyway.

Today, no one seems sure where to direct their anger.

The province's prescription monitoring program could have been faster
to spot the danger, according to some critics.

While Petite says he phoned the program in 2001 to report suspicions
the drug was being abused, the agency did not flag OxyContin for
special monitoring until this year. The program is hampered by an
antiquated paper-based process.

Its manager, Coleen Conway, says an electronic system such as one
currently running in B.C. would allow pharmacists to spot instances of
double-doctoring and disproportionate use on the spot, but the
province has yet to agree to fund one.

Others have focused their ire on individual doctors, who they say have
been prescribing OxyContin too freely. "There's no doubt there's
patterns to this," says one Sydney-area pharmacist who asked not to be
named.

But there have been no official complaints to the province's College
of Physicians and Surgeons, and at least one prominent addiction
specialist in Cape Breton believes that, more than anything, some of
his colleagues have been naive. "By and large, we are a trusting group
of individuals," says Dr. Tom Crawford, who also runs a family
practice in Glace Bay. "It's taken us a long time to convince doctors
around here that they have to be more careful."

IF DOCTORS WERE over-prescribing OxyContin, then family practitioners
say at least some of the responsibility lies with Purdue. Its
representatives, they say, worked at expanding the market by strongly
suggesting OxyContin for less serious ailments like chronic back pain.
Such accusations are nothing new to the company: in the U.S., Purdue
faces some 300 lawsuits alleging improper promotion of the drug, as
well as accusations by the DEA of overly aggressive marketing. In
early 2003, following negotiations with the U.S. Food and Drug
Administration, the company removed information from its Web site that
appeared to suggest unapproved uses of OxyContin. But the criticisms
in Cape Breton strike at the heart of Purdue's marketing strategy.
"The party line is that, if used for the indications it's meant for,
this drug is OK," says Crawford. "I think there are other drugs, with
less potential for abuse, that work just as well for things like
chronic back pain."

John Stewart, executive vice-president and general manager of Purdue
Pharma in Canada, denies his sales reps promoted the drug improperly
in Cape Breton. But he acknowledges its widespread availability may
have led to abuse.

In the meantime, Purdue is working on ways to prevent misuse, he says,
such as adding an "antagonist" that would activate if the drug is
crushed, blocking the effect of the opiate. "But it's not yet in
clinical trials," he warns from his office in Pickering, Ont. "We're
still years away."

Whether such measures would have spared someone like Prendergast is
unclear: by his own admission, he was "the kind of person who'd try
anything once." He stares at his feet when recalling his high-school
graduation -- the day his parents found syringes in his bedroom. "When
I came home," he recalls, "they had the needles laid out on the
kitchen table." That led to the first of several bouts of detox.

But getting clean, he says, is something he chose to do himself.

He's currently taking classes at the University College of Cape
Breton, volunteering at his local Boys and Girls Club and dreaming of
a career in law. It'll be a long, tough road, but hardly as bad as the
one he just travelled.