OXYCONTIN: RX FOR PAIN HITS THE STREETS

OxyContin tablets are shown on the counter of the Catonsville pharmacy.
When crushed, the pills deliver a powerful narcotic high. For patients
suffering from cancer, tooth decay, surgery or a variety of other medical
conditions, the prescription narcotic OxyContin can be a godsend.

But for an increasing number of Marylanders, this controlled-release form
of the analgesic oxycodone is a substitute for its most notorious chemical
relative, heroin.

"It's a very powerful narcotic that you can become addicted to very
quickly," said Preston Grubbs, commenting last week as the U.S. Drug
Enforcement Administration agent in charge of DEA's Baltimore district office.

"As soon as you start (abusing) it, it just grabs you."

Known on the street by slang terms such as oxy, kicker and hillbilly
heroin, OxyContin is growing more and more popular as a drug of abuse, and
has been implicated in recent cases involving high-profile names such as
broadcaster Rush Limbaugh and local dentist Dr. Charles Franz.

OxyContin is manufactured as a timed-release tablet that is approved by the
Federal Drug Administration for around-the-clock pain management.

But as many people soon discovered, the tablets can be manipulated to
release the active ingredient all at once. And in such a concentrated dose,
oxycodone, like heroin, can be used to achieve a euphoric "high."

"It's quick and powerful," Grubbs said.

And while heroin carries the risk of unregulated content and violent crime
- - buyers and sellers are subject to robbery, assault and murder - an
OxyContin tablet can be identified and quantified by its stamped-on label
and acquired from white-collar criminals, not thugs on the street.

Prescription drug abuse also carries less of a social stigma, according to
Det. Mike Lettieri, a member of the Community Drug and Violence
Interdiction Team (CDVIT) at Wilkens Station, in police Precinct 1.

A Different Stereotype

"There's something dirty about heroin or cocaine, a negative stereotype
that isn't associated with popping pills," Lettieri said, noting that many
people who choose pills over traditional street drugs appear to be
functioning members of society, holding down jobs and raising families.

"They're not robbing people to support their habit," he said. "They're not
breaking into houses to support their habit."

Consequently, they receive less attention from police investigators, who
tend to focus their limited time and resources on violence-related crime.

Lettieri said he has no statistics on OxyContin-related crime and recalled
only a few cases.

One ongoing case involves Dr. Franz, the Catonsville and Lansdowne dentist
who was arrested in October for cocaine possession. Responding to
complaints that Franz was practicing dentistry while high on cocaine,
Lettieri was part of a team that arrested him with pills labeled as
OxyContin concealed in his hand, and others stashed at his house, police said.

Detectives also found cocaine in a car Franz was driving and at his house,
police said. He was charged with possession of cocaine only, pending the
results of a drug analysis on the pills.

Another case dates from July 2002 and did involve a violent crime. An
Arbutus pharmacy was robbed at knifepoint of more than $6,000 worth of
OxyContin, police reported. A Baltimore man was arrested and charged with
armed robbery.

Risk Of Overdose

While oxycodone may not be as notorious as heroin, it can be just as
dangerous biologically.

Purdue Pharma, which manufactures OxyContin, issues a warning with every
sample that overdose can be fatal.

Nevertheless, youths and adults across the country have taken their chances
on an oxycodone high.

"The rate of increase is decreasing, but (the numbers) are not going down,"
said Bill Toohey, a Baltimore County police spokesman, commenting recently
on the few county statistics available.

In 2000, at least 43 police cases involved evidence that tested positive
for oxycodone, representing a total 630 tablets. In 2002, the numbers
jumped to 78 and 1,539, respectively.

As of this October, 70 cases were reported, with 1,390 tablets confiscated,
Toohey said.

Local statistics are difficult to obtain because neither the police
department nor the health department in Baltimore County is required by
state law to track OxyContin abuse, according to Renee Samuels, a county
spokeswoman.

But the abuse is "a growing problem in Maryland," Grubbs said.

Oxycodone abuse has been around since the 1960s and is seen in every age
group and all ethnic and economic groups, according to DEA records.

"It doesn't discriminate by race or age or anything like that," Grubbs said.

The number of known cases rose dramatically after OxyContin came on the
market in 1996 as a high-dosage form of the drug. Information from Grubbs
and the DEA shows that people who abuse it are, in many cases, heroin
addicts who turn to oxycodone as a substitute high or as a way to alleviate
heroin withdrawal symptoms and who subsequently make oxycodone their drug
of choice.

This pattern was noted first in the rural hills of Appalachia, hence the
term hillbilly heroin.

Profit Motives

Aside from the physical dependence that keeps users coming back to buy
more, the profitability of illicit OxyContin sales is another factor
driving abuse, Grubbs said.

"There are people who are in it just to make money," he said. "The (street)
prices vary, anywhere from $40 a pill up to $100."

Purchased legally by prescription at Catonsville Pharmacy, OxyContin
carries a price tag of $1.50 to about $9 a tablet, depending on the dosage
per tablet, and can be paid for by Medicaid or private insurance.

"So there's a tidy profit in it," said Grubbs, who outlined other methods
for "diverting" the drug from legal to illegal distribution.

"Doctors overprescribe it, and patients who legitimately have a
prescription sell it to make money," he said. "Or prescription (forms) are
stolen from doctors' offices and forged."

Some patients may begin "doctor shopping" - visiting several doctors to
acquire a larger than necessary supply for their medical needs.

Or the number of tablets on a legitimate prescription will be altered by
the addition of a zero, so the patient receives 10 times the intended amount.

Mapping Strategies

Maryland Attorney General Joseph Curran said Friday that about three years
ago he began working with other state attorneys general to map strategies
for dealing with OxyContin abuse. His office has prosecuted four or five
high-profile cases.

One method proposed for detecting OxyContin abuse would have government
agencies tracking prescriptions, looking for spikes in the data.

"That's very controversial and is just an idea that's been floated around,"
Curran said, noting that prescription tracking could have a chilling effect
on legitimate practices.

"Neutralizing the pill seems to be a potential solution, although (Purdue
Pharma) indicates that's not as easy as it sounds," he said.

The Connecticut-based company has been working since 1995 to produce a
tamper-resistant form of the drug, which would include a chemical agent
that could block the effects of oxycodone if the pill is subject to tampering.

"We take this problem very seriously," said Jim Heins, Purdue spokesman.

"We are in clinical trials with an oxycodone-naltrexone combination, but
this will take a while," he said. "This will take about four or five more
years."

Heins also noted the devastating effect that reported OxyContin abuse cases
can have on patients who have a legitimate need for the drug.

While it is a narcotic on which the body can become dependent, withdrawal
symptoms can be controlled by "carefully decreasing the medication over
time," he said. "But people read 'hillbilly heroin' and decide to stop cold."

Anyone needing further information on the advantages and risks of OxyContin
or methods for discontinuing its use should consult a physician or pharmacist.

Anyone having information about criminal abuse of OxyContin or any other
narcotic should call the Wilkens Station drug hot line, 410-410-887-0869.
Callers may remain anonymous.