PAINKILLER HEADACHE: ADDICTIONS, ARRESTS ON RISE

Treatment Options Expand While Doctors, Drug Companies Wrestle With
OxyContin's Bad Reputation.

Ten-thousand bucks buys an OxyContin addict in Savannah three-weeks of
detox therapy and a new drug to fight addiction - while staying in
anonymity at a plush suite that even allows pets. Or, for a mere $11 a day,
you can try to beat the highly addictive painkiller at a methadone clinic
next to a beauty parlor in a Garden City strip mall.

Treatment for those hooked on the prescription narcotic is far-ranging. So
are the increasing number of OxyContin addicts in Chatham County.

Painkiller junkies vary from executives who got addicted through
prescription use to 20-somethings buying it for a buzz on the street at $60
a pill.

"Oxy knows no boundaries, users are of all ages, groups, backgrounds," said
C. Rick Allen, deputy director of Georgia Drugs and Narcotics Agency in
Atlanta.

Just look at conservative radio talk show king Rush Limbaugh, who admitted
on Oct. 10 to being addicted to prescription painkillers. He told listeners
he is taking a month-long leave of absence to receive treatment; he
reportedly used OxyContin and other painkillers.

On the same day of Limbaugh's announcement, a dentist at the Chatham County
Health Department was arrested on charges related to methadone. Dr. Jon K.
Hicks, 62, remains on paid administrative leave after the Chatham-Savannah
Counter Narcotics Team (CNT) arrested him on a warrant. He faces a felony
charge of criminal attempt to obtain a controlled substance by fraud.

Methadone, used legitimately by clinics to curb OxyContin withdrawal
symptoms, can be teamed with other opiates and taken as a speedball for a
recreational high.

Illegal use of OxyContin, a strictly controlled opiate, has skyrocketed in
the past few years, making it the most commonly diverted pharmaceutical in
Georgia in 2002.

Last year in Florida - where Limbaugh's maid told law enforcement she
supplied him with thousands of painkiller pills - more people were
overdosing on OxyContin than heroin.

In Chatham County, the painkiller ranks third in illegal use behind crack
cocaine and powdered cocaine, according to CNT.

It's also reported to be as difficult to shake as heroin.

More than 4 million Americans are addicted to painkillers. Among those
seeking treatment, only about half are successful.

In Chatham, addicts are trying to kick OxyContin with standard detox
treatments like methadone - as well as with a new drug obtained through
more private settings, such as a doctor's office.

Painkiller paranoia could limit pain treatment

Abuse of OxyContin creates a ripple effect of medical fraud.

A physician writes a patient a prescription for OxyContin for a
non-existent injury. The patient uses a portion of the OxyContin and hawks
the rest for a chunky profit. Or patients visit several doctors and obtain
multiple prescriptions.

When swallowed whole, the pill provides important therapy for legitimate pain.

But if chewed, snorted or injected, OxyContin, the brand name for the pain
drug oxycodone, produces a quick and potentially deadly high. It has been
linked to hundreds of deaths and bears the FDA's strongest warning label,
which says the drug is as potentially addictive as morphine.

The company that makes the painkiller is designing a new tablet. The goal
is to create one that cannot be altered by chewing or crushing to release a
short-acting oxycodone.

A nationwide law-enforcement crackdown on painkiller abuses has made
legitimate doctors and pharmacists reluctant to deal with OxyContin. Many
fear they will lose their license or face criminal action.

"It is now common for legitimate intractable pain patients to encounter
signs in offices of even pain specialists that state flatly... 'do not ask
for OxyContin,'" said Dr. Joel Hochman of the National Foundation for the
Treatment of Pain in Monterey, Calif.

"The government's indiscriminate attack on pain management physicians and
clinics throughout the South ... has cast a pall across pain management
that may take years to reverse."

OxyContin still is prescribed, albeit carefully, by local doctors like Dr.
David Weems, chairman of the department of radiation oncology at Memorial
Health University Medical Center and medical care director of VistaCare
Hospice.

Weems said the narcotic is especially helpful for terminal cancer patients.

"I have no plans of changing the use of it in my patient population," Weems
said.

Weems said he practices extra precautions when prescribing it.

"We try to make sure with patients with multiple physicians involved that
only one physician is handling the pain medication and there is
communication between the doctors and pharmacies."

Hospice Savannah uses oxycodone for patients with severe chronic pain. St.
Joseph's and Candler hospitals also are restrictive about its use.

"It is to be used in cases of chronic severe pain, unresponsive to other
medications. It's not a drug intended for acute pain management," said Ray
Maddox, director of Clinical Pharmacy Research and Pulmonary Medicine. "It
is not normally used in patients who are in the immediate pre-or
post-operative state of their care."

No methadone clinic needed

With the help of a newly approved drug, addiction to opiates can be broken
in the privacy of your home, doctor's office or even a Savannah hotel suite.

For decades it was illegal for doctors to prescribe narcotics to treat
people addicted to opiates. Methadone clinics were the only real option for
treatment.

But critics said methadone was simply swapping one addiction for another.

Last year, the government began allowing authorized doctors to use the
drugs buprenorphine and naloxone to treat addiction to opiates in private
practice. The FDA approved two different buprenorphine pills, Subutex and
Suboxone, last October.

The new treatment, dissolved under the tongue, has won praise because
addicts don't feel high or experience the lethargy they do with methadone,
allowing them to look toward recovery. Unlike methadone, Suboxone includes
an ingredient that produces withdrawal symptoms in high doses, discouraging
further abuse.

With the approval of these new outpatient treatments, individuals have
another potentially valuable treatment at their disposal. But finding a
doctor who offers the treatments may be difficult.

In Savannah, Suboxone is being used to treat OxyContin addicts in at least
two separate locations - Assisted Recovery Center of Georgia Inc. and the
practice of Dr. Ray Gaskin, an internist/addictionist.

When it opened in 2000, Assisted Recovery Center helped mostly alcoholics.
This year, the center on Waters Avenue started treating OxyContin addicts.

"Now I am getting more calls on OxyContin than on alcohol," said director
Terry Bruce.

The private outpatient facility averages about seven new patients a month
and has attracted people from as far away as Hong Kong. Most are
out-of-town patients who stay at a southside hotel suite and undergo therapy.

The program also does in-home detox and even offers an executive program to
work around patients' schedules.

"There are places for the extremely wealthy, like Betty Ford, and places
for the indigent, but there is no place for the middle class. We fill that
niche," Bruce said.

About 30 patients, mostly OxyContin addicts, have taken the new treatment
in a program at Dr. Gaskin's practice on Commercial Drive. He's prescribed
the new drug since about March as part of treatment, which includes regular
counseling sessions and random drug screens.

The standard amount of Suboxone ranges from $12 for a daily pill to $21 for
three.

Gaskin said the new drug is going to revolutionize doctors' ability to help
addicts.

"Because of the stigma associated with going to a methadone clinic, there
were a lot of people reluctant to go into that situation. This allows
people to come to a doctor's office to be treated," Gaskin said. "There
should be hope, because effective treatment is available."

Methadone still most common treatment

While no longer the sole effective drug-treatment, methadone remains the
most sought-after treatment locally for OxyContin addicts.

The Georgia Therapy Associates methadone program in Garden City has
increased from 70 in 2000 to close to 200 today. Patients daily walk into
the clinic, in the Food Lion shopping center, to take their liquid dose
before heading to work.

"Methadone does not impair a person. It normalizes you so there is no
appearance of being under the influence of a drug," said Dr. Gordon Ifill,
medical director the methadone clinic. "You don't get a recreational high
from taking methadone."

In the past year, about 90 percent of the recently admitted patients are
being treated for prescription opiates. Most are employed, white and in
their 20s and 30s.

"The typical OxyContin user is the housewife, the guy who goes to work, the
doctor, the lawyer, the dentist," Ifill said. "A lot of these people don't
get into treatment until their lives are torn apart, until they've lost the
house, the practice."

The Recovery Place and the Savannah Area Behavior Health Collaborative also
treat OxyContin addicts, but not as consistently as the methadone clinic.

The methadone program, the only one in a 150 mile radius, draws patients
from as far away as Statesboro, Brunswick or Beaufort. They must have been
addicted for at least one year to be eligible. Some started on methadone
treatments in other areas and have been on it for 20 plus years.

Patients gradually can take doses home. For patients in advanced stages of
recovery, the maximum is 13 take-home doses. All patients must pay for the
service, which is less pricey than the newer treatments.

Methadone costs about $11 a day. Reduced rates are available for indigent
patients who live in Chatham or Effingham counties.

Methadone buys time to allow patients to get their heads together and
undergo regular counseling, also part of the methadone program.

At least 50 percent of the patients have given up opiates entirely, Ifill said.

And each new patient receives the same warning from Ifill: "Recovery from
opiate addiction is going to be the hardest job that you ever are going to
have to do."

FAQs about OxyContin

What Is OxyContin?

OxyContin, a form of oxycodone, was approved in 1996 for the treatment of
moderate to severe pain and is valuable for use in people with chronic pain
or pain from cancer. OxyContin tablets are controlled-release, which means
the drug dispenses its relief in a continuous manner for up to 12 hours.

Do other drugs contain Oxycodone?

Many pain-relieving drugs contain oxycodone. Percocet is a combination of
oxycodone and acetaminophen. Percodan, another painkiller, is made of
oxycodone and aspirin.

How is OxyContin different from these other drugs?

OxyContin is plain oxycodone containing anywhere from two to 32 times the
amount of oxycodone found in Percocet or Percodan. For people with chronic
pain or pain related to cancer, OxyContin is one of a few drugs that can
provide many hours without break-through pain.

How does OxyContin work to relieve pain?

OxyContin tablets are designed to be swallowed whole. They should not be
cut in pieces or chewed. The tablet is designed so that the dose of
oxycodone is slowly absorbed in the intestines to provide a steady,
pain-relieving level in the bloodstream.

Why is there so much concern about OxyContin?

The narcotic has recently come under intense scrutiny by the U.S. Food and
Drug Administration (FDA) and the U.S. Drug Enforcement Agency due to
widespread abuse. Abusers can bypass the drug's time-release aspect by
crushing, chewing, snorting or shooting OxyContin pills to get a quick
morphine-like high.

Source: www.intelihealth.com

The Georgia numbers

2000: police made 173 oxycodone seizures; three deaths involved oxycodone;
the painkiller turned up in 213 toxicology tests

2001: police made 404 oxycodone seizures; 76 deaths involved oxycodone; the
painkiller turned up in 348 toxicology tests

2002: police made 429 oxycodone seizures; 93 deaths involved oxycodone; the
painkiller turned up in 356 toxicology tests

2003 through Oct. 14: police made 309 oxycodone seizures; 62 deaths
involved oxycodone; the painkiller turned up in 249 toxicology tests

Source: Georgia Bureau of Investigations