'ELITE' DRUG ABUSE ON RISE

Frontline Workers Say Prescription Drug Abuse Just Beginning

Our Painkiller Plague -- Special Report Opiate Drug Abuse

OxyContin, Dilaudid and Percocet are known to more New Brunswickers than
the painkillers' medical use suggests should be the case.

Used legitimately, the drugs help sick people, often the terminally ill,
live and frequently die more comfortably.

But stories of abuse, when these drugs are used as an escape from life,
have become common in the province. And, the tales are usually
stomach-churning.

Many of those stories were reflected during one coroner's inquest in Saint
John last year, as a jury heard details surrounding the death of Rothesay
resident Stephen Beshara, 20, who died in his sleep on Dec. 19, 2000, with
several prescription drugs in his system.

That jury heard about some of the pain caused by the painkillers. They
heard about doctors and pharmacists being threatened and intimidated if
they refused to prescribe, or fill prescriptions for such narcotics.

The inquest also heard that with one pill costing between $25 and $40 on
the street, many people have $400-a-day habits that spur them to turn to
crime, including theft, break-and-enters and armed robberies.

And, the inquiry heard how some desperate addicts injure themselves to try
to get prescriptions. One man cut his forehead with a knife and told
doctors at the emergency department he had been beaten up and robbed.

Once considered a drug of choice for small-town folk who didn't have access
to heroin, cocaine and other street narcotics, prescription opiates have
moved up in the drug world.

Nancy Green, a nurse midwife and president of Neighbors Against Drug Abuse
in Calais, Me., across the border from St. Stephen, said some prescription
drug junkies don't consider themselves addicts at all.

"They never considered themselves addicts or, there's a hierarchy in the
world of addictions and they were at the top," she said. "The ones that
were shooting up heroin were at the bottom, the mudbugs, they were called.
They were at the low end of the chain. If you were snorting OxyContin, you
were the elite. If you were injecting OxyContin, you were the next level
down. The heroin users, those were the addicts."

In three years, Ms. Green and the anti-drug group have worked to change
that thinking, within the drug community and the community at large.

"We need to get out there, we need to pound the pavement. People don't hear
about it and they think the problems have gone away. It's not gone, it's
still here and there's still a lot of work to do," Ms. Green said.

Nancy Hicks, a nurse manager with Ridgewood Addiction Services
rehabilitation program in Saint John, was among that first group in New
Brunswick to see prescription addiction and its consequences. With about
one-fifth of the Saint John centre's detox treatments dedicated to
prescription opiate addicts, Ms. Hicks said she's only seeing the early
stages of the problem.

"This is just the beginning. Those drugs are out there now more than they
were a year ago so it's really going to change the face of who we're seeing
coming in here," she said.

She has difficulty describing a "typical user," saying that most people
seeking treatment are men in their 20s and 30s. But users who aren't coming
forward for help are out there - young and old, men and women, she said.

The effect of the drugs is more clear, more universal. Addicts, those who
are aware of their addictions and want to kick them, are scared to death.
They may be afraid of what the drugs can do to them, but they're more
terrified about what they'll do without the drugs.

When alcoholics enter detox, their withdrawal is, medically, more risky,
more dangerous, Ms. Hicks said. Narcotic withdrawal, while actually a
lesser health risk, is a nightmare for addicts. "There's a phenomenon with
narcotic withdrawal that the brain kicks in and will do anything to avoid
withdrawal. It's something we don't fully understand and I don't think we
have anything that compares with it," Ms. Hicks said. "It's this fear of
withdrawal. They would rather die."

There have been no deaths in the border community of St. Stephen attributed
to illegal prescription drug abuse but Atlantic Canada's main gateway to
the U.S. has been identified as one of the hot spots for abuse, dealing and
smuggling of the drugs.

The Charlotte County Hospital in St. Stephen was among the first places to
feel the pain of prescription drug addiction. In the 1990s, even as the
much-publicized drug OxyContin was first coming to market, emergency room
doctors started feeling pressure to prescribe painkillers. In one incident,
a man showed up at the ER in St. Stephen with a shotgun and demanded the
drug Demerol. It was an early warning and it didn't take long before Canada
Customs and law enforcement officials were identifying the drug problem as
"an epidemic."

But even with local and national media exposure, it's an epidemic that
remains too quiet, almost a dirty little secret.

It's the same in Calais, Ms. Green said.

"It is underground but if I have a patient who is now willing to talk, or
even a client who is not a patient and I always say, 'Well, where do you
get this stuff' and they just smile and say, 'It's everywhere.' It's
anywhere and everywhere but it is underground," she said.

"We used to say a great supply of medications were coming in from New
Brunswick and now it just doesn't even seem to be an issue anymore. It's
everywhere."

Cpl. Greg MacAvoy, a long-time member of the St. Stephen RCMP detachment
who is involved in community and youth activities, agrees that prescription
drug abuse remains, largely, a quiet epidemic.

"I think a lot of this is within itself, like there's not a lot of
tentacles reaching out into regular society," Cpl. MacAvoy said.

"It's a whole, well, that underworld or underground that they used to talk
about."

Cpl. MacAvoy is part of another group trying to shine light on the problem,
to get the community at large to take note and take action.

The Charlotte County Coalition for a Drug Free Community includes police,
health officials, addictions agencies, Canada Customs and others. Members
have one thing in common - they see the effects of prescription drug
addiction in ways most New Brunswickers never will. They saw it first; they
see it often.

Ms. Hicks, from Ridgewood, is part of that group and she understands why
health-care, social workers and law enforcers are the most involved and
most active in drug awareness.

"We often see the human tragedies well before the community," Ms. Hicks said.

That exposure explains the willingness of those people to gather regularly
in St. Stephen to talk about drugs, their impact and how to turn people off
of them. It's a battle that would be easy to quit.

At any given time at Ridgewood there are two or three people in the
facility's 20 detox beds who are trying to kick prescription drugs. Ms.
Hicks and others in the coalition want to find ways to prevent those
addictions and they're hoping that by keeping communication lines open,
keeping the issue a priority for all agencies involved, they're on the
right track.

"In some ways, we are ahead of the problem here. We don't have a fix, I
don't want to say that," Ms. Hicks said.

But she is buoyed knowing the coalition formed quickly and early and is
supported by a wide range of agencies.

Still, the coalition has struggled to get its hopes and fears to the
general public. Like Cpl. MacAvoy, Ms. Hicks said for the average citizen,
drug abuse seems to be someone else's problem.

"It hasn't affected that general community yet. We know the community
doesn't understand what this issue is, it hasn't impacted them. It's like
an underground culture," she said.

And, that's a scary place. Ms. Hicks fears it will take some tragedy linked
to the abuse of such drugs for the average person to feel their impact.

"When the public will respond is when there's break and enters and when
there's deaths," she said.

Even for those in the know, who see the effect drugs have on addicts, there
are, in the big picture, other issues to deal with. In the world of
addiction treatment, prescription narcotics represent a fraction of the
problems. Addictions to alcohol, marijuana, gambling and cigarettes are
more wide-spread and their social and economic costs dwarf those related to
opiates. With those other issues to deal with, addictions services agencies
can't attack prescription drugs with all their resources.

That makes the St. Stephen drug coalition's job extra difficult yet even
more important, Ms. Hicks said. Those people who work in jobs that put them
in contact with addicts regularly want to strike a blow now, before those
deaths, those crime waves strike in St. Stephen and other communities.

"Let's make sure it doesn't go to the next level," Ms. Hicks said.

She has faith in the province's addiction treatment facilities, calling the
services here among the best in Canada. Still, it will be impossible to
solve addiction problems through treatment - detox and rehabilitation.
There will never be enough beds, never enough counsellors. Treatment can
help addicts but without prevention, the problem never goes away.

"We just can't keep up with it," Ms. Hicks said. "There are more people
knocking on our door than we can handle but that's true with all our
hospital services."

The justice system can't win a war on drugs. Convicting drug users and
dealers is difficult and police recognize that even if they sweep a dealer
off the streets, someone else will take his place.

The results of recent law enforcement efforts - including an intense
undercover operation targetting alleged St. Stephen drug kingpins -
illustrate the challenges. Eight charges of trafficking, four convictions
for a grand total of seven months in jail. Hardly a knock-out blow.

Schools can play a part but anyone who points to teachers and counsellors
as a first line of defence to keep their kids away from drugs are pointing
to the wrong people, Ms. Hicks said. If anything, school is the place where
kids learn about and feel pressure to try drugs - from their peers.

"Who do we listen to, who do we believe? Our peer groups," Ms. Hicks said.

"Everybody's got to play a part in this. It's not addictions services to
fix, it's not the schools to fix. You can educate kids till you're blue in
the face but it's not going to change whether they choose to use alcohol or
drugs. It's only a piece to the puzzle."

Ms. Hicks is a believer in family, in fighting a war on drugs from the home
front. She said the greatest heroes in waiting are parents.

"If there is one major influence on a young person who may be travelling on
that journey of whether they get involved with alcohol or drugs, the
biggest influence is their relationship with their parents," Ms. Hicks said.

"The parents have a vital role."

Elvy Robichaud, New Brunswick's Minister for Health and Wellness, has also
said communities play a key role in tackling drug issues. He supports calls
for computerized drug monitoring that would track prescriptions and could
cut into illegal use of prescription narcotics. But until money is found to
implement such a system, other alternatives must be pursued.

"We're encouraging community involvement in promotion and prevention of
drug abuse," he said. "We still want to partner with those communities like
we're doing in Miramichi and the St. Stephen area."

Ms. Hicks said education and prevention is the only potential long-term
solution to substance abuse. Prescription monitoring may make it more
difficult to abuse narcotics but as long as there is pain, as long as their
is suffering, as long as there are people looking to fill voids or escape
reality, there will be drugs.

"There will always be a new drug on the horizon that promises something,"
she said.

Ms. Green, in Calais, is watching the spread of heroin through Maine.

"Heroin is moving up this way because it's much cheaper than OxyContin,"
she said. "Heroin, certainly, is creeping through Maine and it's moving
into Washington County."

She, too, says education and prevention are the only potential solutions to
all drug problems.

"We got a lot of people's heads out of the sand. If you talked to somebody
three years ago, they said, no, we don't have a problem. And now everybody
says, yes, we do have a problem," she said.

"We certainly brought awareness to the community, or both communities. We
certainly stirred things up in St. Stephen."