'ELITE' DRUG ABUSE ON RISE

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.

Last year a jury heard details surrounding the death of Rothesay
resident Stephen Beshara, 20, above, who died in his sleep on Dec. 19,
2000, with several prescription drugs in his system.

"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."

Elvy Robichaud, New Brunswick's Minister for Health and
Wellness: 'We're encouraging community involvement in
promotion and prevention of drug abuse.'

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."