A GROWING THREAT

Reality TV celeb Jack Osbourne, son of rocker Ozzy Osbourne, recently
admitted to being addicted to a narcotic sometimes known as killers, OC,
Oxy, hillbilly heroin or Oxycotton.

In North Carolina, law enforcement officers know the drug well. It's been
linked to the deaths of several people in Rowan County, most recently Jerry
Caster, a China Grove man who died of a drug overdose last month.

OxyContin is the brand name of a time-release form of oxycodone, an opium
derivative that is also the active ingredient in Percodan and Percocet.

Oxycodone isn't anything new; it's been used since the 1960s. OxyContin,
however, contains a much higher concentration of oxycodone than previous
formulations.

According to the National Drug Intelligence Center, oxycodone is the
fastest growing prescription drug threat in North Carolina.

Drug du jour

Kevin Auten can attest to that. As lieutenant over special investigations
with the Rowan County Sheriff's Department, Auten deals mostly with
narcotics cases, which frequently involve the diversion of prescription
drugs. He sees plenty of OxyContin abuse.

"I think it's on the upswing tremendously," he says.

"It came on the scene maybe two years ago, and you didn't hear a lot about
it then, but lately, we're hearing more about people who are abusing it.

"In the drug world, there are fads that pop up. A year from now, who knows?
For the longest time it was Xanax and Valium; then it was Lortab. Now it's
Oxycontin.

"It's bad," says Detective J.D. Barber of the Salisbury Police Department.
"It's really more prevalent than we had thought."

And it can be very dangerous. OxyContin has been linked to hundreds of
deaths nationwide.

Police Chief Mark Wilhelm says that forged OxyContin prescriptions are a
problem in Rowan County, as elsewhere. Users will go to great lengths to
get the drug, sometimes traveling from Winston-Salem to Salisbury to
Statesville to get different prescriptions filled.

Many drug users prefer OxyContin because the euphoric effect of the drug
lasts much longer than the high from crack cocaine, Barber says.

"It's basically, in a nutshell, legal heroin," said Jack Osbourne in a
recent MTV interview.

"As long as it's being prescribed, it's going to be a problem,"Barber says,
"although it's my understanding that it's a good drug for those who don't
abuse it."

Ernest Kirchin, a detective with the Charlotte Mecklenburg police
department, says that OxyContin abuse tends to be more prevalent in rural
counties. Most of the problems that the vice and narcotics unit faces in
the Charlotte area are with another narcotic, hydrocodone, which is sold
under the brand names of Lortab, Lorcet and Vicodin. Hydrocodone drugs
account for some 60 percent to 70 percent of the drug activity that
Kirchin's unit deals with.

Formulated by Purdue Pharma of Stamford, Conn., OxyContin was introduced in
1996 for use by terminal cancer patients and chronic pain sufferers. During
its first five years on the market, OxyContin revenues approached $2
billion -- far higher than initial projections of $350 million.

While the drug has been hugely successful, Purdue Pharma and Abbott
Laboratories are facing numerous lawsuits, charged with encouraging the
widespread prescribing of OxyContin without adequately warning doctors and
patients about the highly addictive nature of the drug.

Potential for abuse

OxyContin is a time-release narcotic, formulated to last 12 hours. Abusers
of the drug disable the time-release feature by chewing the tablets or
crushing and snorting the powder.

"Once that pill is crushed, the time-release aspect is gone and you get the
full monty," Auten says. The drug can also be dissolved in water and injected.

Bought on the street, an OxyContin pill might cost up to a dollar a
milligram. Recently, the street price has been going down, a sure sign that
the drug's availability is increasing, Auten says.

Most often, people get the drug legally with a prescription and then sell
the pills. Medicaid patients may pay very little for a month's
prescription, which can net them hundreds of dollars on the black market.

"I don't know the answer to the problem," Auten says. "People go to the
doctor and the doctor does what he thinks is right. The doctor has no way
of knowing what will happen."

Auten believes that the drug is sometimes prescribed improperly. He cites a
case of a doctor prescribing it to a new mother for post-partum pain.

"I thought that was inappropriate," he says.

"It is not indicated for management of post-operative pain," says Teresa
Casmus, a pharmacist at the Medicine Shoppe on East Innes Street.

"In my practice, what I have seen are people who are on it for chronic back
pain, chronic injuries. That's appropriate use because of its controlled
release. Rarely do I see it used for short-term pain."

Hydrocodone is more appropriate for that, she says.

Boon for cancer patients

Dr. William M. Brinkley, an oncologist in Salisbury, frequently prescribes
OxyContin for cancer patients who are experiencing severe pain.

"In our practice, it's a wonderful drug," he says. "Our patients often have
a great deal of pain; they are truly hurting. If people are taking it for
the right reason, it is a wonderful drug."

Although he realizes that there's potential for abuse, Brinkley says that
patients with real pain who use OxyContin as prescribed are not likely to
become addicted.

The widely publicized problem of OxyContin abuse has not affected use of
the drug in his practice, Brinkley says.

"There's been a big push to make sure doctors treat pain appropriately,"
Brinkley says. He believes that it's reasonable for doctors to start with
less powerful narcotics to treat pain and then work up from there if necessary.

Some older patients have a kneejerk reaction against narcotics, even if
they are suffering.

"They'll say, 'I don't want to become addicted,' " Brinkley says. "You have
to explain that if they have real pain and take the medicine as prescribed,
they won't become addicted."

Stealing pills

One problem that occasionally surfaces in Brinkley's practice is family
members stealing pain medication -- and that's a problem that the Sheriff's
Department is familiar with.

"In one week, we had four cases involving Oxycodone pills being stolen from
homes," Auten says, with 170 pills taken in one theft. Auten suspects that
some of these reports may not be legitimate. It's possible that at least
some of those reporting drug thefts are simply trying to get another
prescription for more pills -- either for personal use or to divert to the
street.

The Health Insurance Portability and Accountability Act, better known by
its acronym, HIPAA, has made investigating prescription drug abuse more
difficult, Auten says. Designed to protect a patient's health information,
the new laws make it harder for law enforcement to investigate suspected
prescription drug fraud. A patient's prescription records can no longer be
accessed by law enforcement unless criminal charges have been filed.

Drug seekers

OxyContin winds up on the street in several different ways. One way is
through forged prescriptions. Another widely used method is "doctor
shopping." Individuals who may or may not have a legitimate need for
prescription medication will approach numerous doctors in order to get
multiple narcotics prescriptions. Doctor shoppers may use the pills
themselves or sell them to others. Sometimes, patients with true chronic
pain give up their medication in order to make money. Abusers often fake
injuries in order to get prescriptions from hospital emergency rooms.

Pharmacists are on the alert for people who doctor shop, Casmus says.
Sometimes, a patient will come in with three prescriptions, each from a
different doctor. Casmus will contact the doctors to verify that only one
prescription is appropriate.

But drug seekers can be sneaky, she says. To prevent the pharmacist from
talking to the doctor, a customer will sometimes wait until 5:30 to come to
the pharmacy so that the doctor whose name is on the prescription will be
unavailable if the pharmacist tries to contact him or her.

While pharmacists would like to prevent prescription drug diversion, it's
becoming harder for them to take action. They can no longer share
information with one another about suspected drug seekers for fear of
violating confidentiality laws, Casmus says.

Casmus understands that there is potential for OxyContin abuse -- a
potential that exists with virtually any narcotic. Different people react
differently to drugs, she says. People predisposed to addiction are at
danger of becoming addicted even if they take the drug as prescribed, she says.

Part of the problem is that pain is so subjective. Doctors have been sued
for not treating pain adequately, she says.

"You have to assume that patients are telling the truth about the severity
of their pain unless you have a reason to believe otherwise," she says.

People could take the drug for more than a year without becoming addicted,
she says. If they are having chronic and significant pain, then the
OxyContin simply brings them to a level of functioning -- and will not
produce a feeling of euphoria.

"But -- if you have that tendency to become addicted and it sends you on a
high, then it becomes an issue," she says.

She and Brinkley agree that there is a greater likelihood that those who
are using OxyContin for reasons other than pain control will become addicted.

OxyContin has its place and its purpose, Casmus says. One advantage is that
unlike morphine or codeine, it does not induce nausea.

Helping abusers

Angie Banther is the substance abuse program supervisor at Piedmont
Behavioral Healthcare. She has been working with substance abuse in Rowan
County since 1990, including a short stint at the detoxification center
then serving Rowan, Davie and Iredell counties.

She believes that the medical profession has become much more aware
recently about the issues regarding OxyContin abuse and dependence.
"Physicians are monitoring the use more than they once did," she says.

Addicts who are indigent do not have to go without help, she says. Piedmont
Behavioral Healthcare has contracts with three different detox facilities
for indigent clients, she says.

Clients must be motivated to get clean and stay clean, she says. If family
members are not supportive, treatment is easily derailed. Detox is not the
cure-all that family members think, Banther says.

"People do not become addicted overnight," she says. "It's a process for
them to get clean."

The initial withdrawal period is "miserable," she says.

"Typically, the addict will call and whine enough to a family member and
the family member will go and pick them up," she says. "It's sad.

"It's a family addiction. It's not just the person who's using it. Every
person in that family is affected. The addict has picked up habits, and so
have the family members."

Parents may not want to see their adult children going through the pain of
withdrawal, she says. And they will often blame the treatment center,
saying that not enough was done.

"It's never, 'My son didn't put enough into it' or 'My daughter didn't
tough it out.'

"By far, we see the highest success rates for clients whose families
actually get involved and come to family treatment and go to Nar-Anon
meetings."

Corporate response

Despite some bad press and attempts to take it off the market, Purdue
Pharma has yet to settle a claim or lose a case in court over OxyContin,
and the revenues continue to roll in.

Purdue Pharma is using some of its profits to make sure OxyContin -- and
other prescription drugs -- stay in the hands of those who need them. To
help prevent prescription drug diversion, the Stamford-based company has
hired a former DEA agent to oversee a program that gives grants to law
enforcement agencies to use as "buy" money in pharmaceutical cases. Rowan
County received $7,500 in Purdue Pharma grant money recently, the full
amount requested, Auten says. (See related story.)

States are also trying to do what they can to help curb abuse. Recently,
North Carolina's Medicaid program implemented a 34-day supply limit on the
drug.

Medical professionals and drug enforcement officials like the idea of a
national prescription drug database, but that is unlikely to happen unless
patient confidentiality laws change.