I WANT A NEW DRUG

OxyContin, A Powerful Prescription Painkiller Popular In Other Parts Of The
Country, Has Moved Into Memphis.

It's a typical Saturday night for 22-year-old Jason Reyick,* a cook at a
Midtown restaurant. He went to work around 5 p.m., walked home at midnight,
then set about finding some drugs. Sometimes this task involves a trip to
the liquor store, sometimes a phone call to his trusty pot dealer. But
tonight a friend with a baggie full of little yellow pills shows up.
Tonight, there's just a payment of $20 for a 40-milligram tablet of
OxyContin, a powerful prescription painkiller that's recently entered the
illegal drug market and rapidly gained popularity.

Later, a few friends from work show up, ready to party. Each purchases a
pill, and their fun begins. Reyick, who prefers to snort OxyContin rather
than chew or inject it, chops his pill into a fine powder with a pocket
knife. He lays a dollar bill over the crushed pill and runs a lighter over
it to crush all the chunks. Then he uses his knife to form the powder into
a neat line, rolls up the dollar bill, and proceeds to snort the powder.

His friends follow suit, and minutes later, they enter a dreamlike state.
Reyick slowly leans back on his ratty black couch, takes a deep breath, and
closes his eyes, letting his body totally relax as peaceful thoughts sweep
through his mind. The back pain from work floats somewhere far away. For
the next several hours, he moves only to go to the bathroom a few times --
and once to dry-heave over the toilet.

You may never have heard of OxyContin, but the scene described above is
growing more common all over the Mid-South, a reflection of a national
trend toward increasing abuse of the potent painkiller. In Tennessee,
reported cases of OxyContin abuse are more prevalent in the eastern part of
the state, but state DEA officials report that the drug is being
increasingly seen in the Memphis area.

Trading Pain For Pleasure

Despite the number of strong painkillers on the market before 1996, people
with severe pain due to cancer or other debilitating conditions were in
need of something more. Oxycodone-containing medications available at the
time, such as Percocet and Vicodin, contain additional ingredients, such as
acetaminophen, which can cause organ-toxicity problems in large doses.

Since opiates cause tolerance to develop rather quickly, chronic pain
sufferers would eventually have to up their dose to achieve the desired
effect, thus also increasing the dose of acetaminophen or other added
ingredients.

In December 1995, Purdue Pharma introduced OxyContin, a time-release pill
which contained a much higher concentration of oxycodone and no
acetaminophen. The oxycodone level in one 40-milligram tablet of OxyContin
is equal to eight five-milligram Percocets. It was made available in a
variety of strengths -- 10, 20, 40, 80, and 160 milligrams -- and
prescribed according to the severity of pain.

"The indication is for an intensity and longevity of disease. It's for
people who feel pain 24 hours a day and people who're going to be in pain
for the rest of their life," says Jim Heins, associate director of public
affairs at Purdue Pharma. "Say a back surgery has failed or they have
cancer or maybe they've been in an accident and they're going to be in pain
for decades. It's not disease-specific. It's prescribed due to the
chronicity of the pain."

Oxycodone, the active ingredient in OxyContin, is a derivative of opium.
Its effects are similar to that of morphine. In the Comprehensive
Controlled Substances Act of 1970, Congress placed the drug under Schedule
II status, which includes drugs that have some medical use but a high abuse
potential. Oxycodone is cited as an effective analgesic for mild to
moderate pain control, for chronic-pain syndrome, and for the treatment of
terminal-cancer pain. OxyContin pills are covered with a coating that
time-releases oxycodone into a user's system for 12 hours. Abusers of the
drug typically chew or crush the pills to get past the coating, releasing
all the oxycodone at once for a much stronger high.

"OxyContin is kind of like a dream, but you can control it," says Reyick.
"It comes on slow and steady, kind of like a cocaine buzz, but once it
hits, you're just in a hole. It's not a bad hole, though. It's just the
kind of hole that you can cruise through."

When asked to explain the buzz, many users report something similar to a
dreamlike state, where the body feels loose and heavy but the mind is in a
state of intense euphoria. High doses of OxyContin, also known as OCs or
Oxys, can cause loss of concentration, dizziness, skin that is sensitive to
the touch, heavy sweating, and slurred speech. When there is little food in
the stomach, the drug can also cause mild nausea.

According to the Office of National Drug Control Policy's Pulse Check
report, released in April 2002, many users in the Memphis area are engaging
in OxyContin use in nightclubs and at parties, where it is often associated
with the use of club drugs such as Ecstasy.

The Pulse Check also reports that OxyContin in Memphis is regularly
bartered for other drugs, such as crack cocaine or other prescription
pills. Twenty-milligram pills are sold for $10-$30 each, depending on the
dosage strength.

Drugstore Cowboys

There are a number of ways OxyContin is being diverted from pharmacies to
the streets. According to Mike Arpiao, a prescription drug diversion
officer for the Tennessee DEA, the state is 16th in the nation in acquiring
the drug for pharmacies, physicians, and hospitals. "People are obtaining
it through doctor shopping [obtaining multiple prescriptions from a variety
of doctors], forged prescriptions, or buying it off the street from people
who are selling their prescriptions," he says. "There are also unscrupulous
pharmacists that could be selling it out the back door without a prescription."

Drugstore robberies are another method of diversion, and the Pulse Check
reports that thefts from the homes of legal users are also common. But
according to the report, most of the OxyContin sold in Memphis has been
diverted from the Northeast and shipped to the South.

The Shelby County vice-narcotics unit made only 10 OxyContin-related
arrests last year, according to Major D.A. Betts. But the unit is seeing an
increase in the use of the drug locally. Officers knew of the growing
OxyContin abuse problem in eastern Tennessee and were aware of the
potential problem. The drug is already very popular in the local DJ and
rave circuit.

Accidental Addiction

Not everyone who's abusing OxyContin is doing it purely for pleasure.
Barbara Teague,* a 55-year-old local, was diagnosed with polio at age 3 and
now suffers from a chronic muscle deterioration known as post-polio
syndrome. The condition makes her bones brittle, and last year some bones
in her hips were broken beyond repair. Doctors performed hip-replacement
surgery, but Teague still suffers an extraordinary amount of pain. She's
prescribed 90 milligrams of OxyContin a day.

Her 28-year-old daughter Anna,* a pharmaceutical sales major at the
University of Memphis, thinks her mother, who's been taking the drug for a
year and a half, has developed an addiction and says it's caused multiple
problems in her family.

"Sometimes, I'll have to monitor her medication without her knowing it,"
she says. "I'll count them and look at the date on the bottle. She's
supposed to be taking three a day, so if there's eight gone in a day, I'll
know she's overmedicating. She takes care of my daughter during the day
when I'm in school. One day she was so screwed up, she couldn't find her
ass from a set of bullhorns. I couldn't leave my daughter with her. I had
to miss school."

Anna says her mother has trouble admitting she may have a problem and often
resorts to excuses: "Well, I accidentally overdid it." Or "I forgot I'd
already taken some." Or "I need to get one of those little pill dispensers
with the numbered days so I won't mess up."

"She knows what she's doing, but she's in denial," Anna says. "She wants to
get a little high sometimes, and that's the way she does it. Some people
smoke pot. Some people drink. She takes pills by the handful."

The Teague family's OxyContin problem is not uncommon. In recent years,
Purdue Pharma has been hit with a number of lawsuits from patients who were
prescribed the medication and claimed to have become addicted.

Jim Heins of Purdue Pharma told the Flyer that the company has no hard
numbers on how many lawsuits they've faced since 1995 regarding OxyContin
addiction, but he says they are performing an analysis and will eventually
release a report to the public. Heins adds that the recent increase in
media coverage of OxyContin has created a negative picture of the drug,
leading many patients to believe they are addicted when they may not be.

Dr. Clifford Bernstein, medical director of the California-based Weismann
Institute, an opiate treatment center, disagrees. He says that many of the
cases they treat involve people who were prescribed OxyContin and became
hooked.

"We used to only treat heroin addicts, but now we're about 70 percent
prescription medications, and OxyContin's my number-one drug. Purdue Pharma
is denying the stuff's even habit-forming, just like the tobacco industry,"
he says. "A lot of patients don't realize that after a while, the drugs
don't work and your dose is escalated. The next thing you know, you're hooked."

Hope & Healing

Addiction to OxyContin can result in the same kind of gradual wasting away
that affects heroin and morphine addicts. Not all of those who engage in
occasional recreational OxyContin are addicted, however. In fact, those who
are prescribed the drug may run a higher risk of addiction because their
supply is so readily available.

Reyick says he doesn't have a problem and only occasionally uses OxyContin.
He says he only does it when it happens to be around, although he adds that
if he had more access to the drug, he'd have to watch himself.

"OxyContin's one of those things that if you think you have control, then
you've already fooled yourself and you're in a dangerous position," says
Reyick.

For those who have a problem, extensive -- and often expensive -- treatment
programs are available for opiate abuse. The programs fall into two
categories: medical and social.

Medical treatments include the highly effective but very pricey
rapid-detoxification method as well as the more traditional methadone
program. Social treatments include drug counseling, such as Narcotics
Anonymous. Medical treatment is recommended for serious opiate problems due
to possible life-threatening withdrawal symptoms.

Methadone is administered orally to opiate-addicted patients once a day in
clinics such as the Memphis Center for Research and Addiction Treatment on
Madison Avenue. It's a medically-safe drug, with no toxic side effects,
that relieves withdrawal symptoms, eliminates opiate cravings, and allows
for normal body functioning. Methadone has no narcotic effects but can
cause withdrawals if not properly administered. Patients are normally
weaned from methadone over a six-month period.

The Substance Abuse and Mental Health Services Administration reports that
methadone clinics nationwide have seen an increase in OxyContin abuse in
recent years, including a particularly significant increase in 2001. Lisa
Massey, a counselor at the Memphis Center, says the center has not seen a
large number of patients with OxyContin problems, but she says it may be
moving this way soon from East Tennessee. Massey says the number-one drug
they treat is probably Dilaudid, a synthetic form of heroin.

(Treatment at the Memphis Center costs about $5,700 if a participant
completes the entire program. Patients are charged $77 per week for 18
months, in addition to an initial fee of $127.)

The other form of medical treatment available, rapid detoxification,
involves the administration of a pill called Naltrexone and promises
results in three days. There are several methods of rapid detox performed
at various clinics across the country, but the original method, practiced
by the Weismann Institute in San Diego, has been around the longest and has
a success rate of 65 percent after a year. There are no rapid-detox centers
in the Memphis area.

"The Weismann method blocks cravings after bringing people through the
withdrawals as humanely as possible," says Dr. Bernstein, the institute's
medical director. "Methadone blocks cravings, but so do other opiates.
They're 100 percent interchangeable. The Naltrexone that we leave people on
afterwards is exactly the opposite. If you're hooked on an opiate and you
take a Naltrexone pill, you'll get very sick."

"Look at OxyContin as a key that fits in a lock, the lock being the
receptor. The key goes in the lock, opens the door, and turns on the
receptor," Dr. Bernstein explains. "That's what gives the effect of
OxyContin. Naltrexone is the drug we use to compete for that lock. It's
like a key that's been broken in half. You can put the key in the lock, but
you can't open it. It blocks that receptor."

Social treatments, such as the 28-day program at New Directions Inc. on
Semmes Street in Memphis, provide patients with group counseling and
one-on-one therapy. Sharon Couch, administrative assistant for New
Directions, says they have yet to see large numbers of OxyContin abuse but
pointed out that when someone comes in with a severe opiate addiction, she
usually sends them to Central Intake at the Memphis and Shelby County
Health Department for medical treatment to bring them through withdrawal.

"We're strictly social. We don't give any medicines. So if they've been off
it a couple days and they're pretty stable, we take them on in," says
Couch. "What we try to do is get people to change their thinking, not just
their behavior."

The U.S. DEA has recorded 318 deaths in which OxyContin was a contributing
factor. Although OxyContin overdose is usually a result of poly-drug
toxicity, it still plays a major role. According to Major Betts, there is
one case in federal court involving an OxyContin overdose in the Memphis area.

Of the 20 major cities studied in the Pulse Check report, Memphis is among
12 in which OxyContin availability is reported as increasing markedly. The
Tennessee Bureau of Investigation's 2001-2002 Annual Report shows an
increase in OxyContin abuse statewide. You may not have heard much about it
yet, but OxyContin is coming, and the problem is likely to get worse before
it gets better.