LESSER-KNOWN FAVORITES CHEAP, ABUNDANT

While OxyContin was making headlines in 2001, another group of powerful
painkillers was pouring into Eastern Kentucky at a higher clip -- with
little publicity, but eager acceptance in illegal markets.

Pills such as Lorcet, Lortab and Vicodin -- as easy to find in the hill
country as dogwoods in spring -- are the drugs of choice in a region
swamped with prescription narcotics.

The pills all share the same key ingredient: hydrocodone, an opium
derivative that flows into Eastern Kentucky at a higher per capita rate
than anywhere else in America. More hydrocodone pills than OxyContin come
to the region each year,federal data show.

"Oxy" made national news when it was linked to dozens of overdose deaths in
2001, but one close observer said hydrocodone-based drugs might be more
lethal these days. Roger Nelson, coroner in Floyd County, said he's seen
more overdose deaths from them than from OxyContin because "it's easier to
get."

Nationally, abuse of such drugs as Lortab, Lorcet and Vicodin escalated
during the last decade, the Drug Enforcement Administration says. From 1990
through 2000, emergency room visits for hydrocodone overdoses increased 500
percent.

Locally, enough of the stuff went to Johnson, Martin and much of Lawrence
counties in 2001 to provide every adult there with 156 pills, at the
standard dose of 7.5 milligrams per pill.

OxyContin pills range from 20 to 80 milligrams worth of narcotic, and their
active ingredient is slightly more potent than hydrocodone. Still, abusers
seek Lorcet, Lortab and Vicodin, partly because they're cheaper on the street.

Undercover police officers recently bought OxyContin from street dealers
for about $40 a pill, said Capt. Mike Reichenbach of the Kentucky State Police.

Lorcet tablets went for about $9 a pill, and Lortabs brought $20 a pill,
Reichenbach said.

Hydrocodone-based pills are also less regulated. The DEA ranks them a notch
below OxyContin in terms of their potential for abuse. That means doctors
have fewer restrictions on writing prescriptions for them.

The prescriptions are refillable -- unlike those for OxyContin -- and
there's generally less jail time for those caught abusing them.

Dr. Philip Fisher, a West Virginia pain specialist, said hydrocodone use is
growing in part because negative publicity attached to OxyContin has
frightened physicians away from prescribing it.

Several of his own patients are "deathly afraid that they are going to be
investigated by the local constable" if they take OxyContin, Fisher said.

So Fisher prescribes four hydrocodone-based pills to equal one OxyContin
pill. That's one reason, he says, for rapid increases in the amount of
hydrocodone hitting the market.

Pound for pound, hydrocodone is stronger than morphine, making it an
effective painkiller for people suffering from chronic back pain, severe
arthritis and other problems.

It is usually combined with non-controlled substances such as
acetaminophen, the base drug in Tylenol. That raises another danger, Fisher
said.

In large doses, the acetaminophen can cause liver damage, he said.