EASTERN KENTUCKY PRESCRIPTION DRUG TRADE OUTPACES CITIES

LEXINGTON, Ky. (AP) -- Prescription drugs are moving into eastern Kentucky
in greater volume than they do in any city, statistics show.

In an analysis of data from the federal Drug Enforcement Agency, the
Lexington Herald-Leader found that eastern Kentucky drugstores, hospitals
and other legal outlets received more prescription painkillers than
anywhere else in the nation on a per capita basis in the four-year span
from 1998-2001.

The region led the nation each year between 1998-2000. In 2001, only St.
Louis, home to many oncologists and a teaching hospital, surpassed Kentucky.

Nearly half a ton of narcotics reached six small mountain counties in the
state during that four-year span -- the equivalent of three-quarters of a
pound for every adult who lives there.

"I can't imagine that Kentucky has any more pain than Detroit has. There's
something going on," April Vallerand, an assistant professor at Detroit's
Wayne State University who serves on pain advisory panels.

Richard Clayton, an addiction expert who heads the University of Kentucky's
Center for Prevention Research, said the problem is already out of control.

"This may be the first epidemic -- if it is an epidemic -- that started in
rural areas," he said.

Courts and hospitals are overwhelmed. The newspaper found that possession
and trafficking charges for all controlled substances jumped 348 percent in
eastern Kentucky from 1997 through 2001, while admissions of
prescription-drug addicts to residential drug-treatment centers tripled
from 1998 to 2001.

Eastern Kentucky counties led the nation in per capita narcotics
distribution in 1998, 1999 and 2000, the newspaper found. In 2001, the St.
Louis area passed Kentucky, driven by large increases in the amount of
OxyContin and of morphine, which is widely used to treat pain after surgery.

St. Louis is home to many oncologists, plus a teaching hospital, which
accounts for some of its numbers, said Susan McCann, administrator of the
Missouri Bureau of Narcotics and Dangerous Drugs.

One Appalachian pain specialist suggested that Eastern Kentucky, with its
older population, many injured coal miners and high rates of lung cancer,
might need large amounts of narcotics to treat legitimate pain sufferers.

"An older population with more chronic disease and more chronic pain would,
of course, explain at least part of the need for more pain meds," said Dr.
Philip Fisher, head of the Huntington, W.Va.-based Appalachian Pain
Foundation, a non-profit organization.

Fisher and other pain specialists argue that law enforcement intimidates
too many doctors into avoiding the use of OxyContin to treat pain. The
American Pain Foundation, a non-profit that lobbies for better access to
pain treatment, says that 33 million to 125 million Americans suffer from
undertreated pain -- a claim other experts find hard to believe.

"Pain in the butt, I can believe," said Clayton, laughing at the suggestion
that more than 40 percent of Americans are in pain.

It ought to be easy to tell the difference between legitimate sufferers and
addicts, Vallerand said. In 2000, she won a three-year, $489,000 grant from
the National Cancer Institute to study cancer pain management in the home.

"My patients with pain take these drugs so they can go back out and do the
things that are important in their lives," Vallerand said. "My addicted
population takes them to escape."

Peyton Reynolds, head of the Hazard office of the Department of Public
Advocacy, said he sees many addicts among his clients -- 95 percent of whom
sell or use prescription drugs, he said.

"Our economy has failed," Reynolds said. "Young people are in despair. They
have no future."

Those who get arrested sometimes wind up in the care of people such as
Scott Walker, the substance abuse program director for Mountain
Comprehensive Care.

Every person in Mountain Comp's 21-bed Layne House in Prestonsburg is a
recovering prescription-drug addict.

Prescription-drug abuse has been "slow and insidious over the years; the
last three or four years, it's been overwhelming," Walker said.