RURAL PRESCRIPTION DRUG TRADE OUTPACES CITIES

"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.