ADDICTS STRUGGLE TO BREAK DRUG'S GRIP

He made his home in crack houses, sleeping beneath beds to avoid gunfire.

He made money by begging: Homeless. Need to eat.

He bought drugs by selling drugs. He'd keep a few pills as payment for his
work.

Then, in early May, Derek Collins showed up at the Julian F. Keith Alcohol
and Drug Abuse Treatment Center near Asheville, determined to kick an
addiction to OxyContin.

He came because at 23, he feared he was going to die.

For months, OxyContin abusers have strained drug treatment centers across
the Carolinas, forcing counselors into a frantic scramble to find support
and services.

No one knows for sure how many people in the Carolinas abuse drugs or
alcohol, but estimates put the number at 876,000 in North Carolina and
310,000 in South Carolina, roughly 8 to 10 percent of each state's
population. Every year thousands go untreated because rehab centers,
particularly those offering inpatient treatment, often lack bed space and
staff.

Those shortages only grew worse, experts say, when OxyContin abuse struck
the Carolinas.

"It's the newest, strongest, most seductive drug out there," says Bill
Rafter, director of Julian F. Keith center, which some addicts call The
House of New Beginnings. "It put more strain on a system that already can't
handle what it's supposed to do."

Now, as law enforcement pushes to rid the region of OxyContin abuse,
substance abuse leaders say the Carolinas must focus not only on dealers,
doctors and the drug, but on the treatment of addiction. They also say
legislators and the medical community must quickly take steps to fight drug
abuse, such as creating a prescription monitoring system and offering
health care professionals training in addiction and the use of narcotics.

In 1998, every American paid an estimated $277 in state taxes to deal with
the burden of abuse and addiction on social programs, according to The
National Center on Addiction and Substance Abuse at Columbia University.
That compared with just $10 for prevention and treatment.

In North Carolina, repeated studies ordered by the General Assembly have
found dangerous gaps in substance abuse treatment. About 3,000 patients
whose primary diagnosis was substance abuse were sent to state psychiatric
hospitals last year -- 22 percent of overall admissions -- even though
hospitals provide little in the way of focused treatment.

Of North Carolina's 100 counties, about 65 have no inpatient treatment
centers, according to a 1999 study. And those that do frequently run
waiting lists.

Counties hard-hit by OxyContin abuse, such as Rutherford, have no beds.
Gaston and Cleveland counties have an average of just 1.3 beds for every
10,000 residents. Mecklenburg, with about 69,000 people needing treatment,
has 3.6 beds for every 10,000 residents even though the county has some of
the state's more extensive treatment options.

North Carolina has three state-run, drug treatment centers, but they also
run waiting lists. In May, 176 people were waiting for a bed at the center
in Black Mountain -- at any one time, about 90 are from Mecklenburg County.
Most patients at the center stay 28 days. Waiting lists at the other two
centers, one just north of Durham, the other east of Raleigh, are slightly
smaller but that's partly because those centers offer shorter stays.

South Carolina has a larger system for addicts, with 34 local agencies
charged solely with providing support, referrals and services. But
officials say too many abusers still end up in psychiatric hospitals. The
state has only 70 beds for patients who need short-term detox services. And
while the state runs inpatient programs for women, it has none for men.

When OxyContin abuse struck communities from Rock Hill to Myrtle Beach
beginning in 1999, treatment centers felt the impact.

"When you have a substance like OxyContin...it rises like a tidal wave all
at once," says John Hart, spokesman for the S.C. Department of Alcohol and
Other Drug Abuse Services. "If you've got 12 beds for detox and you're
running 90 percent full all the time, it doesn't take much to overwhelm the
system."

Making matters worse: The Carolinas have only a small network of private
agencies that provide support such as halfway houses.

Almost 60 percent of treatment facilities nationally are run by nonprofit
organizations, compared with 28 percent in each of the Carolinas. The
number of private, for-profit treatment centers is waning. A number of
facilities have closed because of operational or financial concerns.

Overall, North Carolina lost 230 beds for substance abuse treatment in the
last three years. South Carolina lost 150 beds.

Private health insurance often doesn't cover extensive inpatient treatment.
And policies that do pay typically won't cover repeated stays even though
research has shown that a majority of abusers need more than one round of
treatment.

"The first thing everybody needs to do is treat addicts like they're people
and not as though they're criminal weirdoes," says Tony Mulvihill, with the
Durham-based Alcohol/Drug Council of North Carolina. "We don't have
sufficient treatment for anybody who abuses drugs of any type at this time."

In Myrtle Beach, one of the region's most affected by OxyContin abuse,
addicts have overwhelmed the nearby Shoreline Behavioral Health Services.

In 2000, the center served just four people whose primary problem was abuse
of opiate prescription drugs, which include painkillers like OxyContin. In
2001, the number grew to 24 patients, most struggling with OxyContin abuse.

Some reported they started abusing the painkiller while seeing doctors for
chronic pain. They told staff they began to crush the drug, mix it with
water and inject it for an immediate rush. Others, looking to reduce their
pain, bought more pills from dealers when their prescriptions ran out.

They came to the private, not-for-profit center in severe withdrawal,
shaking, sweating, vomiting and dehydrated. Off the drug, the pain returned
sharper and more pronounced.

"I remember thinking that this was the most urgent situation that we've
been in and feeling rather helpless in how to solve the problem," says
Tonya Compton, Shoreline deputy director of clinical services. "People
would tell us, 'I never knew about the potency. I never knew how quickly I
could become so dependent on it.' "

The staff worked triage. The center mostly provides outpatient treatment
and therapy, so counselors worked the phones trying to reserve beds in
medical detox units and residential facilities in other Carolinas' cities.
Often, they encountered waiting lists, or patients couldn't afford the
rates. Some had no transportation, others no family support.

Some clients returned to Shoreline several times, staffers say, unable to
wean themselves off OxyContin. The slightest trigger can throw a
prescription drug abuser into relapse, such as driving by the doctor's
office that first provided the pills.

Most nights, Compton left exhausted. She'd go home and her fiance would
say, "Bad day with OxyContin, huh?"

At the York County Treatment Center, half of the last 20 people admitted
for outpatient treatment in recent months were OxyContin abusers.

"It's the heroin of the 2000s, no doubt about it," says Rob Priest, medical
services coordinator at the center.

Derek Collins showed up at the center in Black Mountain after months of
living beneath bridges or in crack houses. He says he would crush a dozen
of the strongest-strength OxyContin pills -- or the equivalent of 192
average-strength narcotic painkillers -- and snort the powder through a
straw throughout the day.

"It puts you in such a state of ecstasy," he says. "Nothing else can touch it."

From Wilkes County, north of Catawba, Collins started taking drugs at 10.
He was arrested several times on charges ranging from drunken driving to
breaking and entering. A friend told him about OxyContin.

He says he started selling the drug, often to college students. He sold the
Mazda pickup truck he got for his 16th birthday for $500 worth of drugs
including OxyContin and heroin.

In early spring, police in Asheville found him stoned, drunk and bumming
money for food. They took him to Broughton Hospital, a state psychiatric
center in Morganton. Collins asked to be transferred to the treatment
center in Black Mountain.

The center, which has five doctor positions, is down a psychiatrist. A
dozen jobs, mostly support staff, were eliminated in 2000 to create six
nursing positions in a new crisis detox unit.

But Collins says the center's staff has helped him cope with his addiction,
and now he hopes to become a drug counselor.

Eight months ago, he used a cigarette lighter to burn the track marks off
the undersides of his arms because he didn't want to look like a
needle-user at job interviews.

"I feel the best now since I was a little kid," he says. "It's nice to have
a bed to sleep in at night and know that you're getting three meals and
that people here are supporting you."

That's why psychiatrist Tony Bird stays. Specializing in addiction, he's
helped even hard-core addicts build stronger, healthier lives.

Sometimes, they stumble. They return to the rehab center in worse shape
than before.

But Bird tries again.

"There's something very special about dealing with someone who is kind of
waking up for the first time," he says. "They've been numbing themselves.
They've been escaping from life, and all of the sudden they're waking up
and they're finding meaning in life."

"There's something very special about that."