DRUG OVERWHELMS STRAPPED SYSTEM

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, N.C., 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 310,000 in South Carolina and
876,000 in North Carolina - roughly 8 percent 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 the 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, Americans 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.

South Carolina's system for addicts has 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."

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.

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.

Most patients at the center stay 28 days. Waiting lists at the other two
centers, one just north of Durham, N.C., the other east of Raleigh, N.C.,
are slightly smaller, but that's partly because those centers offer shorter
stays.

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

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.

In Myrtle Beach, one of the areas 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 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?"