OXYCONTIN CAN EASE PAIN, BUT FOR ABUSERS, IT'S DEADLY

The man Shana Dunn planned to marry stumbled into the apartment, covered
with mud and grass, mumbling words she could barely understand.

He tripped over furniture. He was missing a shoe. Billy Elliott had
proposed to Dunn almost every day for a year, but now he seemed like a
frightening stranger.

For weeks in 1999, Dunn watched, sickened, as her fiance grew addicted to a
narcotic painkiller prescribed by her doctor for chronic discomfort in her
arms and wrists. Elliott, 35, would borrow a pill for a bad back or a
toothache. He always wanted more.

On this spring afternoon in Spartanburg, Elliott lurched like a drunk but
he didn't smell of alcohol. As Dunn tried to help Elliott into bed, she
feared that a prescription drug, so capable of easing the pain that
darkened her past, could devastate her future.

Dunn brought the painkiller home only months earlier, as the couple planned
their wedding.

"OxyContin," Elliott said, scanning the label. "I've never heard of that
before."

Now, three years later, law enforcement and addiction experts in the
Carolinas say abuse of few other prescription drugs has ever struck so
quickly, hurt so many or posed so complicated a challenge.

Introduced in 1996, OxyContin delivered pain relief more powerful and
longer-lasting than most other prescription narcotics. But abusers, from
longtime addicts to teens to some chronic pain patients, discovered that
crushing OxyContin disables the drug's patented time-release formula,
releasing 12 hours-worth of narcotic at once. When swallowed, snorted or
injected, it produces an immediate, heroin-like high.

As Shana Dunn struggled with one of the earliest cases of OxyContin
addiction in the Carolinas, drug informants began to warn police of a new
pill coursing through groups of mostly white, blue-collar prescription drug
abusers.

OxyContin was easier to get than heroin. Cheaper than cocaine. Gentler on
the stomach than alcohol or similar prescription narcotics.

The addicts called it Oxy or OC.

Experts suggest abuse hit the Carolinas largely because addicts from some
of the hardest hit states, like West Virginia and Kentucky, moved to the
region after law enforcement there cracked down.

Also, two pain clinics in the Carolinas -- one in Grover in Cleveland
County, the other in Myrtle Beach -- wrote unusually high numbers of
prescriptions for OxyContin and other narcotics to hundreds of people
across the region. Officials believe those clinics helped fuel a thriving
and sometimes deadly OxyContin black market.

Law enforcement and the medical community have faced a staggering
challenge: Crack down on abuse of OxyContin without limiting supply of the
drug to people who need it.

"We kind of walk a tight rope here," says Richard Seidel, Drug Enforcement
Administration deputy chief of drug operations. "No one is saying OxyContin
is a bad drug. It's a bad drug when it's abused."

An Observer investigation found:

. OxyContin abuse may have caused or contributed to at least 97 overdose
deaths in the Carolinas in 2000 and 2001. In most cases, other drugs or
alcohol may have played a role. A majority were accidental overdoses,
though 19 were suspected suicides. In some cases, casual users took the
drug and died hours later.

In at least another 104 cases, oxycodone, the main ingredient in OxyContin,
played a role in an overdose death. It was unclear whether OxyContin or
another oxycodone-based pain pill was involved.

The Carolina death count is far higher than what was reported in an April
national study, based on limited data. The DEA estimated that OxyContin
abuse may have contributed to 464 overdose deaths nationwide in the last
two years. But that estimate included only 14 S.C. cases and none from
North Carolina.

. In some areas in the Carolinas, distribution of OxyContin is among the
nation's heaviest. DEA reports show those areas include Myrtle Beach and
Spartanburg, and a region that runs from Rutherford to Cabarrus counties,
including almost all of Gaston County, Concord, Lincolnton and the area
around the Grover pain clinic. Those areas are in the top 7 percent
nationally for OxyContin distribution per-capita.

DEA officials say some of the regions in the United States where OxyContin
is distributed most heavily are among the same areas most affected by abuse
of the drug.

. OxyContin addiction has overwhelmed some drug detox centers already
lacking staff and services. And across the region, law enforcement has
arrested hundreds of suppliers and dealers. In Charlotte, where some
addicts call OxyContin pills "coffins," police have investigated 40 cases
of abuse or diversion.

. In some Carolina communities, law enforcement fears young people are
beginning to abuse OxyContin. The drug has been found at rave parties; some
dealers say they've sold OxyContin to college students.

. At least nine doctors in two pain clinics have faced accusations of
inappropriately prescribing OxyContin and other narcotic painkillers. In
the Carolinas' most high-profile case, Dr. Joseph Talley of Grover, has
been linked to the deaths of 23 patients who overdosed on OxyContin or
other narcotics he prescribed. If Talley is charged criminally, his case
would likely be the largest of its kind in the nation.

Some pharmacists and law enforcement believe OxyContin's manufacturer,
Connecticut-based Purdue Pharma, may have contributed to the problem in the
Carolinas, particularly in the Myrtle Beach area, by overpromoting the drug
for widespread use despite reports of crime and abuse.

Purdue officials say they have responsibly marketed their product according
to its approved use by the Food and Drug Administration, and do not have
regulatory or law enforcement authority over how physicians use medications.

Purdue spent about $200 million on OxyContin promotion last year. The
company says that's an industry standard.

Purdue did not anticipate the extent of abuse involving OxyContin, and
researchers there are now developing an abuse-resistant pill, says
spokesman Jim Heins. Purdue has also strengthened the warnings on the
drug's label.

By all accounts, OxyContin is safe when taken as prescribed, though there's
a risk of addiction when taking any narcotic painkiller.

Heins says Purdue can't be held responsible for deliberate abuse of its
medications.

"These are federally controlled medications that have had a known abuse
potential since before OxyContin was ever on the market," he says.

But while other prescription drugs can cause fatal overdoses, OxyContin is
more potent than most pain pills because it is delivered in higher doses --
making it attractive, and highly dangerous, to those who misuse or abuse it.

"There are a number of cases where individuals literally took a single,
large dose, and maybe had some alcohol or other drugs, and the next
morning, they're dead," says Dr. Andrew Mason, a forensic toxicologist in
Boone who analyzed the Carolinas deaths for The Observer.

Abuse of OxyContin has also fueled crime.

In Myrtle Beach, a man in a ski mask held a pharmacist and technician at
gunpoint demanding OxyContin -- not cash.

In Concord, police charged a former high school teacher with trying to hire
a man to kill two people who owed him money for OxyContin.

And last month in Columbus County, about 160 miles east of Charlotte,
police sought 32 people accused of selling their Medicaid cards to drug
dealers who billed the state for thousands of dollars in OxyContin
prescriptions.

N.C. Medicaid paid $14.7 million for OxyContin prescriptions in 2001, more
than three times higher than in 1999. South Carolina paid $8.4 million,
almost an eightfold increase.

While both Carolinas have attempted to curb Medicaid costs, neither state
has what experts consider among the best tools to fight prescription drug
abuse: a statewide monitoring system. The computer system would track
prescriptions and expose patients filling suspicious quantities of drugs
like OxyContin. About 15 states have systems in place.

"Maybe this could have saved one person's life. We'll never know," says
John Womble, who oversees the regulation of controlled substances for North
Carolina and has pushed for a monitoring system. "We have a prescription
drug abuse problem here, and OxyContin is at the forefront."

But in 1999, when Shana Dunn's fiance started taking her pain pills, the
Carolinas were only beginning to see the effects of a drug that would
quickly become one of the most abused prescription painkillers in the
Southeast.

"OxyContin really helped with my pain," says Dunn, "...but it has caused me
nothing but agony."

OxyContin Hailed For Relief

To people with cancer, debilitating back aches, headaches that never go
away, or elusive pain so severe that working, walking and even sleep become
unmanageable, OxyContin is in every sense a miracle drug.A single pill
offers pain patients 12 hours of steady relief. And while many pain pills
contain 5 milligrams of oxycodone, an opiod similar to morphine, OxyContin
comes in strengths up to 16 times higher. By releasing pain medicine
through a time-release formula, patients can tolerate larger doses with
fewer side effects.

OxyContin has become the number one prescribed narcotic of its kind in the
United States, with about 2 million people taking the drug.

"The abuse is a tragedy, because the good far outweighs the bad," says Mark
Gordon, with the National Foundation for the Treatment of Pain. "It's the
most remarkable pain medication around, hands down."

OxyContin gave patients like Mary Salopek of Cornelius hope of returning to
a more normal life.

Salopek, an optician, suffered persistent pain after breaking her wrist in
2000. She couldn't shower by herself. She couldn't sleep. She stopped
cooking dishes she was so proud of, such as stuffed cabbage. She laid in
bed for hours -- moving even a finger induced painful spasms.

A proud woman who doesn't complain, Salopek cried to her grown daughter:
"It's like labor pains that never go away."

Charlotte pain specialist Dr. Mark Romanoff studied her hand and wrist, so
swollen he could barely make out her fingers. His diagnosis was reflex
sympathetic dystrophy, or RSD, characterized by severe burning pain,
swelling and changes in bone and skin, often occurring at an injury site.
Romanoff prescribed OxyContin, as well as physical therapy and injections
to block pain.

"It's like a miracle," Salopek remembered telling her daughter after taking
the drug. She still takes OxyContin as prescribed. "I can't believe I
suffered for so long."

By 2000, OxyContin sales in the United States reached almost $1 billion, 22
times more than in 1996, and the number of prescriptions grew to 5.8
million. In 2000, 189 million prescriptions were dispensed for all opiod
drugs, including OxyContin.

Drug enforcement agents across the eastern United States worried.

Reports from pharmacists, doctors and families described a growing and
suspicious interest in OxyContin not only among addicts, but among young
people experimenting with drug abuse and some pain patients who abused
their medication either for a quick high or because they thought taking
more drug would reduce their pain. There were national reports of
prescription forgeries and pharmacy thefts.

Other prescription drugs, such as Dilaudid, have posed problems for law
enforcement. But drug enforcement agents say OxyContin abuse struck more
swiftly than abuse of any other drug in decades.

Rural areas in Maine, Alaska and Appalachia were hit first in the late
1990s, mainly in poor, working-class towns without easy access to illicit
drugs like heroin and cocaine. OxyContin was government-approved, and often
paid for by insurance or Medicaid, the federal health insurance program for
the poor.

In 1999, abuse reached a second group of states.

In Atlanta, DEA diversion chief Bob Williamson studied reports of abuse in
the Carolinas, Georgia and Tennessee. He expected to find the usual, drugs
like Xanax, Valium and hydrocodone.

This time, he saw a new drug: OxyContin.

Abuse Hits The Carolinas

Thirty-five miles south of Myrtle Beach, drug informants in 1999 started
telling police about the "next good thing," a tiny white pill with the
marking OC.

"We didn't even know what it was," says Georgetown police Sgt. Jim Arnold.
"And then suddenly it was like, wham. Overnight it was everywhere."

In York County that same year, narcotics officers used a Physicians' Desk
Reference to identify an OxyContin pill found on a 16-year-old selling
drugs out of his parents' home.

In Durham, the Sheriff's Office received faxes from pharmacists, warning of
forged OxyContin prescriptions.

In Lenoir, north of Hickory, a 25-year-old mother started spending hours
hunting for the drug.

Lisa, not her real name, had abused cocaine months before, but by 1999, she
was trying to stay clean. Recently separated from her husband, she had a
5-year-old daughter to raise, and she wanted to remember their outings at
the park or their giggles over games like Chutes and Ladders. Cocaine
blurred her memory.

Then Lisa's sister started using OxyContin.

"They make you feel so good," her sister had said.

Lisa crushed and snorted a 20 milligram tablet she got from a friend. She
was quickly hooked. She started spending $200 a week on OxyContin,
eventually pawning her wedding ring, television, CDs, even her daughter's
Disney movies.

Most days, Lisa would wake up sick, and wander the streets looking for a
dealer.

"It was like 10 hours of searching for four hours of a high, and then
starting all over," she says.

She stopped going to church. She stopped spending time with her daughter.
When she became pregnant last year, Lisa still abused the drug, even when
she feared she could no longer feel the baby kick.

"I had gotten to the point where in my mind I was thinking if I lose this
baby, at least I'll have something to keep me numb," she says.

The baby was born, premature but healthy. Weeks later, Lisa enrolled in a
drug rehab center near Asheville.

"Once," she says, "I had everything."

Addicts Plead For Help

On the front lines in the battle against addiction -- drug treatment
centers and emergency rooms -- a new wave of addicts in 1999 started
showing up for help. Pain patients, teens and recreational drug users who
had abused OxyContin: sweating, vomiting, holding their heads, begging for
relief.Coming off oxycodone produces symptoms similar to food poisoning or
a massive case of the flu. Every ache becomes sharp. A headache feels like
a migraine, a toothache like a root canal.

At Horizons at Carolinas Medical Center-Mercy in 1999, certified substance
abuse counselor Ben Roberts met addicts melting their OxyContin, mixing the
powder and injecting the drug for an immediate high. One told Roberts that
OxyContin was like 10 pain pills combined.

In Myrtle Beach, medical director Dr. John Molnar talked with his staff at
Grand Strand Regional Medical Center about treating patients suffering
OxyContin withdrawal.

"As soon as someone sees a pill that's strong and says, 'Do not crush. Do
not chew. Do not break,' the first thing they do is crush it and chew it
and break it," Molnar said.

South of Spartanburg in Laurens County, Deputy Coroner Bill Seawright got a
call from his office: "We've got a Clinton High student up here."

The 15-year-old had overdosed on OxyContin and alcohol, Seawright says. A
coach and driver's education teacher, Seawright remembered the teen from class.

"I didn't sleep for a couple of nights," he says. "After that, it was boom,
boom, boom. We started seeing one case after another."

Loss In Spartanburg

In Spartanburg, OxyContin in 1999 allowed 26-year-old Shana Dunn to live
without pain. But her fiance, Billy Elliott, was quickly hooked.

Dunn met Elliott over the Internet two years earlier. He was studying to
become a doctor, and was taking undergraduate classes at USC Spartanburg.
Dunn wanted to get a job teaching elementary school.

Within months, they moved in together, and Elliott asked Dunn to marry him.
They set a wedding date: July 29, 2000.

Then, in January 1999, Elliott dropped out of college.

He had kicked an alcohol addiction before but started drinking heavily.
Dunn also suspected he was abusing his anti-depressant medication.

That spring, Dunn started taking OxyContin. It immediately eased knife-like
pain caused by lupus, an inflammatory disease.

At first, Elliott asked for an occasional OxyContin. She eventually told
him he had a problem and tried to get him into rehab, but he was released
after several days.

In April 1999, Dunn hid her pills in a refrigerator at work.

Days later, she found Elliott staggering into the apartment. She put him to
bed. Later that night, a friend called to say Elliott had slipped out of
the house while Dunn slept. He was disoriented and obviously high.

Again, she settled him back into bed, then fell asleep on the couch.

The next morning, May 2, Dunn checked on Elliott. She knew instantly he was
dead.

His skin was gray, and there was a pool of vomit around his mouth. She ran
to him, crying, "Billy, Billy, wake up!" She touched his arm. It was cold.

An investigator from the Spartanburg Coroner's Office ruled the death due
to oxycodone intoxication. Elliott had choked on his own vomit. The coroner
also noted Elliott had taken several sleeping pills.

Later, Dunn discovered that Elliott had taken the key to her office and
stolen some OxyContin.

"When he took those pills, it was like something took over his mind," says
Dunn, who teaches first grade and is single. "I lost my best friend...my
everything."

Elliott was among the first in the Carolinas to die of an overdose related
to OxyContin abuse. In 1999, few suspected abuse of the drug would so
quickly devastate families and communities.

The Carolinas were about to find out.