OXYCONTIN ABUSE EXPLODES

For weeks in 1999, Shana Dunn watched, sickened, as her fiance, Billy
Elliott, grew addicted to OxyContin, a narcotic painkiller prescribed by
her doctor for chronic discomfort in her arms and wrists.

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.

Elliott, 35, would borrow a pill for a bad back or a toothache. He always
wanted more.

On a spring afternoon in Spartanburg, the man Dunn planned to marry
stumbled into the apartment, covered with mud and grass, mumbling words she
could barely understand.

Elliott lurched like a drunk, but he didn't smell of alcohol. As Dunn, 26,
tried to help Elliott into bed, she feared that the prescription drug, so
capable of easing the pain that darkened her past, could devastate her future.

Introduced in 1996, OxyContin delivered pain relief more powerful and
longer-lasting than most other prescription narcotics. But abusers, from
long-time 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, heroinlike 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, such as 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, N.C., the other in Myrtle Beach - prescribed 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 tightrope here," says Richard Seidel, Drug Enforcement
Administration deputy chief of the drug operations section. "No one is
saying OxyContin is a bad drug. It's a bad drug when it's abused."

An investigation by The Charlotte (N.C.) Observer 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 a April
national study, based on limited data. The DEA estimated that OxyContin
abuse may have played a role in 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.

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 some Carolina communities, law enforcement officers fear 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.

Some pharmacists and law enforcement officers 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 it.

Purdue spent about $200 million on OxyContin promotional activities last
year. The company says that's 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.

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 abusers.

"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 caught a former high-school social studies teacher
trying to hire a hit man to kill two people who owed him money for OxyContin.

And last month in Columbus County, N.C.,which borders Horry County, police
sought 32 people accused of selling their Medicaid cards to drug dealers
who billed the state for thousands of dollars in OxyContin prescriptions.

OxyContin hailed for relief

To people with cancer, debilitating back aches, headaches that never go
away, or elusive pain so severe that working, walking or even sleep becomes
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 five milligrams of oxycodone, an opioid similar to
morphine, OxyContin comes in strengths up to 16 times higher. By releasing
pain medicine through a patented time-release formula, patients can
tolerate larger doses with fewer side effects.

OxyContin has become the No. 1 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."

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 opioid
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 drugs and some pain patients who abused their
medication either for a quick high or because they thought taking more of
the 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 such as 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
such as 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 told
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.

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 OxyContin, 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."

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 came in 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
the 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 allowed Shana Dunn to live without pain.

But her fiance, Billy Elliott, was quickly hooked.

Dunn met Elliott over the Internet two years earlier in 1997. 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 knifelike
pain in her arms and wrists 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 into bed, then slept 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 choked on his vomit.

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

INFO: Coming Monday | Law enforcement fights back, in Myrtle Beach and
across the state.