Pubdate: 22 Apr 2001 Source: Salisbury Post (NC) Copyright: 2001 Post Publishing Co. Contact: http://www.salisburypost.com/ Details: http://www.mapinc.org/media/380 Author: Jill McCartney OXYCONTIN: DOCTORS, POLICE SAY ABUSERS MAKING BAD USE OF A GOOD DRUG For years we have heard of police combating drugs such as marijuana, cocaine and heroin. But now officials in Rowan and Cabarrus counties are paying attention to a new drug - a legitimate drug that is being misused. Police says OxyContin is making some dealers a tidy profit and hooking - sometimes killing - its users, including at least one victim in Kannapolis. OxyContin has made itself known in dramatic fashion. According to the State Bureau of Investigation, the prescription drug contributed to 28 deaths in North Carolina in 1999, but only a year later, investigators connected it to 70 deaths. Likewise, in 1999, OxyContin was blamed as the sole cause of six deaths in the state. In 2000, that number had more than tripled to 21 deaths. Sammy Monte Andrew Bringle died of an overdose on Nov. 18. An autopsy found oxycodone, the base ingredient of OxyContin, in his system. Authorities believe the 17-year-old A.L. Brown student stole the drug from Martin Drugs in north Kannapolis, where he worked. OxyContin, an opiate derivative, is a controlled time-release tablet prescribed for pain. Doctors prescribe it for problems ranging from fractures, joint and back pain and arthritis to cancer and childbirth. The drug also falls under the generic name Oxycodone HCL. OxyContin, a schedule II narcotic, is among the drugs with the greatest potential for addiction. Other schedule II drugs with the same potential include painkillers methadone, mepergan fortis, percodan, percocet, tylox and narcotics such as Ritalin, which is commonly prescribed for Attention Deficit Disorder. Aside from potentially fatal doses, the major risk is addiction, according to Tim Williams, pharmacist for Rowan Medical Facility at Rowan Regional Medical Center. "They need more and they'll get it any way they can," he said. Addiction Individuals who take the drug run a high risk of becoming addicted, according to Williams, who has been a pharmacist for 22 years. He said much of this addiction can be attributed to doctors over prescribing the drug. As a pharmacist, Williams is frustrated by the growing problem with addiction and looks to physicians to help solve the problem. "I think that doctors need to be especially careful about how they prescribe OxyContin or any narcotic," he said. To obtain any schedule II drug, patients must have a written prescription every time they need a refill. Some doctors avoid the annoyance of writing repeat prescriptions, Williams says, by writing prescriptions for a large number of pills. He said he has seen a prescription for up to 270 pills. Purdue Pharma LP is the pharmaceutical company that manufactures OxyContin. The company has gotten national attention in the recent months about its controversial product, and in a recent news release, the company said it is concerned about the diversion and abuse of the drug. Jim Heins, assistant director of public relations for Purdue, acknowledged that OxyContin, even if taken as prescribed, may create physical dependency, though he said that's "very rare." People get addicted when they abuse the drug, Heins said. Dr. J. David Haddox, senior medical director for health policy at Purdue, said that a person who has no history of drug abuse has a very low risk of developing an addiction to an opioid if taken as directed. Pain specialist Dr. Alan Spanos, who has a private practice in Chapel Hill, N.C., and teaches at UNC Chapel Hill's medical school, thinks that part of the problem - aside from doctors engaging in criminal activity - is doctors under prescribing medications for those who legitimately need them. He said when patients do not get the needed amount of medication, they can exhibit addiction-like behavior. "It's not a disease, but a predicament." However, Spanos said, some blame does fall on the addicts themselves. "Addicts want to blame their addiction on someone other than themselves," he said. Williams, the Salisbury pharmacist, said that aside from the quantity of pills prescribed, some doctors continue to write prescriptions for people who have been on the drug for an extended period of time. He said patients who have been on the drug just a few weeks may need to be weaned off it. "If people are going to abuse these drugs, tighter controls need to be put on these drugs," Williams said. "It should not be allowed any more." He pointed out the effects on the patient's family as well as the long-term cost to the health care system. Several Rowan County doctors contacted by the Post last week said they did not have time to comment. Likeness to heroin Purdue manufactures OxyContin in a time-release pill, to release the pain-killing effects gradually. But Williams and local law enforcement agents say people short circuit the company's intent by crushing the pills and snorting or chewing what's left - and getting a tremendous, immediate high. That makes the potential for an overdose great, they warn. Purdue company officials say that sensational and inaccurate news reporting has contributed to fear and reticence among patients and physicians. For instance, the company disputes the contention that OxyContin can provide a "heroin-like" high. "OxyContin is a FDA-approved medication which, when taken orally, is slowly absorbed into the bloodstream and provides pain relief - not a 'high,' " states a company release. However, Kannapolis Police Sgt. R.A. Adams, a supervisor in the department's vice unit, disagrees. He said heroin users are stepping over their drug of choice to OxyContin, partly due to the similar effects it gives them. Adams said he recently arrested a long-time heroin user, on unrelated charges, who said after more than 15 years of drug use he is now strictly an OxyContin user. Adams said his department is currently investigating several OxyContin cases in the community. He said the drug is a growing problem. Likewise, the Rowan County Sheriff's Department has seen reports concerning the drug increase in the past six months, according to Sgt. Kevin Auten, a narcotics investigator. Some are drawn to the drug by the large profit they can make selling it. A prescription of 30 20-milligram pills costs about $90 at a pharmacy. Each pill can be in turn sold illegally on the street for $1 per milligram - or $600 for the same 30 pills. Auten said the 20- and 40-mg pills seem to be the most popular. The streets Local investigators disagree about how OxyContin will circulate. Mike Dummett, a Salisbury Police narcotics detective, believes OxyContin will show up in Salisbury as a "party drug," shared primarily among white teen-agers, rather than a street drug. He said OxyContin involves too much work for the average street dealer. Fellow Detective Danny Dyles agreed. Getting OxyContin often requires visits to more than one doctor, faking symptoms or forging or stealing prescription pads. The average street dealer would rather sell the traditional cocaine and deal with one distributor. Less steps. Less fuss, Dyles said. On the other hand, Sgt. Auten, the county investigator, said he thinks the drug will find its way to the street. He expects to see people starting to sell OxyContin for its high profit and to support their drug habit. Cabarrus County Sheriff Brad Riley said his deputies are starting to see other street drugs take a back seat to OxyContin. He likened the battle with OxyContin to the advent of crime such as fraud on the Internet. Law enforcement has to figure out a "new way of having to get at these people," he said. So far, most investigations involve people initially prescribed OxyContin who began abusing it. Although pharmacy break-ins have been high in other areas of the country, Rowan and Cabarrus officials have not seen such break-ins. To avoid those types of problems, Auten said pharmacies should avoid stocking large amounts of the drug. What Can Be Done Authorities are working to familiarize themselves with OxyContin to stifle the growth in the area. Dummett, Dyles and fellow investigator Sgt. Greene recently took a class in Charlotte on the drug. Auten said that with any new drug, it takes time to learn the trends. The manufacturer also is working with law enforcement officials and the medical community to address the problem. The company has initiated a number of programs including: a.. Brochures for pharmacists and health care professionals to educate their patients. b.. A pilot program in Maine and Virginia of tamper-resistant prescription pads. c.. Providing law enforcement officers with placebo OxyContin pills, allowing them to pose as sellers and busting people who think they are buying illegal pills. d.. Pledged $100,000 to fund a prescription monitoring program aimed at frustrating "doctor shopping" while not interfering with the delivery of medical services. Local pharmacist Greg Starnes said he has seen so many prescriptions for the drug in recent months that he calls the doctor on almost every prescription. Starnes said pharmacists are in a better position today with electronic technology to verify prescriptions with doctors. "As a physician it incenses me to think that drug abusers and criminals are making it difficult for patients with legitimate medical needs to get the care they deserve," Dr. Haddox of Purdue said.