Pubdate: Mon, 08 Jul 2002
Source: State, The (SC)
Copyright: 2002 The State
Author: DEBBIE CENZIPER, Knight-Ridder Newspapers


Addiction To Narcotic Painkiller Is On The Rise In The Carolinas

Miracle Or Menace?

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,
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 than similar prescription narcotics.

The addicts called it Oxy or OC.

Carolinas Hit Hard By Abuse

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 Carolinasone in Grover in Cleveland
County, N.C., 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 tightrope 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 investigation by The Charlotte Observer found:

. OxyContin abuse might have caused or contributed to at least 97
overdose deaths in the Carolinas in 2000 and 2001. In most cases,
other drugs or alcohol might 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 104 other 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 might have contributed to 464 overdose deaths
nationwide in the past 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, Spartanburg and a region in North Carolina 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.

. 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,
N.C., 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

A miracle painkiller

Some pharmacists and law enforcement officials say they believe
OxyContin's manufacturer, Connecticut-based Purdue Pharma, might 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,
spokesman Jim Heins said. 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.

To people with cancer, debilitating backaches, 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 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."

'I lost my best friend'

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 antidepressant medication.

That spring, Dunn started taking OxyContin. It immediately eased
knifelike 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

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

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
a result of 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."
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