Pubdate: Fri, 31 Jan 2003
Source: Memphis Flyer (TN)
Copyright: 2003 Contemporary Media, Inc.
Contact:  http://www.memphisflyer.com/
Details: http://www.mapinc.org/media/2403
Author: Bianca Phillips
Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone)

I WANT A NEW DRUG

OxyContin, A Powerful Prescription Painkiller Popular In Other Parts Of The 
Country, Has Moved Into Memphis.

It's a typical Saturday night for 22-year-old Jason Reyick,* a cook at a 
Midtown restaurant. He went to work around 5 p.m., walked home at midnight, 
then set about finding some drugs. Sometimes this task involves a trip to 
the liquor store, sometimes a phone call to his trusty pot dealer. But 
tonight a friend with a baggie full of little yellow pills shows up. 
Tonight, there's just a payment of $20 for a 40-milligram tablet of 
OxyContin, a powerful prescription painkiller that's recently entered the 
illegal drug market and rapidly gained popularity.

Later, a few friends from work show up, ready to party. Each purchases a 
pill, and their fun begins. Reyick, who prefers to snort OxyContin rather 
than chew or inject it, chops his pill into a fine powder with a pocket 
knife. He lays a dollar bill over the crushed pill and runs a lighter over 
it to crush all the chunks. Then he uses his knife to form the powder into 
a neat line, rolls up the dollar bill, and proceeds to snort the powder.

His friends follow suit, and minutes later, they enter a dreamlike state. 
Reyick slowly leans back on his ratty black couch, takes a deep breath, and 
closes his eyes, letting his body totally relax as peaceful thoughts sweep 
through his mind. The back pain from work floats somewhere far away. For 
the next several hours, he moves only to go to the bathroom a few times -- 
and once to dry-heave over the toilet.

You may never have heard of OxyContin, but the scene described above is 
growing more common all over the Mid-South, a reflection of a national 
trend toward increasing abuse of the potent painkiller. In Tennessee, 
reported cases of OxyContin abuse are more prevalent in the eastern part of 
the state, but state DEA officials report that the drug is being 
increasingly seen in the Memphis area.

Trading Pain For Pleasure

Despite the number of strong painkillers on the market before 1996, people 
with severe pain due to cancer or other debilitating conditions were in 
need of something more. Oxycodone-containing medications available at the 
time, such as Percocet and Vicodin, contain additional ingredients, such as 
acetaminophen, which can cause organ-toxicity problems in large doses.

Since opiates cause tolerance to develop rather quickly, chronic pain 
sufferers would eventually have to up their dose to achieve the desired 
effect, thus also increasing the dose of acetaminophen or other added 
ingredients.

In December 1995, Purdue Pharma introduced OxyContin, a time-release pill 
which contained a much higher concentration of oxycodone and no 
acetaminophen. The oxycodone level in one 40-milligram tablet of OxyContin 
is equal to eight five-milligram Percocets. It was made available in a 
variety of strengths -- 10, 20, 40, 80, and 160 milligrams -- and 
prescribed according to the severity of pain.

"The indication is for an intensity and longevity of disease. It's for 
people who feel pain 24 hours a day and people who're going to be in pain 
for the rest of their life," says Jim Heins, associate director of public 
affairs at Purdue Pharma. "Say a back surgery has failed or they have 
cancer or maybe they've been in an accident and they're going to be in pain 
for decades. It's not disease-specific. It's prescribed due to the 
chronicity of the pain."

Oxycodone, the active ingredient in OxyContin, is a derivative of opium. 
Its effects are similar to that of morphine. In the Comprehensive 
Controlled Substances Act of 1970, Congress placed the drug under Schedule 
II status, which includes drugs that have some medical use but a high abuse 
potential. Oxycodone is cited as an effective analgesic for mild to 
moderate pain control, for chronic-pain syndrome, and for the treatment of 
terminal-cancer pain. OxyContin pills are covered with a coating that 
time-releases oxycodone into a user's system for 12 hours. Abusers of the 
drug typically chew or crush the pills to get past the coating, releasing 
all the oxycodone at once for a much stronger high.

"OxyContin is kind of like a dream, but you can control it," says Reyick. 
"It comes on slow and steady, kind of like a cocaine buzz, but once it 
hits, you're just in a hole. It's not a bad hole, though. It's just the 
kind of hole that you can cruise through."

When asked to explain the buzz, many users report something similar to a 
dreamlike state, where the body feels loose and heavy but the mind is in a 
state of intense euphoria. High doses of OxyContin, also known as OCs or 
Oxys, can cause loss of concentration, dizziness, skin that is sensitive to 
the touch, heavy sweating, and slurred speech. When there is little food in 
the stomach, the drug can also cause mild nausea.

According to the Office of National Drug Control Policy's Pulse Check 
report, released in April 2002, many users in the Memphis area are engaging 
in OxyContin use in nightclubs and at parties, where it is often associated 
with the use of club drugs such as Ecstasy.

The Pulse Check also reports that OxyContin in Memphis is regularly 
bartered for other drugs, such as crack cocaine or other prescription 
pills. Twenty-milligram pills are sold for $10-$30 each, depending on the 
dosage strength.

Drugstore Cowboys

There are a number of ways OxyContin is being diverted from pharmacies to 
the streets. According to Mike Arpiao, a prescription drug diversion 
officer for the Tennessee DEA, the state is 16th in the nation in acquiring 
the drug for pharmacies, physicians, and hospitals. "People are obtaining 
it through doctor shopping [obtaining multiple prescriptions from a variety 
of doctors], forged prescriptions, or buying it off the street from people 
who are selling their prescriptions," he says. "There are also unscrupulous 
pharmacists that could be selling it out the back door without a prescription."

Drugstore robberies are another method of diversion, and the Pulse Check 
reports that thefts from the homes of legal users are also common. But 
according to the report, most of the OxyContin sold in Memphis has been 
diverted from the Northeast and shipped to the South.

The Shelby County vice-narcotics unit made only 10 OxyContin-related 
arrests last year, according to Major D.A. Betts. But the unit is seeing an 
increase in the use of the drug locally. Officers knew of the growing 
OxyContin abuse problem in eastern Tennessee and were aware of the 
potential problem. The drug is already very popular in the local DJ and 
rave circuit.

Accidental Addiction

Not everyone who's abusing OxyContin is doing it purely for pleasure. 
Barbara Teague,* a 55-year-old local, was diagnosed with polio at age 3 and 
now suffers from a chronic muscle deterioration known as post-polio 
syndrome. The condition makes her bones brittle, and last year some bones 
in her hips were broken beyond repair. Doctors performed hip-replacement 
surgery, but Teague still suffers an extraordinary amount of pain. She's 
prescribed 90 milligrams of OxyContin a day.

Her 28-year-old daughter Anna,* a pharmaceutical sales major at the 
University of Memphis, thinks her mother, who's been taking the drug for a 
year and a half, has developed an addiction and says it's caused multiple 
problems in her family.

"Sometimes, I'll have to monitor her medication without her knowing it," 
she says. "I'll count them and look at the date on the bottle. She's 
supposed to be taking three a day, so if there's eight gone in a day, I'll 
know she's overmedicating. She takes care of my daughter during the day 
when I'm in school. One day she was so screwed up, she couldn't find her 
ass from a set of bullhorns. I couldn't leave my daughter with her. I had 
to miss school."

Anna says her mother has trouble admitting she may have a problem and often 
resorts to excuses: "Well, I accidentally overdid it." Or "I forgot I'd 
already taken some." Or "I need to get one of those little pill dispensers 
with the numbered days so I won't mess up."

"She knows what she's doing, but she's in denial," Anna says. "She wants to 
get a little high sometimes, and that's the way she does it. Some people 
smoke pot. Some people drink. She takes pills by the handful."

The Teague family's OxyContin problem is not uncommon. In recent years, 
Purdue Pharma has been hit with a number of lawsuits from patients who were 
prescribed the medication and claimed to have become addicted.

Jim Heins of Purdue Pharma told the Flyer that the company has no hard 
numbers on how many lawsuits they've faced since 1995 regarding OxyContin 
addiction, but he says they are performing an analysis and will eventually 
release a report to the public. Heins adds that the recent increase in 
media coverage of OxyContin has created a negative picture of the drug, 
leading many patients to believe they are addicted when they may not be.

Dr. Clifford Bernstein, medical director of the California-based Weismann 
Institute, an opiate treatment center, disagrees. He says that many of the 
cases they treat involve people who were prescribed OxyContin and became 
hooked.

"We used to only treat heroin addicts, but now we're about 70 percent 
prescription medications, and OxyContin's my number-one drug. Purdue Pharma 
is denying the stuff's even habit-forming, just like the tobacco industry," 
he says. "A lot of patients don't realize that after a while, the drugs 
don't work and your dose is escalated. The next thing you know, you're hooked."

Hope & Healing

Addiction to OxyContin can result in the same kind of gradual wasting away 
that affects heroin and morphine addicts. Not all of those who engage in 
occasional recreational OxyContin are addicted, however. In fact, those who 
are prescribed the drug may run a higher risk of addiction because their 
supply is so readily available.

Reyick says he doesn't have a problem and only occasionally uses OxyContin. 
He says he only does it when it happens to be around, although he adds that 
if he had more access to the drug, he'd have to watch himself.

"OxyContin's one of those things that if you think you have control, then 
you've already fooled yourself and you're in a dangerous position," says 
Reyick.

For those who have a problem, extensive -- and often expensive -- treatment 
programs are available for opiate abuse. The programs fall into two 
categories: medical and social.

Medical treatments include the highly effective but very pricey 
rapid-detoxification method as well as the more traditional methadone 
program. Social treatments include drug counseling, such as Narcotics 
Anonymous. Medical treatment is recommended for serious opiate problems due 
to possible life-threatening withdrawal symptoms.

Methadone is administered orally to opiate-addicted patients once a day in 
clinics such as the Memphis Center for Research and Addiction Treatment on 
Madison Avenue. It's a medically-safe drug, with no toxic side effects, 
that relieves withdrawal symptoms, eliminates opiate cravings, and allows 
for normal body functioning. Methadone has no narcotic effects but can 
cause withdrawals if not properly administered. Patients are normally 
weaned from methadone over a six-month period.

The Substance Abuse and Mental Health Services Administration reports that 
methadone clinics nationwide have seen an increase in OxyContin abuse in 
recent years, including a particularly significant increase in 2001. Lisa 
Massey, a counselor at the Memphis Center, says the center has not seen a 
large number of patients with OxyContin problems, but she says it may be 
moving this way soon from East Tennessee. Massey says the number-one drug 
they treat is probably Dilaudid, a synthetic form of heroin.

(Treatment at the Memphis Center costs about $5,700 if a participant 
completes the entire program. Patients are charged $77 per week for 18 
months, in addition to an initial fee of $127.)

The other form of medical treatment available, rapid detoxification, 
involves the administration of a pill called Naltrexone and promises 
results in three days. There are several methods of rapid detox performed 
at various clinics across the country, but the original method, practiced 
by the Weismann Institute in San Diego, has been around the longest and has 
a success rate of 65 percent after a year. There are no rapid-detox centers 
in the Memphis area.

"The Weismann method blocks cravings after bringing people through the 
withdrawals as humanely as possible," says Dr. Bernstein, the institute's 
medical director. "Methadone blocks cravings, but so do other opiates. 
They're 100 percent interchangeable. The Naltrexone that we leave people on 
afterwards is exactly the opposite. If you're hooked on an opiate and you 
take a Naltrexone pill, you'll get very sick."

"Look at OxyContin as a key that fits in a lock, the lock being the 
receptor. The key goes in the lock, opens the door, and turns on the 
receptor," Dr. Bernstein explains. "That's what gives the effect of 
OxyContin. Naltrexone is the drug we use to compete for that lock. It's 
like a key that's been broken in half. You can put the key in the lock, but 
you can't open it. It blocks that receptor."

Social treatments, such as the 28-day program at New Directions Inc. on 
Semmes Street in Memphis, provide patients with group counseling and 
one-on-one therapy. Sharon Couch, administrative assistant for New 
Directions, says they have yet to see large numbers of OxyContin abuse but 
pointed out that when someone comes in with a severe opiate addiction, she 
usually sends them to Central Intake at the Memphis and Shelby County 
Health Department for medical treatment to bring them through withdrawal.

"We're strictly social. We don't give any medicines. So if they've been off 
it a couple days and they're pretty stable, we take them on in," says 
Couch. "What we try to do is get people to change their thinking, not just 
their behavior."

The U.S. DEA has recorded 318 deaths in which OxyContin was a contributing 
factor. Although OxyContin overdose is usually a result of poly-drug 
toxicity, it still plays a major role. According to Major Betts, there is 
one case in federal court involving an OxyContin overdose in the Memphis area.

Of the 20 major cities studied in the Pulse Check report, Memphis is among 
12 in which OxyContin availability is reported as increasing markedly. The 
Tennessee Bureau of Investigation's 2001-2002 Annual Report shows an 
increase in OxyContin abuse statewide. You may not have heard much about it 
yet, but OxyContin is coming, and the problem is likely to get worse before 
it gets better.
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MAP posted-by: Jay Bergstrom