Pubdate: Sat, 29 Jan 2005
Source: Globe and Mail (Canada)
Page: M1
Copyright: 2005, The Globe and Mail Company
Contact:  http://www.globeandmail.ca/
Details: http://www.mapinc.org/media/168
Author: Peter Cheney
Bookmark: http://www.mapinc.org/find?232 (Chronic Pain)
Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone)

HILLBILLY HEROIN HEADS DOWNTOWN

If you were on Queen West this week, you may have noticed Jennifer, an 
unlikely figure even by the loose standards of Skid Row. Snow was falling, 
and a cold wind raked the street, but Jennifer was wearing a purple velvet 
miniskirt, a nylon bomber jacket and a pair of teetering heels.

She had the desperate air that comes with being a 43-year-old prostitute 
whose best-before date has long since passed, but for Jennifer, career 
problems paled in comparison to the matter immediately at hand -- where she 
was going to get the money for her next hit of OxyContin, her drug of choice.

Less than five years ago, she had a husband, a job and a house in the 
suburbs. Now, thanks to her drug addiction, that's all gone, replaced by 
her life on the street and the endless, grinding quest for a fix.

"It's got to happen soon," she said, as yet another car passed. "I'm 
feeling rough. And I know what happens next. . . ."

Unless she came up with the money for some Oxycontin within a few hours, 
she would begin suffering the agonies of withdrawal.

The combination of chills and pains is so unbearable one addict compared it 
to "having a migraine while your hair is being burned off your head."

Jennifer hiked up her skirt and moved a step closer to the curb. "I wish I 
could stop," she says. "But I can't . . . that's just the way it is."

Jennifer is far from alone in her struggle with OxyContin, a well-regarded 
medicinal painkiller that has found a sinister second life as a street 
drug. It's referred to as Oxy, OC, Killer and Hillbilly Heroin -- a name it 
earned when it rose to popularity in rural Kentucky after going on the 
market in 1996.

But Hillbilly Heroin has since moved downtown. According to a public-health 
report released this month, OxyContin (and drugs related to it) were 
responsible for 27 deaths in the city of Toronto in 2002 -- a sharp 
increase over previous years, when it typically caused between one and 
seven deaths.

The statistic is reflected in countless other major cities, where OxyContin 
has rapidly become an addict staple. Dr. Kumar Gupta, a leading Toronto 
addiction specialist who sits on the board of the Canadian Society of 
Addiction medicine, says he encounters ever-rising numbers of OxyContin 
addicts in his practice. Some are existing drug users who have discovered 
OxyContin. Others are people who find themselves hooked after using 
OxyContin as a prescription for pain -- like the 19-year-old high-school 
student who became an addict after a car crash (or, to cite a recent 
headline-making example, U.S. talk-show host Rush Limbaugh) -- or teens who 
simply tried it once at a party and liked the blissful rush it offers. 
"This drug is replacing heroin as the leading problem drug of abuse," says 
Dr. Gupta.

One of the most troubling aspects of the OxyContin scourge, Dr. Gupta says, 
is the fact that many addicts are supplied by doctors who are duped into 
writing multiple prescriptions. One of his own patients, he says, got 
prescriptions from eight doctors at once.

Dr. Gupta believes Ontario should set up a central prescription registry 
like the one British Columbia instituted in 1996. The need for a registry 
was highlighted this week when Ontario Provincial Police laid 58 charges of 
"double-doctoring" and one count of fraud against a Barrie woman who 
allegedly visited five doctors and six pharmacies to obtain more than 200 
narcotic pills.

"The sad reality is that there are some physicians that dispense high 
quantities of this drug to patients in a dangerously liberal fashion that 
render the patients vulnerable to getting hooked," Dr. Gupta says.

Jennifer, the Parkdale prostitute, is a case in point. Crying, she related 
her story this week as she waited for the trick that would pay for her next 
Oxycontin fix. Until 2000, she says, her life was "normal." She worked as a 
cashier in a lumber store, and was married to a man who installed 
eavestroughs. She and her husband had a house, a Labrador retriever and a 
Toyota Camry.

Then came her long, deadly dance with OxyContin. It began when she hurt her 
back in a car accident and was given OxyContin to control the pain. Soon 
she was taking twice as many pills as her initial prescription required. 
When she asked for yet another increase, her doctor refused. So she went to 
another doctor. Then she saw a third doctor, who knew nothing about the 
other two.

For Jennifer, the three prescriptions weren't enough. She started buying 
OxyContin from a friend at work, who had a connection at a pharmacy. Her 
habit quickly escalated to the point where it was costing her several 
hundred dollars a week. She drained her bank account, then her husband's. 
She took cash advances on their credit cards until they were maxed out.

Unable to focus, she lost her job, She and her husband split. Jennifer 
tried to kick OxyContin, but the pain of withdrawal was crucifying. 
"Everything in me hurt," she says.

Jennifer moved into a cheap apartment downtown and collected welfare. Some 
time in 2001 she found herself turning tricks on the street. "I'd like to 
quit," she says. "I just don't see how. If you tried it, you'd see."

Countless other addicts have stories that differ only in the details. 
"Addiction levels the field," says Betty Walker, manager of the Renascent 
Centre's Munro House, a residential treatment program for addicted women. 
"It can be anyone."

As an opiate-based pain-reliever, OxyContin is closely related to heroin, 
and to the opium smoked by addicts in Victorian England. OxyContin is 
designed by its makers to be a slow-release painkiller, but addicts quickly 
learn how to short-circuit that feature by crushing the pills, so the 
entire narcotic content is dumped into their system at once.

The sheer pull of the drug is illustrated by the experience of a woman 
called Nancy, whose descent into OxyContin addiction began in 1999, when a 
boyfriend gave her a painkiller pill in a bar. "Try it," he said. "You'll 
like it."

She was amazed by the euphoria it produced. She felt herself buoyed in a 
wave of bliss. "It was great," she says. "Who wouldn't want that feeling 
again?"

For about six months, she "dabbled" in painkillers, buying Percocets from a 
dealer who hung out in an east-end bar. Within six months, she was taking 
one every day. Then it was two. In 2001, she moved up to OxyContin, which 
provided a bigger hit: "One Oxy was worth five Percs," she says.

She bought the pills at a doughnut shop on Dundas. At first, she took three 
or four 40-milligram pills a day, crushing them to defeat the time-release 
feature. Within a few months, she was doing 15, by a new means -- injection.

When she injected the drug, it instantly reversed the painful effects of 
impending withdrawal: "You go from freezing cold to warm and cozy," she 
says. "You go from stomach cramps to feeling great. You stop sneezing. And 
then in a little while it all starts again."

Dr. Mark Weiss, who works in addiction medicine at the Bellwoods Centre, 
says the sharp public debate over OxyContin has obscured some key issues -- 
like the fact that OxyContin is really nothing new. "It's an opiate," he 
says. "And opiates have been around for a long time."

But he says the mechanisms of addiction are only partly understood by 
medical science, although there is general agreement on some fundamental 
issues. "People are constantly describing this incredible feeling they had 
when they first tried drugs," he says. "Every time they use, they're 
chasing that initial high."

In a small East York bungalow, a woman named Darlene is still trying to 
recapture the feeling she had when she tried OxyContin for the first time, 
in 2002. "My mind and my body were separate," she says. "I loved the feeling."

At 40, Darlene is nearing the end of her rope. She used to be a head 
cashier at the Toronto Dominion Bank, but is now unemployed, thanks to her 
addiction. OxyContin wasn't her first run-in with substance abuse -- she 
has used cocaine and alcohol heavily in the past. But OxyContin has been 
her Waterloo. Since becoming addicted after taking the drug for back pain 
three years ago, she's spent an estimated $40,000 on it.

In her kitchen, sitting in the window above the sink, she has a picture of 
her brother, who committed suicide after years of substance abuse by taking 
a massive overdose of OxyContin.

"I'm using the same thing that killed my brother," she says. "How stupid 
does that make me? I know where all this goes, but I can't stop."
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MAP posted-by: Terry Liittschwager