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." - --- MAP posted-by: Terry Liittschwager