Pubdate: Fri, 16 Jun 2006
Source: Times Argus (Barre, VT)
Copyright: 2006 Times Argus
Author: Jeff Douglas, Associated Press
Bookmark: (Heroin)
Bookmark: (Oxycontin/Oxycodone)


ST. LOUIS -- Justin Knox bit down on the bitter-tasting patch, 
instantly releasing three days' worth of a drug more powerful than 
morphine. He was dead before he even got to the hospital.

The 22-year-old construction worker and addict was another victim in 
an apparent surge in U.S. overdoses blamed on abuse of the fentanyl 
patch, a prescription-only product that is intended for cancer 
patients and others with chronic pain and is designed to dispense the 
medicine slowly through the skin.

"I cannot tell you the amount of people I've seen and the creative 
ways they abuse this drug," said Dr. Scott Teitelbaum, director of 
the Florida Recovery Center in Gainesville, Fla. "Fentanyl has been 
abused for years. But recently there has been an increase. I've seen 
more chewing, squeezing of the drug off the patch and shooting it up."

Fentanyl, a synthetic narcotic, was introduced in the 1960s, but it 
was not until the early 1990s that it became available in patch form. 
Last year, the first generic versions of the patch hit the market.

At least seven deaths in Indiana and four in South Carolina since 
2005 have been blamed on abuse of the fentanyl patch, along with more 
than 100 deaths in Florida in 2004. About a week after Knox's death 
in Farmington, Mo., in March, a second man in the same county was 
prescribed the patch legally and died after injecting himself with 
the gel that he had scraped from it.

Emergency-room visits by people misusing fentanyl shot up nearly 
14-fold to 8,000 nationwide between 2000 and 2004, according to the 
U.S. Department of Health and Human Services. The figures do not 
indicate how many of those ER visits were because of the patch.

(In recent months, more than 100 deaths have been reported from 
Chicago and Detroit to Philadelphia among drug addicts who overdosed 
on heroin mixed with fentanyl. And federal drug agents believe 
fentanyl is being made in clandestine labs in Mexico and elsewhere.)

The first fentanyl patch was Duragesic, made by Johnson & Johnson. 
Sales more than tripled from 2000 to 2004, according to the Pacific 
Law Center in La Jolla, Calif. Worldwide sales were more than $2 
billion in 2004, and half of that was in the U.S., according to the 
J&J's Web site.

More than 5.7 million prescriptions were written in 2003 for the 
Duragesic patch, according to IMS Health.

Mark Wolfe, spokesman for PriCari, the J&J unit that oversees 
Duragesic, said the product comes with strong "black box" warnings 
about the dangers of abusing Duragesic.

One theory is that addicts are turning to the fentanyl patch because 
of a government crackdown on abuse of another powerful prescription 
painkiller, OxyContin, or oxycodone.

"The abuse of oxycodone and the fear of litigation is enough to scare 
doctors from prescribing it. Duragesic is in vogue, as we've seen 
over the last year and a half and two years," said Dr. John Brandt, a 
chronic-pain specialist at the University of Florida.

In Missouri, the man accused of illegally selling the fentanyl patch 
to Knox has been charged with murder.

"The awareness is just not out there. I had never heard of this 
patch," said Knox's mother, Rose Marler. "There's a new generation of 
drugs and people just need to be aware."

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