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Painkiller OxyContin 'most commonly abused prescription drug on the streets of Western Pennsylvania'

Sunday, April 08, 2001

By Jonathan D. Silver, Post-Gazette Staff Writer

With startling speed and sometimes deadly consequences, the prescription painkiller OxyContin has shifted from sensation to scourge in Western Pennsylvania.

Federal agents based in Pittsburgh are conducting multiple investigations into the painkiller's illicit use. At least seven counties are reporting fatal overdoses involving OxyContin.

In Johnstown, there have been pharmacy break-ins and strong-arm robberies where only OxyContin is taken. And authorities believe that some unscrupulous or lax doctors and pharmacists are handing out the drug too freely to people faking their pain.

"It's a drug that's just exploding," said Capt. John Duignan of the Pennsylvania State Police's Bureau of Drug Law Enforcement. "Abusers are seeking easier, cheaper ways to get better highs, and word on the street travels quickly. And the word on the street now is OxyContin is available. It gives you a great high."

Patients given the powerful narcotic for moderate to severe pain often tied to cancer treatments or orthopedic problems are supposed to take one tablet twice a day. Unlike other painkillers taken every few hours, each OxyContin pill provides 12 hours of relief.

It was originally hoped that its slow release and long-lasting effects would restrict the potential for abuse.

But by crushing the pills, users are bypassing the drug's protective coating. They're snorting, shooting and chewing it for a rapid rush that resembles heroin. In fact, police are finding that OxyContin abusers who run out of the drug and can't find more on the street are turning to heroin, which is cheaper.

Although Pennsylvania has joined Kentucky, Maine, Maryland, Ohio, Virginia and West Virginia on the short list of states with widespread OxyContin problems, no one is calling it an epidemic.

Drug maker Purdue Pharma LP is not acknowledging that its product has caused any deaths. As it conducts its own research, the company contends that numbers reported by coroners, medical examiners and the media are inflated, inconclusive and unreliable.

All parties agree, however, that there is cause for alarm. In nearly three decades with the U.S. Drug Enforcement Administration, Pittsburgh agent Dennis Johnson has never witnessed anything like OxyContin's sudden spurt.

"This is the most unique situation I've seen in 27 years for a drug, a pharmaceutical," Johnson said. "I had no inkling that this would be a problem."

Rooted in the region

Ground zero for abuse in this part of the state is Cambria County, which has seen at least eight OxyContin-related deaths since 1999, running just ahead of Blair County's seven deaths, according to the coroners in both counties. There also have been deaths attributed to OxyContin in Butler, Crawford, Erie, Mercer and Somerset counties.

Johnstown is home to one of the first drug task forces in the country to target OxyContin. Operation Ox-Bow, formed in September 1999 by federal, county and local authorities, has led to the arrests of more than 50 people, most of them charged as dealers.

Dr. J. David Haddox, Purdue's senior medical director for health policy, has conducted seven seminars in Western and Central Pennsylvania, traveling to Altoona, Ebensburg and Johnstown to educate doctors, pharmacists and law enforcement agents about OxyContin.

Although the painkiller has been on the market since December 1995, it took until 1999 for problems to crop up in Cambria County. When illegal use appeared, it erupted. In 2000, OxyContin accounted for nearly a third of all drugs bought on the street there by task-force agents, up from 3 percent a year earlier.

"It just took off overnight," said Rod Miller, the chief detective in the Cambria County district attorney's office and a task force supervisor.

Abuse of OxyContin has been described as a phenomenon mostly afflicting rural areas where drug abusers don't always have easy access to heroin or other controlled substances. It's just starting to show up in Pittsburgh and is becoming more prevalent in Philadelphia.

Users of "OCs" or "Oxies" run the gamut, from teen-agers to people in their 70s, blue-collar workers to white-collar professionals. Problems began among adults with sincere medical problems but "insincere drug-seeking behavior," said Jan Miller, a registered nurse and director of the methadone program at St. Francis Medical Center. Lately, OxyContin's popularity as a recreational drug among adolescents has begun to grow.

"They're from Mt. Lebanon, Upper St. Clair. They're from the private schools. It doesn't seem to discriminate. It's across the board right now. It's hitting all communities," said Neil Capretto, medical director of Gateway Rehabilitation Center in Aliquippa.

One 20-year-old recovering OxyContin addict interviewed last week at Gateway comes from an upscale Pittsburgh neighborhood and is enrolled in a local university. He and three other recovering users were interviewed on condition of anonymity.

A pill popper since about age 15, he discovered OxyContin after his supply of crystal methamphetamine dried up. At his peak OxyContin abuse, he was taking 240 milligrams a day to function, 500 milligrams to get high. He peeled or licked off the coating, then crushed the pills with a coin before snorting them.

"I was selling them to use them," he said. "It's that warm, blissful rush. It just makes everything surreal. You just float through life."

When his supplier got caught by police, he switched to heroin after six months on OxyContin.

Another man, 24, from Eighty Four, was a longtime abuser of painkillers before he found OxyContin. He was bringing home $675 a week from his job and spending $600 to buy drugs. He forged checks for drug money.

"On a regular day, a good day, I'd do up to about 250 milligrams a day, 300 easy," he said. "Ten, 15 minutes after I'd wake up, I'd need something in me to get me down the stairs to talk to my wife and kid."

Fighting back

OxyContin's active ingredient is oxycodone, an opioid related to codeine and as powerful as morphine. Scientists have known of oxycodone's effects for decades. In the 1920s, a report in Germany about a brand-name drug containing oxycodone described a "striking euphoria," according to a DEA fact sheet.

Since the 1960s, products containing oxycodone have been abused. But Connecticut-based Purdue, the maker of the familiar hospital antiseptic Betadyne, said the company's positive experience over the past 15 years with MSContin, another oxycodone-based product, did not foreshadow the abuse of OxyContin.

"We're trying to figure out why all of a sudden it would be an issue. It's surprising," Haddox said. "We thought, 'Gosh, this is going to be great.' And, I think, for many, many people this has been great."

Haddox said evidence that would tie OxyContin to any overdose deaths wasn't in. He said toxicology reports from autopsies showed only that oxycodone was found. With 40 drugs on the market containing oxycodone, other evidence is necessary to prove that OxyContin was the killer.

"I know that there's a suspicion of it. It's been reported. But it's hard to verify those numbers," Haddox said. "We're having a great deal of difficulty getting reliable information."

Haddox stressed that hundreds of thousands of people in the United States used OxyContin properly for pain relief, and lamented that the negative stories about the drug had made doctors reluctant to prescribe it and pharmacists leery of dispensing it.

"We've had people call us up in tears saying, 'My doctor is afraid to prescribe this medicine. What am I going to do?' Those are hard phone calls. They just tear your heart out," Haddox said.

The same can be said for counselors who treat substance abusers. Capretto estimated that about 1,000 people have sought treatment at his Gateway facility for OxyContin addiction.

"It's by far the most commonly abused prescription drug on the streets of Western Pennsylvania right now," Capretto said. "Rarely does a day go by that we don't see a couple of new people come in for treatment here, with OxyContin being their main or one of their main drugs of addiction."

Often, addicts obtain the drug legitimately. It's not unusual for OxyContin abusers to have real medical problems stemming from falls, car crashes or other accidents. Doctors write the prescription, pharmacists fill it, and addicts abuse it.

Sometimes, shrewd people lie about their ailments. They might show up in doctors' offices with casts on, or they might agree to X-rays. In some cases, they find doctors who are happy to prescribe OxyContin without doing much research into their background. And if they strike out with one physician, they'll seek out others.

No doctors or pharmacists have been arrested in Western Pennsylvania in connection with OxyContin.

Many users also are dealers, which is not surprising since there is a lot of money to be made on the black market.

Pills are selling for about 50 cents to $1 per milligram. OxyContin comes in dosages of 10, 20, 40, 80 and 160 milligrams.

Authorities expect to be fighting OxyContin abuse for at least another six to 12 months. But as the buzz begins about the next hot street drug, it's liable to just fade away.

"OxyContin is just fashionable right now. It's sort of a fad drug. Predictions are that in a year or two the fad will pass and we'll have to worry about something else," said Leon Rodriguez, first assistant U.S. attorney in Pittsburgh.

Even as authorities are cracking down on the illegal distribution of OxyContin, Purdue is looking at ways of improving the drug's safeguards. Scientists are researching ways to make an analgesic that loses its effect if tampered with.

"You try to crush it up, snort it or mainline it, nothing happens," Haddox said. "Abusers won't like that."



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