Rise of 'hillbilly heroin' creates alarm in East

Never, in the 14 years that he has been helping people overcome addictions, has Scott Walker seen anything like OxyContin.

It has swept through the vales of his native Appalachia like crack cocaine saturated inner cities in the 1980s. Folks call it "hillbilly heroin," and during the past few years, the abuse of this prescription pill designed to alleviate severe pain has become the single greatest drug threat in many rural areas from Florida to Maine.

"It got to the point that every single [case] was in some way related to OxyContin," says Mr. Walker, director of substance-abuse services at Mountain Comprehensive Care Center in Prestonsburg, Ky.

Now it's coming to the rest of America. In three months, 14 Boston-area pharmacies have been robbed, while Philadelphia, Kansas City, and Milwaukee have also seen heists. The lure is the drug's potency - as much as 16 times more powerful than similar painkillers on the market.

Some pharmacies are dropping the drug altogether, displaying "No OxyContin" signs. Five states, including Florida, have curbed distribution. Indeed, the speed with which OxyContin theft and abuse have spread nationwide is unprecedented, health and law-enforcement officials agree, and it is rekindling concern over how powerful drugs can be administered to legitimate patients without falling into misuse.

"It is a problem that is growing and can spread extensively," says Charles Miller of the National Drug Intelligence Center in Johnstown, Pa.

The problem has arrived in cities only recently. In the port town of Chelsea, Mass. - across the harbor from Boston - OxyContin was almost unheard of until the past few months. Today, its imprint is unmistakable. Twelve people are recovering from OxyContin addictions with help from Chelsea's Alcohol and Substance Abuse Program.

"That's a huge number of people coming in at one time for one very small clinic," says director Amy Harris. "[OxyContin] is extremely hot. There's an energy around it."

In many cases, abusers are first exposed to it through a parent or grandparent who has a prescription for legitimate medical reasons. From there, they can buy it from someone with a prescription, try to fool a doctor into giving them a prescription, or purchase the tablets on the burgeoning black market.

In Appalachia in particular, doctors seeking to increase business have been accused and convicted of prescribing OxyContin to virtually anyone who wants it. Here in New England, the growing demand for the tablets has been seen more in the spate of robberies.

These concerns have led pharmacies along the East Coast to stop selling OxyContin - although Massachusetts, for one, is reminding pharmacies that they're required to stock prescriptions their customers may need.

Fears are mounting. "I'm getting calls regularly from my members who are concerned," says Carmelo Cinqueonce, executive vice president of the Massachusetts Pharmacists Association. "There's the potential for copycats."

The incentive for dealers is great. The more potent pills, which sell for some $6 each in pharmacies, can fetch $80 in illicit deals, partly because of their reliably high quality - unlike cocaine or heroin, which can vary.

For its part, the maker of OxyContin, Purdue Pharma of Stamford, Conn., has taken steps to limit abuse. It has discontinued the highest-dosage tablet, has trained physicians to recognize fraud, and plans to pay for part of a federal program to monitor prescriptions in five states. Moreover, health officials say, the drug remains a valuable tool in managing pain medically.

But some critics say the manufacturer has made mistakes. Seven plaintiffs filed a $5.2 billion lawsuit in Virginia three weeks ago, charging that Purdue Pharma encouraged doctors to prescribe the drug for many types of pain - not just severe cases - leading to the addictions and deaths of family members and loved ones. In addition, the West Virginia attorney general announced last month that he is suing the company on the grounds that it marketed OxyContin irresponsibly.

Without question, economically depressed places like western Virginia, eastern Kentucky, and central Pennsylvania have been hit the hardest. Walker, of Mountain Comprehensive Care Center in Kentucky, can't even take a lunch break without a reminder of how prevalent OxyContin abuse has become there. When he returned to his desk on a recent weekday, he had notes from two people with OxyContin-related problems who were seeking admission to his treatment program. One was a mother seven months pregnant.

"I've never seen a drug on the market for so short a time abused to the degree that OxyContin has been," he says. "Because of the potency of the drug, people are becoming much more harmfully involved much sooner."

In fact, in an eight-month period last year, Walker had 237 OxyContin-related emergencies - this in an area where the largest town has only 4,800 people. But like many others, Walker doesn't believe the drug should be taken off pharmacy shelves. Yet he hopes the new attention will raise awareness.

"We've got to take something from [a situation] that could have been catastrophic," he says. "Let's inform the public that if you do these things, they are harmful."

(c) Copyright 2001. The Christian Science Monitor