Pubdate: Sun, 30 Jul 2000
Source: Portland Press Herald (ME)
Copyright: 2000 Blethen Maine Newspapers Inc.
Contact:  http://www.portland.com/
Forum: http://www.portland.com/cgi-bin/COMMUNITY/netforum/community/a/1
Author: Peter Pochna

NEW DRUG OF CHOICE SWEEPS STATE: PAINKILLER OXYCONTIN

Euphoria envelopes your body in a warm, cozy hug. Problems dissolve. Limbs 
tingle. Life feels perfect.

These are the sensations that drug addict Christopher Coughlin says he felt 
using OxyContin, a highly addictive opiate that is sweeping Maine, from the 
streets of South Portland to the rural communities of Washington County.

"It's more addictive than any pill I know of," said Coughlin, a 32-year-old 
convicted drug dealer serving eight years in state prison. Coughlin was 
caught in May with a gym bag full of heroin and OxyContin.

"There's a lot of it on the street right now,'' he said. "It's the drug of 
choice."

OxyContin is a highly effective prescription pain reliever that Purdue 
Pharma of Norwalk, Conn., started marketing in 1996. Doctors regularly 
prescribe the time-released opiate to people in severe and chronic pain, 
including patients suffering from cancer and recovering from surgery.

But Oxy, as it's known on the streets, also can produce a high so close to 
heroin that its black market use is soaring. Drug users crush the small 
white pills to remove the time release coating. They snort or inject the 
powder, receiving all the drug's power in one euphoric rush.

Doctors are struggling to effectively treat pain while preventing abuse of 
a dangerous drug. Pharmacists are on the lookout for scam artists with 
forged prescription slips. Drug rehabilitation centers are packed with 
people newly addicted to Oxy. Police are dealing with a crime wave of 
dealers and buyers.

The Maine Drug Enforcement Agency in the past 12 months arrested 156 people 
for crimes involving prescription drugs, twice as many as the previous 
year. The demand for OxyContin drove the increase, police say.

"It's happened very quickly," said Jay McCloskey, the U.S. attorney for 
Maine. "It's caught on with young people in greater numbers than any drug 
I've seen in my 20 years as a prosecutor. It's very, very troubling."

Addicts steal prescription pads. They dupe doctors by feigning severe back 
pain. They break into homes where they suspect somebody has an OxyContin 
prescription.

In South Portland last month, two men, one armed with a knife, the other 
with a handgun, broke into an apartment and demanded that a 52-year-old man 
hand over his OxyContins. They left with the pills and remain at large.

In Bangor in May, a grand jury charged Stephen Sanborn, 50, with selling 
$8,000 worth of OxyContin a week for an entire year. He got the pills from 
his wife, who was sick and had a prescription. They allegedly remodeled 
their house and bought a van with the money.

In Millinocket in March, two masked men broke into an elderly couple's 
home, knocked the woman to the floor and tried to steal a bottle of 
OxyContin from her purse. The intruders fled when the woman screamed and 
her husband came running.

McCloskey is leading an offensive against the drug, which includes 
educating doctors about the scams people use to obtain OxyContin. But he 
and other law enforcement officials have a lot of catching up to do.

Maine ranks second in the nation in per-capita use of OxyContin, according 
to a federal study that used Medicaid statistics. Surging demand for the 
drug mirrors a rise in heroin use in the state. Heroin addicts who cannot 
get heroin turn to Oxys. People who use OxyContin often graduate to heroin.

Many Mainers get the drug, legitimately or not, for free with their 
Medicaid coverage. Police say that some Medicaid patients forge 
prescriptions to get the pills, or they use legitimate prescriptions to get 
the pills and then sell them on the street for a huge profit rather than 
treating their pain.

"It's really federally funded drug abuse," said Helene Kazanjian, an 
assistant U.S. attorney who is prosecuting several Medicaid fraud cases in 
southern Maine involving OxyContin. "We're investigating dozens of people. 
It's almost endless."

OxyContin is one of several opium derivatives available by prescription. 
But it stands apart because of its time-release qualities. It provides a 
steady stream of pain relief over 12 hours. Most prescription opiates 
require the patient to take a new pill every four hours.

Doctors say the long-lasting effect of the pill makes it more effective 
than other opiates. But drug abusers like the time-released capability as 
well, because it means more medication is packed into each pill.

The drug comes in pills ranging from 10 milligrams to 80 milligrams. They 
sell on the street for about $1 a milligram. A 100-tablet bottle of 40 
milligram pills has a street value of $4,000.

That's an appealing piece of merchandise to a drug dealer like Coughlin. 
Coughlin was a math major at the University of Southern Maine before his 
heroin adiction caused him to drop out.

That was eight years ago. Today he has a 7-year old daughter, a half-dozen 
black and blue needle marks on each arm, and a lot of prison time ahead.

He said he dealt drugs to ensure he always had an ample supply for himself. 
He would get Oxys from people who wanted to trade them for heroin. He was 
happy to trade.

Oxys have a higher street value than heroin, and they appeal to a broader 
market of people.

"There's still a taboo about sticking a heroin needle in your arm," 
Coughlin said. "That scares some people. Oxys seem safer."

But snorting or shooting OxyContin can be as dangerous as using heroin. The 
Recovery Center at Mercy Hospital sees new OxyContin addicts nearly every 
day, said nurse practitioner Jane Boyer.

They experience severe withdrawal ­ a condition that feels like "having the 
flu times 1,000," Coughlin said. They vomit. Their entire body aches. In 
bad cases, withdrawal lasts a couple of weeks.

"It's very, very difficult to quit," said Boyer. "People who begin using 
opiates don't realize what they are doing to themselves."

At Portland's Discovery House, a methadone clinic, about a quarter of the 
400 patients are Oxy addicts, said John Destefan, the program's director.

"We've seen a steady increase in the last couple of years," Destefano said.

The problem has put doctors in a bind. Last year, the Legislature approved 
new medical rules that encourage doctors to treat pain more aggressively. 
Research showing that pain has been undertreated throughout the country for 
years prompted the rules.

Patients now can file complaints to the Medicine Board of Licensure if they 
feel they have been undermedicated. So Maine doctors are prescribing an 
increasing amount of painkillers, and OxyContin is considered the most 
effective for many types of pain.

On the other hand, doctors also are being pressured by law enforcers to be 
cautious when handing out OxyContin prescriptions.

In February, McCloskey sent a letter to 4,800 health care providers in 
Maine warning them about "serious problems across the state regarding the 
misuse of OxyContin."

Dr. John Darby, an anesthesiologist at Maine Medical Center and past 
director of the hospital's pain clinic, said OxyContin is an essential tool 
in the medical community's increasing efforts to control pain. He said 
doctors are doing their best to prevent its abuse, but can do only so much.

He said diagnosing pain is highly subjective, and even the best doctors get 
burned.

"When you're seeing 5,000 to 7,000 patients a year, can you tell every time 
who's legitimate and who isn't?" Darby said. "You can't."

Pharmacists throughout the state are showing vigilance in their efforts to 
identify fraudulent OxyContin prescriptions, said Colleen Huff, assistant 
director of Maine Medical Center's pharmacy. But often the frauds are tough 
to spot.

A typical scam allegedly took place at the Forest Avenue Shop n' Save in 
Portland in March. Prosecutors say that Jason Jewett, 24, of Topsham, 
presented a prescription slip and left with 60 OxyContin pills at 40 
milligrams apiece, worth about $2,400 on the street. The problem was he had 
stolen a prescription pad and forged a doctor's handwriting, prosecutors say.

The pharmacist discovered the forgery, but only after Jewett left with the 
pills. He was later arrested and charged with acquiring drugs by deception, 
a felony punishable by up to five years in prison. His case is pending.

The problem is most severe in Washington County, according to McCloskey. 
Police speculate that a doctor or two in the county might be prescribing 
pills to people who don't really need them. Or maybe demand is high because 
the supply of heroin there is limited.

Whatever the reason, the extent of the problem is seen in the rising 
success of the county's pawn shops, said Washington County Sheriff's Lt. 
Michael Riggs.

He said people are doing anything they can ­ selling their TVs, their VCRs, 
their guns, their chain saws ­ to get money to buy Oxys.

"In the past year it seems to have become the drug that everybody wants," 
Riggs said. "And the pawn shops are really doing a great business."

Fighting the illegal sale and use of the drug is draining the resources of 
the Maine Drug Enforcement Agency.

Prescription drug cases are tough to crack, because they often involve 
tracking extensive medical and pharmaceutical records. They are also 
challenging because the source is nearly every family doctor and emergency 
room.

On top of that, budget cuts have reduced the MDEA's staff from 60 to 36 in 
the past 10 years. MDEA Director Roy McKinney said he doesn't have enough 
agents to handle the problem.

"We don't have any more resources to throw at it, " he said. "Something's 
got to give."

The surge in OxyContin crime has prompted action on both the state and 
federal levels.

The Maine Attorney General's Office is drawing up legislation that would 
make OxyContin cases easier to prosecute. Currently, possession of the drug 
is a misdemeanor. State prosecutors want a law that would make possession 
of a large number of pills the equivalent to trafficking in the drug, which 
is a felony.

The law will likely be presented to the Legislature next year.

On the federal level, McCloskey is making the battle against OxyContin 
abuse one of his office's top priorities.

With the help of Dr. Darby, he's organizing a panel of doctors who would 
tour the state lecturing other doctors on how to more accurately prescribe 
the drug only to people who really need it.

McCloskey also has increased the number of U.S. Drug Enforcement 
Administration agents working in Maine solely on prescription drug cases. 
Last December, there was one such agent in Maine. Now there are four.

But he and most other law enforcement officials say the problem will likely 
get worse before it gets better.

Coughlin, from an interview room at the state prison in Windham, said he 
doesn't see how enforcement efforts can be successful."

"You can't stop it," he said. "There's so many people who legitimately need 
it, that there's just no way. It's hard to control something that's right 
there in your grandmother's medicine cabinet."

Susan Butler, library assistant, contributed research to this story.
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