Pubdate: Sun, 12 Oct 2003
Source: Decatur Daily (AL)
Copyright: 2003 The Decatur Daily
Contact:  http://www.decaturdaily.com/decaturdaily/index.shtml
Details: http://www.mapinc.org/media/696
Author: Eric Fleischauer

'HILLBILLY HEROIN' ABUSE EXPLODING

Decatur Police Say OxyContin A 'Big Problem'

An admission by talk radio celebrity Rush Limbaugh on Friday that he was 
addicted to painkillers shocked many of his listeners, but it was no 
surprise to area law officers who are witnessing an explosion of abuse.

"OxyContin and hydrocodone are very abused medications. It's a big 
problem," said Sgt. Faron White of the Decatur Police Department.

Limbaugh admitted his addiction after Florida officials said a drug 
investigation in the state "overlapped" accusations made by Limbaugh's 
former maid, who told The National Enquirer she had helped supply her 
employer with massive amounts of OxyContin and hydrocodone. Limbaugh told 
his audience Friday he was immediately admitting himself to a 
rehabilitation center.

The problem of painkiller abuse is not just big, it is also complex, 
according to doctors. The same drugs that are increasingly targeted by law 
enforcement have also allowed many pain-wracked patients to return to work 
and to a fulfilling life.

Although hydrocodone has for years been the prescription drug of choice for 
abusers willing to tap the Decatur black market, OxyContin - nicknamed 
"hillbilly heroin" because of its initial abuse in rural areas - is 
catching up.

White said one reason OxyContin's popularity is increasing is the ease with 
which it is abused. Manufactured as a time-release pill, addicts can crush 
the water-soluble pills and inject them, chew them or snort them for a 
heroin-like rush.

A rush that is sometimes fatal, especially when combined with alcohol or 
other drugs. At least one Decatur teen died from an OxyContin overdose, 
White said, and he has no doubt more deaths will come.

3 Primary Methods

White said abusers of prescription painkillers use three primary methods to 
obtain the medications. One is "doctor shopping;" another involves forging 
prescriptions. Less commonly, they rob pharmacies.

The doctor-shopping method is hardest to catch, White said, because 
"doctors are probably the hardest to work" from a law enforcement perspective.

Typically, White said, the doctor-shopping method of acquiring OxyContin or 
hydrocodone involves black-market professionals visiting numerous doctors 
and convincing them their symptoms are best treated with one of the 
addictive drugs.

Inherent in any investigation is the assumption that the professional duped 
a doctor - something most doctors do not like to admit, he said.

More advanced black marketers hire people to shop doctors for painkiller 
prescriptions, a method that makes law-enforcement efforts even more difficult.

"They do it for a living. They can say the right thing to get a doctor to 
prescribe the drugs," White said.

More Security

An increase in robberies of area pharmacies has Bendall's Pharmacy in 
Decatur preparing to purchase a bank vault to hold all OxyContin and 
hydrocodone pills.

Tim Douthit, owner of Bendall's, said he is frequently amazed at the effort 
people will expend to get OxyContin and hydrocodone.

"If I get suspicious, I'll ask them if it's a good prescription. Usually 
they'll say, 'Yes,' and then I say I'm going to call the doctor. Most of 
them will then say they'll come back later, or act like they are mad, take 
the prescription and storm out," Douthit said.

"But I had one lady who said it was a good prescription. I started to call 
the doctor, and she actually ran around behind the pharmacy counter, jerked 
the piece of paper out of my hand and ran out the door," Douthit said.

Recalling a more successful scam, Douthit said people would bring in 
official-looking prescriptions from a doctor who supposedly practiced in 
Decatur.

On the prescription was a phone number, but the number was monitored by 
somebody involved in the scam.

"I got duped by that one, but not for long. They were pretty much run out 
of town," Douthit said.

Not Easily Duped

Dr. Eric Beck, board certified in pain management and medical director of 
HealthSouth Rehabilitation Center in Huntsville, said doctors are not as 
easily duped as police may think.

"Patients have to take regular urine drug tests to make sure not only that 
they are taking the medication (instead of selling it), but also that they 
are not taking anything else they shouldn't be," Beck said.

"If they come up short - if they say they lost it, or the dog ate it, or 
they dropped it in the toilet - I normally just quit writing it, and they 
don't get anymore," Beck said.

Beck was skeptical about law enforcement suggestions that doctors are slow 
to cooperate.

"I call the police on a routine basis, and we rarely hear anything back 
from them. We don't know what happens after we call," Beck said.

Abuse Vs. Benefits

The potential for OxyContin abuse should be weighed against the 
medication's tremendous benefits, according to Beck.

"I have patients come in that haven't worked for years. They're placed on 
these medications and suddenly they are gainfully employed. I've had many 
say to me they have not missed a day of work since they started taking the 
medication. That's pretty reinforcing to me," Beck said.

Limbaugh's name came up in connection with a type of drug ring White hopes 
does not exist in Decatur: A ring allegedly dependent upon a corrupt 
pharmacist.

White said he believes area pharmacists are honest, and are fairly good at 
spotting forged prescriptions. But the huge profits possible in 
distributing black-market painkillers are a temptation, he said.

"Pharmacists know what to look for - altered prescriptions, copied 
prescriptions or people calling in to say they're from a doctor's office. 
Doctors know what to look for, too, but these folks are professionals," 
White said.

Monetary Lure

The extent of the monetary lure becomes clear from an affidavit filed in 
Florida to obtain a search warrant. Florida officials said last week that 
they are investigating an allegation Limbaugh illegally purchased 
black-market OxyContin and hydrocodone.

The documents released by law-enforcement officials do not mention 
Limbaugh, but officials said the two investigations are connected.

On Feb. 10, the Palm Beach County Sheriff's Office seized 5,000 hydrocodone 
pills in numerous Ziploc bags from a pharmacist allegedly delivering them 
to a black-market distributor.

When they searched the pharmacist's home, they discovered a bedside trunk 
containing $806,000.

Complex Problem

The problem faced by regulators is complex. OxyContin can be deadly when 
abused, but it is an effective drug in alleviating pain, especially for 
patients with cancer, back pain and arthritis.

The active ingredient in OxyContin is oxycodone, a substance found in many 
pain medications.

Most other pain medications, however, contain small amounts of oxycodone. 
OxyContin's time-release formula contains a significantly greater amount of 
oxycodone.

This same time-release formula, however, is critical both to the drug's 
effectiveness and to suppressing abuse of the drug, according to Beck.

"The time-release prevents the patient from getting an immediate rush from 
the drug. The abuse potential for short-acting narcotics is much higher 
than long-acting narcotics like OxyContin. You get more euphoria from the 
short-acting drugs, and you have to keep taking it to keep getting the effect.

"It's like Pavlov's dog. You take the pill and you get the euphoria, so you 
get conditioned to that response. With time-release formulas you get a slow 
release, which decreases the drug-effect pairing, so there is less 
likelihood of becoming dependent," Beck said.

In 2001, at the urging of the Federal Drug Administration, OxyContin's 
manufacturer added the FDA's strongest type of warning to OxyContin 
packaging - a black box saying OxyContin is potentially as addictive as 
morphine.

While the use of oxycodone in pain relievers is not new, most other 
medications combine the opiate with Tylenol or aspirin.

Those analgesics can be fatal when ingested in large doses, a fact that has 
left OxyContin as a more popular alternative.

Beck said publicity about OxyContin abuse unfairly stigmatizes legitimate 
users.

"They call these patients 'addicted,' but they are not. Addiction is where 
you go out and do illegal things to get medication.

"Yes, these people are physically dependent upon the medication. But if you 
take a blood pressure pill on a daily basis, you are physically dependent 
on that," Beck said. "These people have legitimate needs for adequate pain 
control."
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MAP posted-by: Beth Wehrman