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On a warm December morning, a crowd of men and women wait for the doors to open at Addiction Specialists Inc., a methadone clinic on Route 51 near Uniontown. 

Most are OxyContin addicts who need a daily dose of this synthetic opiate to stave off the painful cramping, diarrhea, sweating and twitching that accompanies withdrawal. 

Methadone, which does not produce the euphoric effects of opiates, is a lifesaver for these men and women.  Without it, they likely would return to using heroin or OxyContin. 

Joe, a tall, burly addict who will only allow his first name to be used, is one of 644 Fayette County residents who are in methadone treatment for drug addiction this year, according to the state Health Department. 

"Addiction is powerful, so powerful," the 36-year-old said.  "I've laid around for six or seven days wanting to kill myself.  As soon as I got some money in my hand, I went looking for the dope man.  It never ended.  Addiction is baffling.  You hurt everyone around you."

Although cocaine and marijuana remain the leading drugs of choice, abuse of OxyContin is growing steadily in Pennsylvania, according to a report by the National Drug Intelligence Center in Johnstown. 

The powerful painkiller "is a serious and growing problem ...  particularly in western Pennsylvania," the report states.  OxyContin "is the pharmaceutical drug of choice" in this corner of the state, it adds. 

OxyContin, which is prescribed for people suffering from chronic pain or terminal illness, is the brand name for oxycodone hydrochloride.  Manufactured by Purdue Pharma, it has a high potential for abuse because it provides 12 hours of pain relief instead of the regular four hours offered by other drugs. 

Addicts boost the drug's euphoria by crushing the tablets, which destroys the timed-release element and gives an immediate rush that can last for several hours. 

Rising User Rates

Addiction to OxyContin has skyrocketed in Fayette County in the past year, the report states. 

This year, the county will spend $600,000 to treat opiate addicts, said David McAdoo, director of the Fayette County Drug and Alcohol Commission. 

McAdoo said the number of people addicted to opiates has increased since the mid-1990s when only 10 people were in treatment.  Today, he has 140 clients "that he can track" enrolled in treatment programs subsidized by taxpayers. 

Addiction has increased significantly in the Connellsville and Dunbar areas, according to McAdoo and drug treatment counselors "because that's where the dealers are," McAdoo believes. 

Roz and Sean Sugarman, operators of Addiction Specialists in North Union Township, are licensed to treat 350 addicts.  Sean Sugarman said a survey of clients revealed that 80 percent of the 330 in treatment are addicted to OxyContin and 60 percent use the painkiller exclusively. 

"It's the primary drug in Fayette County," he said.  "That's why they call it the poor man's heroin."

Seventy percent are from Connellsville and Dunbar. 

In Connellsville and Dunbar, the Sugarmans said, users are crushing the pills and inhaling the powder or cooking it into a liquid so they can inject the drug into their veins like heroin. 

Nationally, OxyContin abuse appears to be confined to the eastern United States, according to the federal report, because addicts find it to be a good substitute for heroin. 

In Pennsylvania, heroin is overtaking cocaine as the primary drug threat, the center found.  More users, the report said, are found in smaller towns like Connellsville rather than urban areas such as Pittsburgh and Philadelphia. 

Statewide, addiction treatment for OxyContin and other opiates increased to 1,201 last year from 859 in 1999, according to the state Department of Health. 

The National Drug Intelligence Center cites increases in addiction in northern Westmoreland County, where OxyContin abuse has doubled in the past year, as well as in Pittsburgh in Allegheny County.  In Allegheny County, 749 of 3,300 clients in treatment are addicted to opiates like OxyContin, according to the health department. 

In Westmoreland County, there are 137 clients from Arnold, New Kensington, Latrobe, Greensburg and Monessen being treated specifically for opiate addiction - out of more than 1,900 in treatment for abusing drugs. 

Increase In Crime

OxyContin abuse has been linked to an increase in crime.  The federal Drug Enforcement Administration reports that Pennsylvania has more OxyContin-related crime than any other state. 

In Cambria County, police report 30 percent of undercover drug purchases involve OxyContin.  The DEA reports OxyContin is the fastest growing drug problem in Lawrence County. 

Police in Blair County report that heroin addicts are purchasing large amounts of OxyContin instead of heroin because users believe it is safer than heroin and produces a better high. 

Since last summer, OxyContin abuse also has led to an increase in holdups and burglaries of pharmacies, including businesses in Greensburg and Connellsville.  The thefts are related to OxyContin, according to police. 

In Greensburg, robbers stole 400 pills from a city pharmacy.  Last summer, Greensburg police arrested two people at a motel who had 300 OxyContin tablets in their possession.  Police believe the pair had been robbing pharmacies from North Dakota to Pennsylvania for the drug. 

State and municipal police departments also have reported home break- ins in which thieves stole OxyContin from people who legitimately were prescribed the drug. 

OxyContin is not a contraband drug like heroin or cocaine. 

There are no cartels in Colombia or Mexico smuggling the drug into the United States or clandestine labs where amateur chemists cook up batches of the drug.  The only sources of OxyContin are physicians and pharmacies. 

Therein may lie the problem, said Roz Sugarman, a former heroin addict herself. 

"Doctors are a little too liberal with their prescription pads," Sugarman said.  "Eighty percent of our clients are strictly Oxy- addicts.  They've never used heroin.  A heroin addict is a rare occasion in this building at this point. 

"Doctors bear a big responsibility for creating the OxyContin problem.  There are two types of physicians who write ( bad ) prescriptions.  The first is a doctor who is ignorant about dispensing prescriptions.  The second is the unethical physician who makes money off somebody's prescription."

In its report, the Drug Intelligence Center said pharmaceutical diversion is increasing in western Pennsylvania, particularly for OxyContin, Percodan and Tylox.  All contain oxycodone. 

One Doctor's Case

When Dr.  Mark Fremd of Connellsville was arrested earlier this year on drug-related charges, state Attorney General Mike Fisher publicly charged that Fremd's alleged professional misconduct "exacerbated" Fayette County's drug problem. 

Fremd is accused of prescribing more than 95,000 individual doses of painkillers including OxyContin, Percocet, Lortab, Vicodin and Darvocet from 1996 through 1998, according to the arrest warrant.  He also is accused of prescribing methadone to addicts and billing insurance companies for detoxification even though he is not licensed to operate a drug treatment center. 

Several witnesses testified before a state grand jury investigating Fremd that they had to enter drug rehabilitation programs because they had become addicted to OxyContin from prescriptions allegedly written by Fremd. 

During Fremd's preliminary hearing, a witness testifying for prosecutors said Fremd prescribed OxyContin for her even when she didn't want it, according to a transcript of the hearing.  She testified he would dump the tablets out of a bottle and wrap them in a napkin before selling them to her. 

Another witness, according to a police affidavit, told state drug agents he and his wife were buying OxyContin from Fremd because they both are addicts. 

One witness said Fremd didn't help her with her addiction "because Fremd is more like a drug dealer, not a doctor because Fremd's patients get whatever prescriptions they want from him as long as they have the money," the affidavit states. 

Roz Sugarman said doctor shopping is the main source of OxyContin for addicts. 

She said one client drove from Pittsburgh to Johnstown several times a week to see a physician for back pain treatment despite the availability of back specialists in Pittsburgh.  "He went to Johnstown because he found a doctor who was writing prescription for OxyContin," she added. 

Joe, the addict, said it is easy to get OxyContin from physicians.  He estimated eight out of 10 doctors he would make appointments with prescribed OxyContin without asking any questions or doing a physical exam. 

Joe said he once saw a Connellsville physician for severe leg pain.  He showed the doctor a scar running from his knee to his ankle from an operation following an accident. 

"He told me to drop my pants.  He took one look at the scar and asked me how much money I had in my pocket.  I said $100.  He gave me 60 OxyContin."

It's that easy, said Joe.  "First, you find out who's writing.  Have some money.  Dress pretty well.  If you know a doctor who's writing, he knows why you're there.  It was pretty much that easy."

Mixing Drugs

Dr.  Anthony Stiles, an addiction specialist with Comprehensive Substance Abuse Services in Greensburg, said OxyContin addicts are taking the drug with powerful sedatives, which can paralyze the respiratory system, causing death. 

"There's a substantial population that is using OxyContin exclusively with Soma, a muscle relaxant which also has addictive potential," Stiles said.  "In 1998, when I first started here, you almost never saw a patient abusing or even prescribed OxyContin.  Now it's more frequent."

Stiles said doctors learn in medical school that morphine is a "top- of-the-line painkiller" and should be prescribed sparingly.  He said morphine is as powerful as OxyContin but you seldom see people addicted to it. 

"It's almost never prescribed or abused," Stiles continued.  "But doctors feel more comfortable prescribing OxyContin as an outpatient."

The U.S.  Food and Drug Administration has strengthened label warnings on packaging to force physicians to be more aware of their prescription practices. 

Roz Sugarman said she worries about the spread of OxyContin because the clients treated at her clinic are getting younger.  "I don't know how many are out there that haven't got to us yet."