The first time Eric tried OxyContin, he knew he was screwed. It wasnt like the other drugs hed popped, snorted or injected after graduating from a public high school in an affluent area.
As a teenager, Ericwho wishes to remain anonymousmanaged to juggle weekend kegs with athletic and academic achievements. While his recreational use eventually expanded to include Ecstasy, cocaine and weed, partying was just a way to let loosenot a way of life. Nothing prepared him for Oxys sucker-punch effect. In fact, the powerful prescription painkiller made all the other narcotics seem about as addictive as Fruit Loops.
I remember thinking, Holy cow, it would be great if I felt like this all day, every day, for the rest of my life, he says. Even now, his excitement is palpable.
Today, he looks back on Oxy as a hot romance turned sour, but hell never forget how it felt to fallfast and hard.
It started on weekends, at parties, in a bedroom with four or five others. For a while, hed split up one OC 20, or 20 mg of pure oxycodone, take half and save the rest for later. But his tolerance went through the roof. He needed more and more, and it was getting expensive. His group of friends started snagging OC 80 at $60 a hit. He tried stopping, but couldnt handle the withdrawals. Chills, fever, vomiting and stomach cramps wracked his body.
He worked as a garbageman, driving trucks around town, high as a kite, reflexes down. Dad and Grandma kept loaning him money, but sooner or later the gig was up. His family intervened, sent him to a pricey treatment center and called it good. Six months later, Eric quit going to Narcotics Anonymous (NA) meetings, stopped calling his sponsor and relapsed. He later tried his hand as a mail carrier, trucking through the Avenues either doped up or jonesing for drugs he no longer could easily afford. His parents cut him off. He pawned prized possessions, committed petty theft and even sold Oxy for a while. But the taste was too sweet. He wanted it all for himself. Giving Oxy up was easier once heroin stepped in. It didnt take long, however, before he had to choose between getting clean and quitting life.
That was three years ago. Today, hes eight months sober. He keeps a steady, blue-collar job, hangs out with his girlfriend and attends NA meetings every day. His drugs of choice are coffee and cigarettes. This morning, he sips a 24-ounce French roast, straight up. His shoulders are wide, cheeks full, dark hair tousled from a good nights sleep. And while his tough, football-player frame has softened, the clear-headed 25-year-old is stronger than ever. He just cant help but wonder how strong he might be today had he never tried Oxy.
Eric isnt unique. Neither is OxyContin. Problem is that few experts agree on how widely its abused. Drug counselors, law-enforcement agencies, former addicts, parents and clergy members all have a different take on the drugs societal impact. Some blame the pharmaceutical industry for marketing the drug so well. Others blame physicians too eager to prescribe it. Still others argue for an outright ban on the drug. Maybe we just need to relax, pop a pill and move on.
Theres no question prescription-medication abuse is on the rise. In fact, prescribed opiate narcotics now rank second to marijuana as the nations most-abused form of drug, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Considering Utah has one of the highest rates of prescription drug abuse in the country, its safe to assume Oxys a smash hit in the Beehive State.
However, Pat Fleming, director of the Salt Lake County Substance Abuse Services Division, says that logic is difficult to prove. The local treatment and prevention center measures patient intake by general drug classification, meaning Oxy is lumped in with other opiates, like heroin. Grouping abused substances together helps researchers track long-term trends, rather than focus on one drugs fleeting popularity.
Its all about the market. When something new comes around, if it can be abused, people will figure out a way to do it. Thats never going to change, Fleming says. Its all about availability and cost.
Oxy, while fairly expensive, is easier to get than heroinespecially if users seek it through legitimate channels.
Thats because Oxy is legitimate, and therefore legal. Since its 1995 debut, the powerful prescription medication has provided chronic pain relief for cancer patients as well as those suffering debilitating injuries to the back and neck, for example. Unlike most painkillers padded with varying amounts of aspirin and acetaminophen, Oxys brilliantly crafted time-release formulation allows users to receive controlled doses of 100 percent pure oxycodone, a central nervous system depressant also found in Percocet, Tylox and Percodan. When used as directed, patients who swallow one OxyContin tablet feel the opiates effect over a 12-hour interval. When crushed, ground up and snorted, however, Oxys distinct sustained-released mechanism is disabled, giving users an unfettered euphoric rush.
It turns out plenty of kids are unlocking Oxys stealth impact. A recent study sponsored by the Partnership for a Drug-Free America shows prescription drug abuse is on the rise among teenagers. The report indicates approximately one in five high school students has taken prescribed opiates to get high. Eighteen percent of kids reported non-medical use of Vicodin, a slightly less addictive combination of two pain relievers, while 10 percent admitted abusing Oxy. The alarming data prompted researchers to dub this new class of users, Generation RX, a catchy term that doesnt do its subject justice.
If the slogans true, Utahs schools could be harboring plenty of RX-ers. Its difficult to track exactly how many local students are experimenting with Oxy, considering theres little data documenting its effects across the nation, let alone in Utah. But anecdotal evidence suggests its more popular here than scarce data indicates.
Eric says his former East Bench high school exemplifies local trends. Most of the students come from wealthy LDS families and have regular access to well-stocked medicine cabinets.Â They dont pay rent, health or car insurance and, with the right ploy, can convince trusting parents to fork over cash for an innocent night at the movies. Plus, physicians tend to find insured clients claims of injury more credible than those of inner-city patients backed by Medicare.
Culturally, Oxy isnt grouped with dirty street drugs like coke and heroin. Many assume that if its legal, its safe. After all, whats the harm in following doctors orders? Thats the sort of attitude that makes Oxy so susceptible to abuse: that, plus its invisibility. Its easier to spot a heroin addict, or at least the gear they use to shoot up. Parents who suspect their kids might be smoking pot can check bedrooms for baggies, pipes, bongs or lingering scents. Prescription medications, on the other hand, are out in the open for everyone to seeand use. All you need is a little water to swallow the tablet.
Availability also contributes to Oxys local appeal. Convenient interstate highways run through Salt Lake City and Ogden, forming appealing routes for dealers pushing high volumes of legal narcotics. Places like Seattle, where heroin is fairly accessible, are less likely to produce Oxy addicts. Why pay more for a drug that, pharmacologically, is a duplicate of a cheaper substance? Utahs heroin supply is dominated by the low-grade, Mexican brown-tar variety, so opting for pure, potent Oxy is a no-brainer.
But while the low-radar prescription medication packs extra oomph, users eventually find Oxys costly price tag outweighs its limited benefits.Â Which is why most experts predict the drugs popularity will be short-lived. While its presence in high schools causes concern, theres little danger of Oxy turning America into a nation of rabid pill poppers.
Robert Heimer, associate professor of epidemiology and public health at Yale University, believes popular opinion is tainted by the myth of it drugs. The truth is much less sexy: abuse is cyclical.
Its going to look like an epidemic because it went from zero to something [significant] in a short period of time, he says, adding that abuse of pharmaceutical opiates has always been a non-inner-city problem that has worsened over the past decade. The trend suggests that theres some misuse of this drug but that theres nothing intrinsic to the drug itself thats the cause of misuse. While theres more bang because the size of the dose is larger, its not more bang for your buck.
Heimer should know. Starting in the summer of 2002, he spent five months tracking Oxy abuse across Washington County, Maine, for what is still one of the few definitive studies on the subject. At the time, Purdue Pharma L.P., the drugs manufacturer, knew very little about its products unintended effects. Heimer and his colleagues approached the company and offered to conduct research in exchange for modest funding. The partnership, Heimer says, stipulated complete objectivity. In other words, Purdue Pharma apparently didnt buy any favors.
Washington County was typical of regions exhibiting early signs of Oxy abuse. The prescription painkiller was prevalent in rural and industrial towns, places run on steel factories and coal mines where bone-crushing, life-altering injuries are a way of life.
When Oxy first hit the market, people viewed it as a miracle cure-all. Physicians, unfamiliar with its long-term effects, didnt hesitate to prescribe liberal amounts to patients clearly in pain. Then people started getting hooked. They learned to work the system by doctor shopping, visiting multiple physicians and pharmacists for enough Oxy to make it through the week. As the problem increased, people started looking for someone to blame. Many fingered Purdue Pharma as the culprit, citing an aggressive marketing campaign that praised a new wonder drug without disclosing its severe drawbacks. Hordes of attorneys, clients in tow, went after the drugs manufacturer. Faced with several class-action lawsuits, the company looked to science for its legal defense. Officials argued that OxyContin itself was not the problem, but rather a persons preexisting inclination to abuse drugs of any kind.
Thats when Heimers group stepped in. They looked at self-reported oxycodone and other opiate use among a wide-ranging sample that included both hardcore addicts and occasional weekend partiers. Their findings showed that Oxy abusers were not unique. There was nothing particularly unusual to distinguish them from other types of people who use opiates, Heimer says, noting that out of all the people who report using Oxy, only a small percentage developed significant long-term problems with addiction and drug dependency.
As far as culpability is concerned, Heimer thinks faulting Purdue Pharma is like holding Harley-Davidson responsible for the guy whose helmet-free cruise down the highway resulted in a mess of broken bones.
They have consistently tried to monitor diversion of their drug, to understand the diversion of their drug and to be responsive to the potential to abuse a drug with that much opiate analgesic, he says.
Judging from recent legal actions, federal courts agree. As of March 2005, the total number of product-liability cases against Purdue Pharma either dismissed or withdrawn by plaintiffs reached 306. Most of the rulings state that since plaintiffs had different reasons and methods for obtaining OxyContin, linking Purdue Pharma to each complaint could prove impossible. The suits dismissal served as partial vindication for the drug manufacturer, leaving physicians to shoulder the blame.
Glen Hansen, director of the Utah Addiction Center at the University of Utah, has been following Oxy for years. Hes read countless stories about its prevalence, and numerous theories on who should keep it in check. Experience leads him to believe that while physicians have a responsibility to manage patients, they arent the sole cause of addiction.
They dont often take someone without a history of drug abuse and turn him or her into an addict. And yet I think thats the image thats left with much of the public, he says. Oxy is a very good drug if managed correctly. [Physicians] know that if theyre administering pain medication for a long period of time, the patient will become addicted to itthats just the nature of the drug.
It doesnt take much to combat nature, however. Physicians who fully inform patients of Oxys severe side effects help decrease the risk of addiction. New users should know from the outset exactly what theyre getting into.
Daniel, 34, his real name withheld, could have used a heads-up. His Oxy addiction began in a hospital room following one of nine knee surgeries. The Bountiful native spent his youth immersed in at least a dozen sports at any given time. In high school, he sacrificed healthy muscle and bone for ski moguls competition and learned to embrace routine medical operations. It wasnt until laterfollowing a successful mission for The Church of Jesus Christ of Latter-day Saintsthat additional surgeries called for more potent painkillers. Unfortunately, no one bothered to tell him just how potent his new medication would be.
I had no idea it was pharmaceutical heroin, he says. It was just another pain pill, like Vicodin. I was just uneducated about it. I think a lot of people are.
Once Daniels doctor figured out his patient was hooked, he suggested stopping cold turkey. When the quick-fix approach failed, Daniel turned to the Internet where online pharmacies offered consistent relief. At the height of his addiction, he was chewing eight to 10 OC 80s a day, at a cost of $3,000 a month. Then the feds caught up with him. They brought Daniel in for pharmaceutical theft for diverting Rx drugs from online sites to the streets, charged him with aggravated robbery and threw him in jail, where he endured three weeks of excruciating withdrawal, dropping 25 pounds in 14 days.
I wouldnt wish that kind of pain on my worst enemy, he says. Its dangerous not to go to a substance-abuse program to help you break free.
Today, Daniel lives at Odyssey House, a local nonprofit treatment center. The judge sent him there pre-sentencing to get his life in order. He wasnt a bad seed, he says. Oxy crept up and threw him for a loop. His wife and two beautiful daughters didnt see it comingneither did his parents, grandparents or LDS bishop. Throughout it all he had maintained a successful career in investment properties. He thought he could handle the seemingly safe, legal drug.
Its just being prescribed freely, so a lot of people are getting into it not knowing how strong it is, how addictive, he says.
If some doctors are perhaps too eager to deliver relief to their patients, others err on the side of selfishnessbypassing standard protocol to score big money. In February, FBI agents along with state and other federal agencies arrested four Utahns for their involvement in a widespread OxyContin distribution scheme. The bust took place following an investigation by the Utah Division of Occupational and Professional Licensing (DOPL).
Purdue Pharma notified the agency after noticing suspicious amounts of OxyContin prescriptions issued by a Salt Lake Valley pain-management clinic. Officials verified claims through the Utah Controlled Substance Database, a system used to track and collect data on the dispensing of Schedule II-V drugs by all retail, institutional, and outpatient hospital pharmacies and in-state and out-of-state mail-order pharmacies.
According to documents obtained through DOPL, Dr. Alexander Theodore allegedly acted as ringleader in a scheme involving some 230 people. His plan allegedly involved hiring people to recruit patients whose health insurance covered the prescription and administration of OxyContin. Patients would then pay $400 to $500 for mock office visits where the doctor allegedly neither performed medical examinations nor issued any diagnoses. Once their prescriptions were filled, recruiters would reimburse them for the office co-pay and sell the pills at street value. Some patients opted to refuse repayment in exchange for their own personal Oxy supply. DOPL two weeks ago placed Dr. Theodore on probation and suspended his license to prescribe controlled substances for at least two years. The case is currently under criminal investigation.
Assistant Attorney General David Geary says current action wont prevent the offender from practicing medicine in the future. Utah law extends physicians the opportunity to reinstate licenses no matter what the circumstances. He adds that while this particular illegal OxyContin ring is more widespread than originally assumed, most physicians strive to uphold the law.
The problem of people seeking narcotics prescriptions and not being forthcoming with their doctor is something we need to be concerned with, Geary says. I do think the medical profession is trying very hard to keep it from happening.
Doctor shopping, however, is not the onlyor even preferredway to access Oxy. The reality is that its being diverted left and right, says Luciano Colonna, executive director for Salt Lake Countys Harm Reduction Project. The thing you have to realize about Oxy is that its a great drug. Its as pure as youre going to get short of methadone. Everything else on the street is cut and cut and cut.
Colonna assures the drug isnt being diverted from pharmaceutical companies, but rather through pharmacies and physicians. Local users like Eric, however, think otherwise. As an addict, he snagged his Oxy supply through a dealer who pushed 3,000 pills a month. Its unlikely his consistent, high-volume supply stemmed from pharmacies. Each shipment, sent to a post office box, contained bottles with expired labels. Eric figures they were destined for an incinerator before someoneassumedly a drug-manufacturer employeedecided to make a quick buck selling stale meds on the side. One dealer managed to satisfy nearly every Utah Oxy addict at one point or another, using that apparent connection inside the drug company. Since Eric distanced himself from the scene, hes not certain whether his former dealer continues to push large volumes, but cant imagine why anyone would abandon the lucrative business.
I mean, when youre talking about 3,000 pills at 60 bucks apiece, thats $180,000 he was making in cashtax-free cash. And it was guaranteed. When he got them, they were gone, Eric says. Thats an addiction all in itself. Im sure he didnt just decide to stop doing it.
Should the street dealer close shop, alternative Oxy avenues are right around the corner. Online pharmacies, for example, dont care if users are 10 or 110 years old. Nor do they screen for legitimate injuries. Recent crackdowns on illicit Internet sales have helped impede access. In extreme cases, addicts sometimes resort to breaking into pharmacies.
While Oxy abuse might not be an epidemic, those caught in its grip need effective treatment. But according to Dr. Thomas McLellan, executive director for the Philadelphia-based Treatment Research Center, most people dont have the luxury of getting better.
The treatment system in our country is in dire straits. The closure rates for all substance-abuse-treatment programs is around 15 to 20 percent per year, he says, adding that the adolescent sector receives the least amount of funding. There are simply not enough slots. The regulations havent made it financially worthwhile.
McLellan thinks a backward cultural stigma has hindered progress. The country hasnt made up its mind whether addiction is an illness that should receive medical care, or a sin that should be punished, he says. We dont want to reward people for doing Oxy. We dont want to make care available and make it easy for them to quit.
Frank, a local 42-year-old social worker who battled various drug addictions, knows this firsthand. The idea of this being an illness is really tough to convey, he says. People look at addiction as a matter of will.
In high school he tried weed, then Demerol, Percocet, cocaine and heroin. His pain-pill abuse jumped back and forth between recreational use and legitimate need. First, it was dental work and numerous surgeries following a nasty car wreck. In 1995, a bone graft to the wrist introduced him to Oxy. For the next seven years he bought it on the street or occasionally through pharmacists who sold Oxy illegally in Utah, Massachusetts, California and Alaska. He went through graduate school, marriage and a child without abandoning his painkillers. Oxy wasnt the most powerful kick hed ever experienced, but it was certainly the most convenient high. He used to chew Percocet, but it tasted nasty. Oxy packed the equivalent of 16 Percocets in one tiny pill. It went down easy and was portable enough to stuff in his pocket.
He thought about quitting, but doctors kept giving it out. When there is legitimate pain its difficult to deny patients help. Many physicians recognized Franks problem, but ignored it.
I had one surgeon who knew I was in trouble and he said, Im not the one to deal with it. I know you have a problem and its not my problem, he says.
Frank took advantage of their refusal to correct bad habits. He worked providers and physicians for all they were worth. Insurance even paid for most of it. His addiction could have gone on indefinitely. Then, for some reason, a fifth round of rehab inspired him.
I had a really profound experience in recovery, he says. The only real treatment is through spiritual awakening. You need something to replace the craving for drugs with something more sustainable.
For those who dont have profound experiences, there are, well, other drugs. While controversial, methadone remains the most common form of treatment for opiate abuse. Its analgesic strength, the same as morphine, acts for 24 hours. One daily dose keeps cravings at bay by counteracting the effects of Oxy. Should a recovering addict decide to start up again, their former drug of choice will no longer offer its powerful kick. Critics say methadone is just as harmful as the drugs it seeks to treat. Most overdoses, however, occur when addicts in treatment supplement methadone with other depressants or simply take more to enhance a slow-acting buzz.
It seems most pharmacology-based rehabilitation carries drawbacks. Hansen of the Utah Addiction Center says another possible method involves circumventing Oxy abuse by changing the drugs formulation. Purdue may be able to adjust its chemical makeup in such a way that it no longer appeals to hardcore addicts. Hansen notes that by adding antagonists, certain molecules could block Oxys concentrated effect.
One idea is abandoning the sustained-released concept, but that would be unfortunate because you would lose the benefits that have been helping legitimate patients, he says.
Robin Hogen, vice president of public affairs for Purdue Pharma, says that while the company wants to help Oxy users avoid addiction, chronic pain patients are their top priority. Purdue Pharma has spent the past three years working to develop a smart pill that combines agonists and antagonists, elements that control the drugs release, in one measured tablet. Oxy, the agonist, a drug that mimics the action of a naturally occurring substance, would be separated from the second chemical by a hard shell. When used as directed, the antagonist remains solid and eventually slips through patients digestive tract without affecting their system. If crushed, chewed or snorted, however, the second chemical will cancel out the effects of Oxy. This method would help stop addiction. But it could also hurt those who need it most.
Hogen says the problem lies in ensuring the antagonist doesnt slip into patients bloodstreams. If someone is in legitimate need of pain relief and the drug suddenly stops working, they will go into withdrawal. Obviously, Purdue Pharma doesnt want that to happen.
Thats the challenge, because we cant produce a product that will put pain patients at riskthats too high of a price, he says. Theres nothing we would like better than to solve this riddle, but this is very difficult science. If it were easy, there would be five different products on the market and wed be killing ourselves trying to outsell competitors.
Twenty other drug manufacturers are currently scrambling to create the perfect opiateone that will relieve severe pain without luring people into addiction. No one seems close to finding the solution. In the meantime, Purdue Pharma is working with health-care professionals and law-enforcement officials to ensure that patients in Utah and other states get the product they deserve.
As for Oxy addicts, theyll have to hope someone else looks out for themsomeone who wont rely solely on science to solve the problem. While theres no cure for drug addiction, prevention and proper treatment can placate abuse. Proven methods of recovery depend on increased dialogue.
No one is communicating, and were turning to criminal justice and were turning to schools to do the education, Colonna says. Physicians need to be more responsible. Law enforcement needs to monitor underground sales. Drug-treatment counselors need to supplement chemical detox with psychological evaluations. Addicts need to recognize that legal doesnt mean safe and they need to put in a tremendous amount of work to stay in recovery.
When all is said and done, those whove made it through will reflect on roads to ruin. Theyll never forget the incredible rush from snorting or chewing Oxy, but memories of hitting rock bottom will resonate the loudest.
Eric remains enamored by Oxy. He raves about its euphoric properties. Theres nothing tempting, however, about returning to life as an active addict.
When youve gotten to that point where you are so morally and spiritually bankrupt, when you dont even want to live anymore, it takes more than a bad day or hearing someone talk about it or seeing a pill to make you crave it, he says. My worst day sober is still better than my best day ever was using.