Feb. 9, 2001 -- The official name is OxyContin, but on the street it's known as "oxycotton." And at a dollar a milligram, it's the drug du jour from the coal-mining country of Kentucky to the bleak factory towns of rural Maine.
When taken in pill form, as intended, OxyContin is a slow-release narcotic prescribed for pain caused by cancer, severe arthritis, sickle cell disease, and nerve damage. The active ingredient in the drug is a morphine derivative, the same as that also found in Percodan.
But when bought on the street, oxycotton is crushed and snorted to deliver a powerful and fast high that many users say is better than heroin.
Purdue Pharma, maker of OxyContin, has known for about a year that the medicine is being abused, says J. David Haddox, MD, senior medical director of the company.
"As soon as we learned about the abuse problems, we went into those areas where abuse was reported and began education programs for physicians," Haddox says. "We also cooperated with law enforcement in those areas because we want to do all that we can to make sure this drug is not abused. We want to stop the drug from being obtained through fraud or theft."
The drug's growing bad reputation is a cause of concern and even fear to those who take it for medicinal reasons. For instance, Jeanette Murray, RN, injured her arm in a fall at work almost two years ago and has suffered chronic pain since then. After trying a number of different painkillers, she finally found relief with OxyContin and now takes two 40-mg pills each day.
But because of newspaper reports of OxyContin's attractiveness to hard-core addicts, Murray says, "she sometimes has trouble getting her prescription because some pharmacies in her Virginia home town won't stock the drug for fear the stores will be broken into. And some physicians are reluctant to write prescriptions for it because they worry that they will become the target of investigations by law enforcement agencies.
"I'm even afraid when I'm carrying pills around that I'll be attacked," Murray says.
Still, taking OxyContin is worth the hassle, Murray says, because it eases her pain and permits her to live a nearly normal life. And taken as directed, under medical supervision, the drug does not lead to addiction, she contends.
"This drug makes it possible for chronic pain patients to live their lives normally. It makes a profound difference in the quality of their lives," says Robert Swerdlow, MD, associate professor of medicine and oncology at the Barbara Ann Karmanos Cancer Institute at Wayne State University in Detroit.
Television and newspaper reports about OxyContin-related arrests in Kentucky prompted many of Swerdlow's patients "to call in and say they weren't going to use the drug anymore because it's bad, it's addictive." That reaction has Swerdlow worried because when the drug is "used medically, as it should be used, it does not cause addiction."
Edward Davis, a 40-year-old who runs a medical billing company in Benicia, Calif., disagrees with Murray and Swedlow.
Davis says he has been hooked on OxyContin for the past year. He began taking it to ease the chronic pain he suffers as a result of a car accident three years ago.
Today, he tells WebMD, "I need about nine 40-mg pills a day." The monthly cost runs from "$1,300 to $1,500, which my insurance company pays," he says.
To "break the cycle and get on with my life," Davis says he tried "going cold turkey, but it was awful. For five days I had tremors, nausea, vomiting, leg pain, diarrhea. I couldn't walk. It was disgusting." On Valentine's Day, Davis will check into the Waismann Institute in Los Angeles for a rapid detox treatment.
Davis' story is pretty typical, says James Mulligan, MD, medical director of the Caron Foundation, a chemical dependency rehabilitation center in Wernesville, Pa. Even when taken as directed, any narcotic can become addictive, he says.
Nevertheless, "long-acting opioids [such as OxyContin] are very appropriate for treatment of chronic pain syndromes," he tells WebMD.
"There are really two types of addiction that we are talking about here," Mulligan explains. "The street use when the pills are crushed then snorted or injected gives a tremendous high. The other addiction is the middle-class 'pill' addiction where someone is taking many pills a day because it tends to increase energy. We see this with Percodan as well as with OxyContin."
It's the street use that has both addiction specialists and police worried. Harlan County, Ky., Sheriff Steve Duff tells WebMD his department has been grappling with "oxycotton" for the past year.
In a sweep last September, Duff and his deputies and arrested 67 people for possession of the drug.
"When I look at drug arrest warrants since 1999, 85% to 90% of them are for OxyContin use," Duff says. Moreover, although the Harlan County population is only 36,000, Duff says there have been eight deaths caused by overdoses of OxyContin in the past year alone.
On Feb. 1, his department arrested Ali Sawaf, MD, and charged him with six counts of illegally prescribing drugs, three counts of bribery of a public official, three counts of witness intimidation, and two counts of being a persistent felony offender.
"We thought we shut him down last fall, but he just moved to another location. This office didn't even have an examining table, just a desk and a receptionist," Duff says. Sawaf is being held in Harlan County Jail for arraignment next week.
Duff says he can't really explain why OxyContin abuse "started here, and in Virginia, West Virginia, Tennessee, and up in rural Maine. I think that here it might be because we have a lot of coalminers and they get hurt and have a lot of pain, so we have a lot of these pain management clinics here. ... It's puzzling because usually the drugs -- you know, cocaine, crack cocaine, even heroin, they start in the cities. This time we're ahead of the trend. Not a good place to be."