It's a typical Saturday night for 22-year-old Jason Reyick,* a cook at a Midtown restaurant. He went to work around 5 p.m., walked home at midnight, then set about finding some drugs. Sometimes this task involves a trip to the liquor store, sometimes a phone call to his trusty pot dealer. But tonight a friend with a baggie full of little yellow pills shows up. Tonight, there's just a payment of $20 for a 40-milligram tablet of OxyContin, a powerful prescription painkiller that's recently entered the illegal drug market and rapidly gained popularity.
Later, a few friends from work show up, ready to party. Each purchases a pill, and their fun begins. Reyick, who prefers to snort OxyContin rather than chew or inject it, chops his pill into a fine powder with a pocket knife. He lays a dollar bill over the crushed pill and runs a lighter over it to crush all the chunks. Then he uses his knife to form the powder into a neat line, rolls up the dollar bill, and proceeds to snort the powder.
His friends follow suit, and minutes later, they enter a dreamlike state. Reyick slowly leans back on his ratty black couch, takes a deep breath, and closes his eyes, letting his body totally relax as peaceful thoughts sweep through his mind. The back pain from work floats somewhere far away. For the next several hours, he moves only to go to the bathroom a few times -- and once to dry-heave over the toilet.
You may never have heard of OxyContin, but the scene described above is growing more common all over the Mid-South, a reflection of a national trend toward increasing abuse of the potent painkiller. In Tennessee, reported cases of OxyContin abuse are more prevalent in the eastern part of the state, but state DEA officials report that the drug is being increasingly seen in the Memphis area.
Despite the number of strong painkillers on the market before 1996, people with severe pain due to cancer or other debilitating conditions were in need of something more. Oxycodone-containing medications available at the time, such as Percocet and Vicodin, contain additional ingredients, such as acetaminophen, which can cause organ-toxicity problems in large doses.
Since opiates cause tolerance to develop rather quickly, chronic pain sufferers would eventually have to up their dose to achieve the desired effect, thus also increasing the dose of acetaminophen or other added ingredients.
In December 1995, Purdue Pharma introduced OxyContin, a time-release pill which contained a much higher concentration of oxycodone and no acetaminophen. The oxycodone level in one 40-milligram tablet of OxyContin is equal to eight five-milligram Percocets. It was made available in a variety of strengths -- 10, 20, 40, 80, and 160 milligrams -- and prescribed according to the severity of pain.
"The indication is for an intensity and longevity of disease. It's for people who feel pain 24 hours a day and people who're going to be in pain for the rest of their life," says Jim Heins, associate director of public affairs at Purdue Pharma. "Say a back surgery has failed or they have cancer or maybe they've been in an accident and they're going to be in pain for decades. It's not disease-specific. It's prescribed due to the chronicity of the pain."
Oxycodone, the active ingredient in OxyContin, is a derivative of opium. Its effects are similar to that of morphine. In the Comprehensive Controlled Substances Act of 1970, Congress placed the drug under Schedule II status, which includes drugs that have some medical use but a high abuse potential. Oxycodone is cited as an effective analgesic for mild to moderate pain control, for chronic-pain syndrome, and for the treatment of terminal-cancer pain. OxyContin pills are covered with a coating that time-releases oxycodone into a user's system for 12 hours. Abusers of the drug typically chew or crush the pills to get past the coating, releasing all the oxycodone at once for a much stronger high.
"OxyContin is kind of like a dream, but you can control it," says Reyick. "It comes on slow and steady, kind of like a cocaine buzz, but once it hits, you're just in a hole. It's not a bad hole, though. It's just the kind of hole that you can cruise through."
When asked to explain the buzz, many users report something similar to a dreamlike state, where the body feels loose and heavy but the mind is in a state of intense euphoria. High doses of OxyContin, also known as OCs or Oxys, can cause loss of concentration, dizziness, skin that is sensitive to the touch, heavy sweating, and slurred speech. When there is little food in the stomach, the drug can also cause mild nausea.
According to the Office of National Drug Control Policy's Pulse Check report, released in April 2002, many users in the Memphis area are engaging in OxyContin use in nightclubs and at parties, where it is often associated with the use of club drugs such as Ecstasy.
The Pulse Check also reports that OxyContin in Memphis is regularly bartered for other drugs, such as crack cocaine or other prescription pills. Twenty-milligram pills are sold for $10-$30 each, depending on the dosage strength.
There are a number of ways OxyContin is being diverted from pharmacies to the streets. According to Mike Arpiao, a prescription drug diversion officer for the Tennessee DEA, the state is 16th in the nation in acquiring the drug for pharmacies, physicians, and hospitals. "People are obtaining it through doctor shopping [obtaining multiple prescriptions from a variety of doctors], forged prescriptions, or buying it off the street from people who are selling their prescriptions," he says. "There are also unscrupulous pharmacists that could be selling it out the back door without a prescription."
Drugstore robberies are another method of diversion, and the Pulse Check reports that thefts from the homes of legal users are also common. But according to the report, most of the OxyContin sold in Memphis has been diverted from the Northeast and shipped to the South.
The Shelby County vice-narcotics unit made only 10 OxyContin-related arrests last year, according to Major D.A. Betts. But the unit is seeing an increase in the use of the drug locally. Officers knew of the growing OxyContin abuse problem in eastern Tennessee and were aware of the potential problem. The drug is already very popular in the local DJ and rave circuit.
Not everyone who's abusing OxyContin is doing it purely for pleasure. Barbara Teague,* a 55-year-old local, was diagnosed with polio at age 3 and now suffers from a chronic muscle deterioration known as post-polio syndrome. The condition makes her bones brittle, and last year some bones in her hips were broken beyond repair. Doctors performed hip-replacement surgery, but Teague still suffers an extraordinary amount of pain. She's prescribed 90 milligrams of OxyContin a day.
Her 28-year-old daughter Anna,* a pharmaceutical sales major at the University of Memphis, thinks her mother, who's been taking the drug for a year and a half, has developed an addiction and says it's caused multiple problems in her family.
"Sometimes, I'll have to monitor her medication without her knowing it," she says. "I'll count them and look at the date on the bottle. She's supposed to be taking three a day, so if there's eight gone in a day, I'll know she's overmedicating. She takes care of my daughter during the day when I'm in school. One day she was so screwed up, she couldn't find her ass from a set of bullhorns. I couldn't leave my daughter with her. I had to miss school."
Anna says her mother has trouble admitting she may have a problem and often resorts to excuses: "Well, I accidentally overdid it." Or "I forgot I'd already taken some." Or "I need to get one of those little pill dispensers with the numbered days so I won't mess up."
"She knows what she's doing, but she's in denial," Anna says. "She wants to get a little high sometimes, and that's the way she does it. Some people smoke pot. Some people drink. She takes pills by the handful."
The Teague family's OxyContin problem is not uncommon. In recent years, Purdue Pharma has been hit with a number of lawsuits from patients who were prescribed the medication and claimed to have become addicted.
Jim Heins of Purdue Pharma told the Flyer that the company has no hard numbers on how many lawsuits they've faced since 1995 regarding OxyContin addiction, but he says they are performing an analysis and will eventually release a report to the public. Heins adds that the recent increase in media coverage of OxyContin has created a negative picture of the drug, leading many patients to believe they are addicted when they may not be.
Dr. Clifford Bernstein, medical director of the California-based Weismann Institute, an opiate treatment center, disagrees. He says that many of the cases they treat involve people who were prescribed OxyContin and became hooked.
"We used to only treat heroin addicts, but now we're about 70 percent prescription medications, and OxyContin's my number-one drug. Purdue Pharma is denying the stuff's even habit-forming, just like the tobacco industry," he says. "A lot of patients don't realize that after a while, the drugs don't work and your dose is escalated. The next thing you know, you're hooked."
Addiction to OxyContin can result in the same kind of gradual wasting away that affects heroin and morphine addicts. Not all of those who engage in occasional recreational OxyContin are addicted, however. In fact, those who are prescribed the drug may run a higher risk of addiction because their supply is so readily available.
Reyick says he doesn't have a problem and only occasionally uses OxyContin. He says he only does it when it happens to be around, although he adds that if he had more access to the drug, he'd have to watch himself.
"OxyContin's one of those things that if you think you have control, then you've already fooled yourself and you're in a dangerous position," says Reyick.
For those who have a problem, extensive -- and often expensive -- treatment programs are available for opiate abuse. The programs fall into two categories: medical and social.
Medical treatments include the highly effective but very pricey rapid-detoxification method as well as the more traditional methadone program. Social treatments include drug counseling, such as Narcotics Anonymous. Medical treatment is recommended for serious opiate problems due to possible life-threatening withdrawal symptoms.
Methadone is administered orally to opiate-addicted patients once a day in clinics such as the Memphis Center for Research and Addiction Treatment on Madison Avenue. It's a medically-safe drug, with no toxic side effects, that relieves withdrawal symptoms, eliminates opiate cravings, and allows for normal body functioning. Methadone has no narcotic effects but can cause withdrawals if not properly administered. Patients are normally weaned from methadone over a six-month period.
The Substance Abuse and Mental Health Services Administration reports that methadone clinics nationwide have seen an increase in OxyContin abuse in recent years, including a particularly significant increase in 2001. Lisa Massey, a counselor at the Memphis Center, says the center has not seen a large number of patients with OxyContin problems, but she says it may be moving this way soon from East Tennessee. Massey says the number-one drug they treat is probably Dilaudid, a synthetic form of heroin.
(Treatment at the Memphis Center costs about $5,700 if a participant completes the entire program. Patients are charged $77 per week for 18 months, in addition to an initial fee of $127.)
The other form of medical treatment available, rapid detoxification, involves the administration of a pill called Naltrexone and promises results in three days. There are several methods of rapid detox performed at various clinics across the country, but the original method, practiced by the Weismann Institute in San Diego, has been around the longest and has a success rate of 65 percent after a year. There are no rapid-detox centers in the Memphis area.
"The Weismann method blocks cravings after bringing people through the withdrawals as humanely as possible," says Dr. Bernstein, the institute's medical director. "Methadone blocks cravings, but so do other opiates. They're 100 percent interchangeable. The Naltrexone that we leave people on afterwards is exactly the opposite. If you're hooked on an opiate and you take a Naltrexone pill, you'll get very sick."
"Look at OxyContin as a key that fits in a lock, the lock being the receptor. The key goes in the lock, opens the door, and turns on the receptor," Dr. Bernstein explains. "That's what gives the effect of OxyContin. Naltrexone is the drug we use to compete for that lock. It's like a key that's been broken in half. You can put the key in the lock, but you can't open it. It blocks that receptor."
Social treatments, such as the 28-day program at New Directions Inc. on Semmes Street in Memphis, provide patients with group counseling and one-on-one therapy. Sharon Couch, administrative assistant for New Directions, says they have yet to see large numbers of OxyContin abuse but pointed out that when someone comes in with a severe opiate addiction, she usually sends them to Central Intake at the Memphis and Shelby County Health Department for medical treatment to bring them through withdrawal.
"We're strictly social. We don't give any medicines. So if they've been off it a couple days and they're pretty stable, we take them on in," says Couch. "What we try to do is get people to change their thinking, not just their behavior."
The U.S. DEA has recorded 318 deaths in which OxyContin was a contributing factor. Although OxyContin overdose is usually a result of poly-drug toxicity, it still plays a major role. According to Major Betts, there is one case in federal court involving an OxyContin overdose in the Memphis area.
Of the 20 major cities studied in the Pulse Check report, Memphis is among 12 in which OxyContin availability is reported as increasing markedly. The Tennessee Bureau of Investigation's 2001-2002 Annual Report shows an increase in OxyContin abuse statewide. You may not have heard much about it yet, but OxyContin is coming, and the problem is likely to get worse before it gets better.