In the six years since it hit the market, OxyContin has gone from being a godsend for terminal cancer patients to a severely abused street drug. "OxyContin is definitely an issue here in Juneau," said Dr. Lindy Jones, a local family practitioner. "OxyContin was heavily marketed by the drug company for chronic pain, and all over the country people were finding it has significant abuse potential."
Editor's note: This is the second in a three-day series that looks at drug trends in the capital city.
Sunday: IV drugs
Monday: The new problem drugs - Meth and OxyContin
Tuesday: Kids and drugs
When OxyContin hit the market six years ago, legal sales totaled $40 million the first year. In 2000, sales topped $1 billion.
Nationally, a black market for OxyContin is fed in part by crime rings that divert drugs back to the United States from legitimate markets overseas.
In Juneau, the drug sometimes comes to town in a quasi-legal fashion. The pills are sold through the mail by Internet pharmacies. One Web site offers 30 pills of OxyContin for $400 without any reference to a prescription.
After a Juneau man was indicted on drug charges this month, a police sergeant testified the man had purchased nearly 6,000 tablets of painkillers, including OxyContin and related drugs. Police suspect the drugs came through the mail.
"It's remarkable what people can get through the Internet," said drug counselor Larry Olson of the Juneau Recovery Hospital. Olson is seeing a dramatic increase in the number of patients in need of treatment for OxyContin abuse.
Drugs also get in the hands of abusers through legitimate channels.
Drug seekers will make doctor's appointments and claim convincing but bogus symptoms. The Bartlett Regional Hospital emergency room sees its share of drug seekers.
"It's a dilemma we face," said emergency room physician Ken Brown. "We want to give pain control to people with a legitimate need for it and we don't want to give unnecessary medicine. We struggle with that all the time here in ER. There are definitely some people we put a stop to."
Drug counselor Matt Felix thinks doctors tend to be too generous with prescription medication.
"A lot of the drugs on the street are over-prescribing from doctors and dentists," he said. "You get a tooth pulled and they give you a whole damn bottle when you just need a few days' worth."
Dr. Jones disagrees.
OxyContin at a glance
What is it: OxyContin is a brand name for the painkiller oxycodone hydrochloride.
Who makes it: Purdue Pharma of Norwalk, Conn.
How it is taken: It is a time-release tablet ingested orally.
How long it lasts: OxyContin acts for 12 hours, making it the longest-acting pain reliever on the market. Related painkillers Percocet, Percodan and Vicodin, containing a fraction of the same synthetic opiate, oxycodone, act for three or four hours.
Use: The drug is very good for terminal or severe pain, said Dr. Lindy Jones, providing improved quality of life and improved functioning.
Abuse: The time-release coating allows the drug to enter the system slowly. Abusers may simply take the pills, but most lick off or wash the time-release coating and crush the tablets. Then they snort the powder or cook it and inject it for an immediate, heroin-like high.
"I don't see over-prescribing," he said. "We're under-prescribing, I think."
He said painkillers such as Percocet are best prescribed for short-term pain. Like related painkillers Percodan and Vicodin, these pills contain about five milligrams of the pain reliever oxycodone, mixed with aspirin or acetaminophen. OxyContin is pure oxycodone, in doses two to 15 times stronger.
Jones said physicians are selective about who gets a powerful, addictive narcotic such as OxyContin.
"If you are going to prescribe it you need to do it with patients who are appropriate, with no abuse history, and who are willing to sign a contract," he said.
A pain contract states the patient will obtain prescriptions from one doctor and set up appointments to monitor the patient's condition before the medication runs out. This helps physicians monitor use and determine if drugs are being abused.
Physicians and pharmacists communicate to keep tabs on drug seekers and are successful at identifying misuse of prescriptions.
But there are some physicians who are less vigilant with painkillers such as OxyContin, said Sgt. Tim Birt of the Southeast Alaska Narcotics Enforcement Team.
"We like to think that all doctors are completely ethical, but it's not always the case," he said. "Doctors can be loose with prescriptions, and people will shop around with doctors and move around the community."
Drug seekers will use aliases, or claim prescriptions are lost or stolen in order to refill them multiple times. Even given a vigilant medical community, Birt said a drug seeker potentially could work a number of angles before being identified.
Riley Woodford can be reached at firstname.lastname@example.org.