The bars of the Lee County Jail are all that keeps Emmanuel Ketron from injecting more OxyContin into his tattooed, needle-scarred arms.
Ketron is so addicted to the prescription painkiller that he became a thief to finance his habit. He stole guns and tools from his neighbors, jewelry from his parents, Nintendo games from his handicapped brother.
He has been locked up for four months now. But he still craves the drug that gave him the best high of his life, then took him to the worst low.
“It got to where I didn’t care to eat,” he said. “I would go four or five days without eating, staying on the needle.
“It ruined my life.”
—-
Two years ago, Dan Pellitteri broke his back in a motorcycle accident.
Surgeons spent nine hours reconstructing his crushed vertebrae. The procedure left him a half-inch shorter and with a scar that runs from his navel around his side to the middle of his back.
Most mornings, the pain is so bad that Pellitteri has to wait in bed for his wife to bring him a glass of water and two 40-mg OxyContin pills.
Only then is he able to pick up his 18-month-old son and move around his Roanoke apartment without hurting. “To a person who is in pain, it’s like a miracle drug,” Pellitteri said. “It gave me my life back.”
‘It gave me my life back’
—–
One life ruined. Another life salvaged. Since OxyContin was approved by the Food and Drug Administration in 1995 as a treatment for moderate to severe pain, it has become both an effective painkiller and a devastating pain-maker.
When abused by addicts who crush the pills and then snort or inject the powder, OxyContin is the pharmaceutical equivalent of heroin.
The drug has swept through the rural counties of far Southwest Virginia in the past two years, bringing to the coalfields the big-city problems of addiction and high crime rates.
West of Roanoke, 37 people have died of fatal overdoses attributed to oxycodone, the active ingredient in OxyContin, since 1998. Cocaine, by comparison, caused nine fatal overdoses during the same period.
OxyContin abuse has driven crime up, as addicts rob pharmacies, con doctors into prescribing the drug, and steal from rural residents who until now had no reason to lock their homes and cars.
“It’s taken away a way of life that makes a rural area what it is,” Lee County Sheriff Gary Parsons said. “It’s taken away an innocence that our area once had.”
What is happening in places like Lee County “is a tragedy, and I’m not trying to belittle that,” said David Haddox, senior medical director of Purdue Pharma L.P., the Connecticut-based company that makes OxyContin.
“But there is every bit of a tragedy going on in this country with untreated pain.”
With an estimated 50 million Americans suffering from chronic pain, the company is concerned that people who need OxyContin soon may not be able to get it.
In recent months, the drug has come under siege. More than 5,000 people have signed a petition seeking to have it recalled; a lawsuit is pending against Purdue Pharma in West Virginia; and both the federal Drug Enforcement Administration and a state task force are starting to ask questions about its use.
Doctors spooked by often-exaggerated reports of abuse are becoming more reluctant to prescribe OxyContin, Purdue Pharma spokesman James Heins said. He declined to release sales figures to back that statement.
If there is a backlash, it comes at a time when the medical profession is just beginning to recognize that treatment of pain – often a foggy concept when compared with treatment of easily diagnosable diseases and injuries – has been overlooked for years.
Earlier this year, the Joint Commission on Accreditation of Healthcare Organizations mandated that pain should be considered the fifth vital sign, behind heart rate, blood pressure, respiration and temperature.
Doctors are now asked to have their patients rate pain on a scale of one to 10, and then to treat it accordingly. They need OxyContin to do that, said Dr. Richard Wilson, head of the New River Valley Pain Society.
“We seem to be in the cradle of OxyContin abuse, which is taking a good medication and demonizing it,” Wilson said. “We need to be more concerned about our patients than what a bunch of felons are doing with the drug.”
Purdue Pharma is a private company and does not disclose details about how much OxyContin it produces or where sales are most heavily concentrated.
But according to the market research firm Scott-Levin, sales are up. OxyContin was prescribed 5.5 million times last year, generating sales of more than $1 billion. The year before, 3.2 million prescriptions were written for $602 million in sales.
Those figures alarm law enforcement officials, who say the potent, addictive narcotic is being dispensed not just for cancer patients and those in severe pain, but also as a remedy for such things as toothaches and menstrual pain.
Kathryn Daniels of the DEA says she believes the way Purdue Pharma markets OxyContin is a significant part of the problem.
“Who really needs this drug? said Daniels, the DEA’s diversion program manager for a three-state area that includes Virginia. “Are you marketing the drug to the people who really need it?”
Purdue Pharma disputes suggestions that its drug is overpromoted.
But some in law enforcement say it clearly is overprescribed.
“From my perspective, the physicians are part of the problem,” said Julia Pearson, a toxicologist for the state Division of Forensic Science. “You have physicians who are prescribing the pills to people who have a headache. That’s not managing pain. That’s feeding an addiction.”
– –
When a new drug sweeps the country, it usually starts in big cities and gradually spreads to the hinterlands.
Illegal use of OxyContin appears to be doing the opposite.
Southern Maine and far Southwest Virginia were among the first regions hit. Both areas have common demographics: low-income populations far from the large cities where cocaine and heroin are readily available.
And both areas depend heavily on high-risk industries – logging in Maine, coal-mining in Virginia – that are likely to generate large numbers of disabled residents and, consequently, high use of pain medication.
As abuse of OxyContin took off in 1998 and 1999, it generally followed the Appalachian mountain range up and down the East Coast, causing havoc in such places as western Pennsylvania, Ohio, West Virginia, eastern Kentucky and Alabama.
Many of those areas are medically underserved. Parts of far Southwest Virginia have a population-to-physician ratio of more than 4,000-to-1, compared with the statewide average of 1,695-to-1.
That means rural doctors overwhelmed by high patient loads might use OxyContin as a time-saving cure-all.
“It’s supposed to be the medication of last resort,” said Beth Davies, co-director of Addiction Education Services in Lee County. “But in many cases, it’s the one of first resort.”
As the drug began to flow from pharmacies across the country, the number of people seeking emergency room treatment for oxycodone overdoses doubled – from 3,190 cases nationwide in 1996 to 6,429 in 1999.
Now, the problem is making inroads into larger cities. Daniels, of the DEA, said abuse has been reported in such places as Philadelphia and Northern Virginia. South Florida is another hot spot.
In Roanoke, two people have died of oxycodone overdoses since 1998. City police have made about a dozen OxyContin arrests, and parts of the New River Valley are also experiencing problems.
Although abuse in urban areas pales in comparison to what is happening in the coalfields, state and federal officials are joining the fight.
Last month, the National Association of Attorneys General began looking for ways to stop abuse of prescription drugs in general and OxyContin in particular.
And in April, the DEA asked Purdue Pharma to limit distribution of the drug, rethink its marketing strategy, and consider reformulating OxyContin to make it less appealing to addicts. It was the first time the agency has targeted a particular brand name in its efforts to police prescription drug abuse.
“In my entire history with the DEA, I’ve never seen anything like this,” said Daniels, a 25-year veteran of the agency.
Purdue Pharma has devised a 10-point plan to curb abuse of its product. Among the actions: mailing educational brochures to nearly a half-million doctors and pharmacists, distributing tamper-proof prescription pads, emphasizing a more cautious pitch by sales representatives in high-risk areas, sponsoring medical education programs that advocate responsible pain management, and airing public service announcements warning about the dangers of abuse.
The company has also stopped distributing its most potent form of OxyContin, the 160-mg pill, and reduced shipments to Mexico in light of reports that the drug was being smuggled back into the United States.
“We want to be part of the solution, not part of the problem,” Haddox said.
Dr. Art Van Zee, a Lee County physician who is organizing a national petition drive to have OxyContin recalled, is not convinced.
“They will always give lip service to the fact that this is a drug that’s dangerous when abused,” he said of Purdue Pharma.
“But there’s never been a real attempt to make physicians aware that in some areas of the country, there has been major, disastrous abuse of this drug, and caution should be exercised when prescribing it.”
– –
When Lee County’s drug subculture began to buzz about “Oxies,” Emmanuel Ketron knew he had to try the drug.
The 22-year-old had already experimented with prescription sedatives such as Lortab and Xanax, but word on the street made those sound like aspirin compared with OxyContin.
Ketron went to a feed store and bought a syringe used for injecting livestock with medicine. His next trip was to an OxyContin dealer.
He went straight home and shot up. “It was the best feeling I ever had in my life,” he said.
Ketron soon began to steal to support his habit. His addiction made him a sloppy thief, and it wasn’t long before sheriff’s deputies came knocking on his door. After being placed on probation for burglary and grand larceny, Ketron was charged again with stealing a garden tiller.
This time, the judge sentenced him to three years in prison.
Ketron’s father was outraged. Bobby Ketron said his son is an addict who needs treatment – help that no one in Lee County seemed interested in providing. A brief stay at a drug detoxification center in Russell County didn’t keep Ketron clean for long. Supervised probation worked no better.
Frustrated and bitter, Bobby Ketron made signs and put them up in the front yard of his Dryden home.
“If you are hooked on OxyContin, get help,” one of the signs reads. “Out of Lee County, because the law and the judges won’t help our children. They will send them to prison.”
The way Lee County Commonwealth’s Attorney Tammy McElyea sees it, more people need to be sent to prison. Time after time, McElyea said, the state’s sentencing guidelines call for little or no incarceration for the people who use and deal OxyContin.
“They’re beating me out of the courtroom,” she said of defendants who plead guilty and are placed on probation. “They laugh at me on the way out.”
But when Emmanuel Ketron comes out of prison three years from now, will he be any better? his father wonders. “When he comes out of there, he’ll be bitter,” Bobby Ketron said.
And if the first four months behind bars are any indication, Emmanuel Ketron may well go back to drugs.
“If they let me out today,” he said. “The first thing I would do is go find me some dope.”
– –
All of the controversy over OxyContin has Dan Pellitteri a little worried.
Even though he takes the drug exactly the way his doctor prescribes it, he’s concerned about getting hooked.
“As soon as my back is fixed, I want off this,” the 34-year-old said. “It’s got my mom scared to death.”
Legitimate pain patients may become dependent on OxyContin and other opium-based narcotics, but can gradually come off the drug under a physician’s care. Addiction is rare; a study by the National Institute on Drug Abuse found that it happened to only four of more than 1,200 patients who were prescribed opium-based drugs.
The real danger seems to come when OxyContin goes from the medicine cabinet to the streets.
Last month, a state task force headed by Attorney General Mark Earley began to study ways to curb prescription drug abuse.
The panel, law enforcement officials and the health care community have a tough job ahead of them: finding a way to keep OxyContin away from abusers such as Ketron, while making sure it remains available to patients such as Pellitteri.