Illicit Trade in OxyContin Plagues Atlantic Provinces

Illicit Trade in OxyContin Plagues Atlantic Provinces

THE 10-MINUTE TRIP from Donkin, N.S., to downtown Glace Bay is the kind even locals seldom tire of driving. The narrow, seaside highway winds through one of those postcard stretches of coastal Cape Breton, among churches and cemeteries and shoebox houses that seem to cling to the hills above the water. But when Morley Prendergast drove it during his last year of high school, he rarely noticed the sights. By then, the route had dimmed in his mind to a single, vital line - his sole link to the potent prescription painkiller OxyContin. "The only thing I cared about was getting into town and finding a dealer," recalls Prendergast, now 20. "Sometimes I'd have to pull over and throw up, because you get sick if you stop taking it. I'd just close the door and keep going. I needed it just to feel normal."

We're seated in the den of Prendergast's home in Donkin, where he's under two years' house arrest for holding up a convenience store, a crime committed so he could illicitly buy more OxyContin. He's a laughable excuse for a robber - soft-featured and thin, with a kitten named Mia to keep him company during his sentence. His crime, he explains, marked the end of a descent into addiction that started in Grade 11, when he began snorting ground-up tablets with schoolmates whenever he got the chance. "I could run into the washroom," he says, "crush up a pill on the back of the toilet and take it right there." Within months, the former honour-roll student was injecting the drug in liquid form, relying on OxyContin to get him through his weekend shifts at a theatre in Sydney, stealing cheques from his parents to pay for it. Then, two winters ago, having lost his job and exhausted all sources of cash, he made a clumsy attempt to rob the store. "There were times when I was spending $200 a day," says Prendergast, who's been clean since his arrest. "I spent all my savings, and I still owe my parents about $2,000. It takes over your whole life."

Or, in some cases, your whole town. Communities in Cape Breton and other pockets of Atlantic Canada have become veritable fonts of such tales in recent months, as a drug that has already wreaked havoc in rural areas of the eastern U.S. cuts a swath north. There are the two Glace Bay brothers who received last rites in one 12-hour period after overdosing last February. Or the 65-year-old grandmother in New Waterford, N.S., who was ordered to jail for selling OxyContin pills from her purse. She cried upon sentencing, but got a scolding from the judge for trying to make "easy money." Or the former Glace Bay coal miner who'd been legally prescribed OxyContin for eight years, yet went into shock during a routine hospital visit when staff administered his "usual" dosage. He survived, but it turned out he'd been selling off his pills all along, and had no tolerance for the drug.

All this, and a startling spike in fatality statistics. Cape Breton Regional Police attribute eight of 20 sudden deaths in the last 18 months directly to OxyContin abuse, while the number of prescription opiate addicts reporting to Sydney's detoxification unit has more than doubled in the last four years. Authorities in other Atlantic provinces report similar grief: a task force into the issue in Newfoundland and Labrador recently linked the painkiller to six overdose deaths there since 2001, while police in New Brunswick and Prince Edward Island also report misuse of the drug. Anti-drug units are quickly retrenching, shifting their attention from old bogeymen like pot and liquor to one that lives in the cabinet of their local pharmacy. "We got used to seeing the town wino standing on the corner," says Sgt. Doug Lawrence of the Cape Breton regional police street crime and drug unit. "Now the concern is some guy selling pills."

THIS WASN'T SUPPOSED to happen to OxyContin, a drug once heralded as a godsend for cancer and palliative-care patients. Developed by chemists at Connecticut-based Purdue Pharma LP, the drug was designed to treat severe, long-term pain. Its genius was in a "controlled-release" system preventing all of the opiate in each pill - in this case, a morphine-like compound called oxycodone - from taking effect at once. That allowed its maker to pack more of the feel-good stuff into each tablet. Instead of giving patients dozens of pills per day, doctors could now prescribe one or two. Within five years, OxyContin accounted for 90 per cent of Purdue's U.S. prescription sales, raking in more than US$1 billion for the company annually.

Trouble was, abusers soon learned that grinding up the pills broke down that control mechanism, unleashing the drug's full force. Snorting OxyContin in powder form, or injecting it in a water-based solution, produces a euphoria rivalling that of heroin, say those who've tried it. "Three days of being on it, and you become addicted," one Cape Breton user told Maclean's. "It's a very, very powerful drug." And potential abusers didn't have to look very far for mixing instructions: Purdue was required by law to include a warning on its label reminding users that breaking, chewing or crushing the tablets "leads to rapid release and absorption of a potentially fatal dose of oxycodone."

For these reasons, and because of its widespread availability, OxyContin became known as "hillbilly heroin" - a high-powered opiate readily obtainable in the woods of rural America. After its introduction in 1996, an illicit trade of OxyContin swept West Virginia and Virginia, along with parts of Ohio, Pennsylvania and rural Maine. Patients were caught double-doctoring, then selling off their extra prescriptions, while pharmacies began reporting increased numbers of break-ins for OxyContin. In 2000 and 2001, the U.S. Drug Enforcement Administration linked 146 deaths to OxyContin abuse, lamenting the drug as a "significant problem for law enforcement authorities throughout the United States."

THE TRADE WAS slower to take root in Canada, but has proven no less insidious. On a recent evening in Glace Bay, Sgt. Lawrence and his partner, Const. Shaun McLean, cruise the city of 20,000 in an unmarked vehicle, pointing out some of the 14 homes where they believe OxyContin is for sale. "The dealers use cellphones and pagers," explains McLean. "They give their customers passwords." He parks on a side street, not far from a rundown, two-storey home, and settles lower in his seat. Within minutes, a white sedan rolls past the house, letting out two men who quickly go inside. "This is a place we've been watching for a while," McLean murmurs. "But we have to wait for the right time." In the past, he explains, police have gotten wind that dealers have obtained supplies of pills, "but in the few hours it takes for us to go to a judge and get a warrant, they've sold it all off." Wary of alerting these suspected dealers, McLean quietly starts the vehicle and drives away.

Why Cape Breton became an epicentre of this market remains a matter of heated debate. Lawrence and McLean, both of whom grew up in the region, suspect pot users and alcoholics are graduating to more serious stuff; the island, they point out, has always had its share of substance abusers. But a tour of withering communities around Glace Bay - Dominion, New Waterford, Reserve - highlights socio-economic factors that may have played a role, too. Like residents of West Virginia or Pennsylvania, Cape Bretoners live amid the ruins of once-thriving coal mines and steel mills, industries that have left a legacy of double-digit unemployment and illness. And while the average Cape Bretoner is likely to live two years less than other Canadians, he's also likely to spend six more of those years fighting some form of long-term disability. It's just the kind of place for a miracle painkiller.

The result: OxyContin began turning up in medicine cabinets in Cape Breton just as economic hardship made reselling it attractive. Between 2000 and 2003, the number of OxyContin prescriptions dispensed in Cape Breton rose 270 per cent, to almost 4,000. People taking the drug were averaging 15,200 mg per year - fully 2,000 more than the provincial average. Some seniors took to calling it the "pension pill," because they could hawk it to augment their incomes, says John Malcom, chief executive officer of the island's regional health authority. Brian Petite, a pharmacist who operates a dispensary in Glace Bay, saw prescription holders who were obviously fronted by buyers who'd followed them to the store. "I knew a couple of guys who wouldn't have $10 in their pockets," he says. "All of a sudden, they're handing me hundreds." He called authorizing doctors to double-check the prescriptions, he says, but was instructed to fill them anyway.

Today, no one seems sure where to direct their anger. The province's prescription monitoring program could have been faster to spot the danger, according to some critics. While Petite says he phoned the program in 2001 to report suspicions the drug was being abused, the agency did not flag OxyContin for special monitoring until this year. The program is hampered by an antiquated paper-based process. Its manager, Coleen Conway, says an electronic system such as one currently running in B.C. would allow pharmacists to spot instances of double-doctoring and disproportionate use on the spot, but the province has yet to agree to fund one.

Others have focused their ire on individual doctors, who they say have been prescribing OxyContin too freely. "There's no doubt there's patterns to this," says one Sydney-area pharmacist who asked not to be named. But there have been no official complaints to the province's College of Physicians and Surgeons, and at least one prominent addiction specialist in Cape Breton believes that, more than anything, some of his colleagues have been naive. "By and large, we are a trusting group of individuals," says Dr. Tom Crawford, who also runs a family practice in Glace Bay. "It's taken us a long time to convince doctors around here that they have to be more careful."

IF DOCTORS WERE over-prescribing OxyContin, then family practitioners say at least some of the responsibility lies with Purdue. Its representatives, they say, worked at expanding the market by strongly suggesting OxyContin for less serious ailments like chronic back pain. Such accusations are nothing new to the company: in the U.S., Purdue faces some 300 lawsuits alleging improper promotion of the drug, as well as accusations by the DEA of overly aggressive marketing. In early 2003, following negotiations with the U.S. Food and Drug Administration, the company removed information from its Web site that appeared to suggest unapproved uses of OxyContin. But the criticisms in Cape Breton strike at the heart of Purdue's marketing strategy. "The party line is that, if used for the indications it's meant for, this drug is OK," says Crawford. "I think there are other drugs, with less potential for abuse, that work just as well for things like chronic back pain."

John Stewart, executive vice-president and general manager of Purdue Pharma in Canada, denies his sales reps promoted the drug improperly in Cape Breton. But he acknowledges its widespread availability may have led to abuse. In the meantime, Purdue is working on ways to prevent misuse, he says, such as adding an "antagonist" that would activate if the drug is crushed, blocking the effect of the opiate. "But it's not yet in clinical trials," he warns from his office in Pickering, Ont. "We're still years away."

Whether such measures would have spared someone like Prendergast is unclear: by his own admission, he was "the kind of person who'd try anything once." He stares at his feet when recalling his high-school graduation - the day his parents found syringes in his bedroom. "When I came home," he recalls, "they had the needles laid out on the kitchen table." That led to the first of several bouts of detox. But getting clean, he says, is something he chose to do himself. He's currently taking classes at the University College of Cape Breton, volunteering at his local Boys and Girls Club and dreaming of a career in law. It'll be a long, tough road, but hardly as bad as the one he just travelled.

'Little Blues' in the Big City

"Hillbilly heroin" was the name that stuck, but there's mounting evidence to suggest OxyContin's fan base reaches far beyond the Ozarks. Police in both the U.S. and Canada are uncovering increasing numbers of OxyContin trafficking rings in metropolitan centres, while big-city doctors are accused of writing fake prescriptions for the painkiller. And - as with practically anything you shoot or snort - celebrity abusers are helping push the drug into the spotlight.

Its best-known abuser may be Rush Limbaugh, the right-wing radio host who railed against drugs (insisting, among other things, that addicts should be jailed) before admitting his own addiction to painkillers last October. His former housekeeper, who served as his drug connection, says Limbaugh was particularly attached to OxyContin, referring fondly to the pills as "little blues." Rocker Courtney Love also told police she was on the drug when she was arrested that same month outside her ex-boyfriend's house, and is now facing unrelated charges of illegal possession of prescription drugs. There's even a rock 'n' roll song about OxyContin: Hillbilly Junk is a tinny, rollicking paean to the analgesic that appears on a recently released album by Paul Westerberg, former front man for the Replacements.

OxyContin still has nowhere near the street popularity of cocaine and heroin. But one recent case in Toronto illustrates the changes afoot: a 57-year-old doctor, Ravi Devgan, is accused of faking prescriptions so pills could be diverted to illegal users. At his trial last week, prosecutor Moiz Rahman warned the jury to forget their Hollywood notions of the drug trade - of white powder in bags and briefcases full of money. "The tools of the trade here," he said, "are a white lab coat, a pen and preprinted pieces of white paper."

See also MEDICAL DRUG ABUSE.

Maclean's May 24, 2004