Donna Stocks has conceded that, to some degree, she will just have to live with pain that lingers from a nearly 16-year-old automobile accident. Earlier this year, she said she discontinued her daily prescribed use of the pain medication OxyContin because it was the source of too much trouble.
"I had my doctor take me off OxyContin in January because of all the stealing and because Medicaid was giving me such a hard time," Stocks said. "I had been taking pain pills for 15 years, and I was never questioned. And now because of these addicts, they question me?"
She had gone to great lengths to protect the medicine she used daily to abate debilitating pain, buying a safe to keep the drugs in and contracting a nurse so she wouldn't have to keep more than a week's worth of the drug with her. But after two break-ins at her home in Soldotna, and numerous episodes where she said Medicaid would not approve her periodic refills, forcing her to go for up to 10 days without the best medicine she had found to control her pain. Stocks finally said she had had enough.
This story easily could apply to the many Kenai Peninsula residents with medical conditions ranging from cancer to arthritis who depend on OxyContin to ease the burden of serious pain they live with each day. Because of crime resulting from addicts trying to access the high-priced narcotic and despair from overdose and related accidents -- 61 emergency visits on the central peninsula in the past year and six deaths in the first half of 2002 -- a negative stigma surrounds the drug, and often the people who need it the most.
OxyContin is a time-released prescription narcotic analgesic that was introduced in 1996 by Stamford, Conn.-based Purdue Pharma for those with moderate to severe pain. When taken as prescribed it provides up to 12 hours of relief from pain.
Oxycodone, the principal ingredient in the drug, acts upon nerves in the spinal cord, brain and certain muscle tissue in much the same way that morphine does. As a result, it can produce a euphoric high similar to morphine or heroine.
The peninsula has become a hot bed for a culture of diversion, or illicit distribution and use of prescription drugs, and leads the state in misuse of the potentially dangerous and addictive OxyContin.
"While prescription pain medicines are excellent for some things, they have caused a disproportionate impact on drug abuse on the peninsula," said Dr. Ned Magen, an emergency and osteopathic doctor at Central Peninsula General Hospital in Soldotna and a member of a task force organized in October 2001 by CPGH surgeon Byron McCord to find solutions to pain drug abuse on the peninsula.
According to the state Division of Medical Assistance, Medicaid paid for $7.9 million worth of narcotic analgesics statewide last year, including OxyContin and other oxycodones like Percocet and Percodan that don't use a time-releasing agent.
Although it represents only 6 percent of the state population, the peninsula accounted for 15 percent of the entire state's Medicaid prescription costs for such drugs -- nearly $1.2 million.
Pharmacies in the Kenai and Soldotna area report an average of 13,000 OxyContin tablets dispensed each month. And 80 percent of these tablets, averaging $400 for 100 at a retail pharmacy, were paid for by Medicaid.
Purdue Pharma spokesperson James Heins said the first indication his company received that there was widespread abuse of the drug came in March 2000 when Maine's attorney general sent out a bulletin alerting law enforcement agencies about the emerging problem in that state.
But Tim Cutler, a pharmacist at Soldotna Professional Pharmacy, said there had been reports of patients selling their prescriptions in Alaska as early as 1998.
"They would sell them right out in front of the pharmacies," he said.
Tablets have been known to sell for as much as $1 per milligram on the street, as opposed to $1 per tablet, Cutler said. So a bottle of 20 at 60 milligrams each could net a seller $1,200.
Tablets are available containing between 10 and 80 milligrams of the medication. Cutler said although each tablet only releases a controlled amount of the medication when taken orally, people seeking a quick high can crush and snort them.
Stocks said the chance to finance one's own addiction is a powerful motivator.
"I know of people without Medicaid or insurance who would buy OxyContin and sell half to pay for the prescription," she said.
Magen pointed out there also is the danger of children and high school students finding their parents' pain pills and either trying them or distributing them.
Illegal use doesn't represent the only dark side associated with the drug, however.
Combining OxyContin with alcohol or overusing the drug can have significant health hazards. A pain task force report showed 5,261 emergency room visits involving oxycodone nationwide in the first half of 2000.
Two peninsula tragedies related to misuse of the medication stand out as reminders of worst-case scenarios. In the summer of 2001, a head-on collision near Solid Rock Bible Camp on the Sterling Highway took the life of an elderly man. He was hit by a younger man who, while driving under the influence of OxyContin, drifted over the center line and rammed into the oncoming car.
In 2000, the death Meghan McCord, Dr. McCord's daughter, was attributed to OxyContin.
Cutler, a member of the pain task force, said those with the most vested interest in addressing the problem are people who have legitimate pain and have to justify taking the medicine. He said it is unfortunate that those who need the drug have to suffer because of those who abuse it.
"We've had really good stories from patients who have been using OxyContin," he said. "And I've had patients tell me they're embarrassed about getting these drugs because of the stigma."
Stocks, 42, was hit by a drunk driver in Chicago in April 1987. She suffered a number of significant injuries, primary among them being degenerative disks in her neck and lower back, ripped muscles between her neck and right shoulder and severe nerve damage in her right arm.
As a result, even after six operations, she said she experiences piercing migraines, needling pain in her right arm, oftentimes debilitating pain in her lower back and chilling sensations in her neck, which she said sometimes "feels like I've been shot in the back of the head point-blank by a shotgun."
And, she said, it hurts most just lying down.
Until recently, Stocks believed she had found a solution to managing the pain and discomfort she has experienced every day. About five years ago, she was prescribed OxyContin by her doctor to replace a variety of pain medicines she had taken that either made her feel too "dopey" or were ineffective.
Now Stocks takes another oxycodone medication four times a day and practices alternative pain management methods like stretching and physical therapy. She said her present regimen isn't as effective, and the current medicine often makes her nauseous. OxyContin reduced her pain level from a 7 -- on a scale with 10 being the worst -- to a 5, she said.
"Once I got the OxyContin it was so perfect," she said. "Why did these stupid (people) have to screw it up?"
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