After OxyContin Scare, Appalachian Addicts Turn to Hydrocodone

Associated Press Writer

CHARLESTON, W.Va. (AP) - In more than 33 years in Logan County, John Mays has never seen things this bad.

More people than ever are seeking treatment at Logan/Mingo Mental Health Inc., where Mays is director of clinical services. And when they arrive, many tell the same story.

"I'd almost say it starts out legitimately," he says.

"Believe it or not, we have a lot of people who come in here and say, 'I played high school football, I tore a tendon, and my coach sent me to a doctor who prescribed this,' and the next thing you know, they're hooked."

Alcoholism and drug addiction have long been problems in the southern West Virginia coalfields, but in recent years the old problems have intensified with the quiet arrival of the painkiller hydrocodone.

Propelled by Internet sales, hydrocodone has become the most commonly abused pharmaceutical of its kind in the country, according to the federal Drug Enforcement Administration, and it has hit central and southern Appalachia - burned several years ago by its experience with another, more famous painkiller - especially hard.

Partly, that's because hydrocodone - a cough suppressant and analgesic frequently prescribed for moderate to severe pain - doesn't have as many restrictions as more potent drugs, like oxycodone.

Unlike oxycodone and the brand OxyContin, which became famous as "hillbilly heroin" in 2001 and 2002, hydrocodone has garnered relatively little attention.

"OxyContin got a lot of media attention but nationwide, hydrocodone was always number one," says Cmdr. John Burke of the Warren County, Ohio Drug Task Force.

With 124 million prescriptions in 2005, hydrocodone is the most often prescribed opiate painkiller on the market. When misused, it can be dangerous: the Drug Abuse Warning Network reports that hydrocodone products were associated with nearly 42,500 emergency room visits in 2005, more than any other drug of its type.

Spurred in part by fears about over-prescribing oxycodone, prescriptions for hydrocodone have risen rapidly. Between 2001 and 2005, the retail distribution of the drug - as measured in grams - increased by an average of 65.5 percent nationally, according to the DEA. In West Virginia, it increased by 105 percent. In Tennessee, it nearly doubled.

Overall, DEA figures show that four of the five states where hydrocodone has the highest per capita distribution are in Appalachia - West Virginia, Tennessee, Kentucky and Alabama.

Its increasing popularity as a licit painkiller means more prescriptions are being written, which makes it easier to divert doses to the black market, says Jeff Wallenstrom, DEA resident agent in charge in Charleston.

In addition, as pain clinics flourish and prescription drugs become easier, some are noticing that former users of street drugs are "switching addictions."

"It's not as much of a social stigma as drugs like heroin or crack," says John Lafevor, helpline coordinator for the Alcohol and Drug Council of Middle Tennessee.

Bob Noone, a lawyer who takes on child welfare cases in Logan County, sees the problem firsthand. Here, rural communities struggle with drug and crime problems more familiar to big cities.

"I miss the old abuse and neglect cases where people just had incredibly dirty homes," Noone says. About 80 percent of his cases involving parental abuse and neglect stem from drug use, he says.

"If you're faced with this choice - pills or your kids - you think you'd make the right choice," Noone says. "But the drugs are more powerful."

State and federal agencies have begun to address the problem. In 2005, Kentucky passed the Internet Pharmacy Act, making it illegal for unlicensed pharmacies to sell drugs online. Since then, state authorities have seized more than $1 million worth of pharmaceuticals.

"When I talk to people about this, I tell them, if your family's not been affected by this, you should go home and say a special prayer," says Kentucky Attorney General Gregory Stumbo.

Even as law enforcement responds, Burke warns against a panic over hydrocodone. The ratio of abuse incidents to prescriptions written shows that a low percentage of users become addicted to the drug.

"The goal is not to deprive people who are in serious pain from getting proper treatment," he says.

During the OxyContin scare, prosecutors targeted unscrupulous doctors, which left many honest doctors unsure about when to prescribe the drug. Between 2001 and 2003, at least 13 doctors in the region were convicted of funneling prescription medication to drug addicts, with seven of those doctors coming from eastern Kentucky.

As a result, says Dr. Alvin "Woody" Moss of the West Virginia University Medical Center, some patients in severe pain weren't able to get the most effective medications available.

"As physicians become educated, they become better at treating pain. It's part of the curriculum now, but I can tell you it wasn't that way 10 years ago," he says.

Moss was instrumental in promoting legislation requiring two hours a year of end-of-life pain management training for newly licensed doctors in West Virginia.

That training made doctors far more confident in prescribing even OxyContin, according to Robert C. Knittle, executive director of the West Virginia Board of Medicine. In the past two years, he said, inquiries to his office from anxious doctors about the propriety of painkiller prescriptions have virtually ceased.

(Copyright 2007 by The Associated Press. All Rights Reserved.)

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