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OxyContin abuse is growing in Minnesota
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Dr. William Dicks is director of chronic pain management services for MeritCare Clinic in Bemidji. Dicks doesn't prescribe OxyContin anymore, because of concerns about how addictive the drug is. (MPR Photo/Tom Robertson)
A controversial pharmaceutical drug is destroying lives in northern Minnesota. OxyContin is a powerful narcotic painkiller that's been available since 1995. To cancer patients and chronic pain sufferers, OxyContin is a wonder drug that allows them to lead a more normal life. But OxyContin is highly addictive. And when it's snorted or injected, the drug produces a heroin-like and potentially lethal high. Some law enforcement officials in northern Minnesota say OxyContin abuse has become one of their biggest problems.

Bemidji, Minn. — A few years ago in Cass County, few people had ever heard of OxyContin. Now, law enforcement officials say OxyContin is a problem drug. Pharmacies have been robbed for it. There's an increase in forged prescriptions. Last year, a woman died in a hotel room in Cass Lake after injecting OxyContin. It's known on the street as Oxy, or the bobble-head drug.

"I think it's relatively easy to get as long as you've got the money," says Mike Diekmann, an investigator with the Cass County Sheriff's Department. He says the drug is not coming from some international drug cartel. It's being prescribed by doctors. And OxyContin abusers have learned to manipulate the medical system.

"They travel throughout the state of Minnesota, and sometimes other states, and we call it doctor shopping. And what they do is they go in and complain about a mysterious pain, ... and a lot of times these doctors don't check the past history. And so that ... allows them to give the patient another prescription of OxyContin," says Diekmann.

There's big money in OxyContin. A 40-milligram tablet sells on the street for $50. That's $4,500 for a 90-tablet prescription. Mike Diekmann says Oxy dealers often get their first prescription paid for by Medicaid. They then sell those pills on the street, and use the cash to pay for additional prescriptions.

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Image Law enforcement concerned

The state can restrict Medicaid patients who are known to abuse the system. But officials have no way of tracking prescriptions that are paid for with cash.

"A lot of these people who are obtaining OxyContin are getting it through public assistance, meaning the taxpayer is paying for it. And what's happening is, they're getting it legally. Therefore, law enforcement can't do a whole lot about it," says Diekmann.

The earliest reported cases of OxyContin abuse in the U.S. were in the late 1990s in rural Maine, rust-belt counties in Pennsylvania and Ohio, and in rural areas of Virginia and Kentucky. The outbreak areas have a few defining characteristics. They're remote, with high unemployment and large populations of chronically ill people.

The Leech Lake Indian Reservation fits that profile. American Indians suffer higher rates of cancer and other chronic disorders. In just a few years, OxyContin abuse on the reservation has grown to what some call an epidemic.

Dr. Diane Pittman, clinical director at the Cass Lake Indian Hospital, says several patients each day come to the hospital trying to obtain OxyContin.

"There are some people you wouldn't think of as in the profile of a drug dealer, who are quite willing to take the OxyContin that they got at the clinic and turn it into cash that they need to live their lives," says Pittman. "We all have our stories of yes, being duped by patients."

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Image Oxy abuse on the reservation

Pittman says the Cass Lake hospital has tightenened its rules. Doctors now require full drug histories before prescribing OxyContin. Patients must sign contracts vowing not to try and get the drug elsewhere. And doctors are working more closely with regional pharmacies for signs of abuse.

Pittman says the Leech Lake Band is looking into developing its own narcotic addiction treatment facility. Tribal officials would not allow any of their employees to comment for this story.

OxyContin came on the heels of a shift in the medical community regarding pain management. For years, opiate narcotics like OxyContin were considered too dangerous and addictive to use except in cases of terminal illness, like cancer.

Then a number of studies showed chronic pain was being undertreated. Narcotics became an acceptable treatment for chronic headaches, back pain and other non-terminal conditions. The company that manufactures OxyContin, Purdue Pharma, aggressively marketed the drug to mainstream family doctors.

Dr. William Dicks is director of chronic pain management services for MeritCare Clinic in Bemidji. Dicks doesn't prescribe OxyContin anymore.

"I had used it fairly often, initially," says Dicks. "But as time went by, I started realizing that we were really creating some kind of a monster here."

Oxycontin works well. It's very addictive, but I don't know what I'd do without it. It's what makes me want to be alive and what takes care of my pain.
- Kelly, OxyContin user

Dr. Dicks says OxyContin revolutionized chronic pain treatment. The problem, he says, is its strong euphoric quality. It creates a good buzz, and addicted abusers will stop at nothing to get it.

"I tell people -- if I ever do give them prescriptions of the stuff -- don't tell anybody you have this, because people will kill you for it," says Dicks.

Dicks say some of his biggest struggles now are getting patients to stop using OxyContin.

"It was actually a very good drug. I mean, it really did help with pain. Unfortunately ... adjustments became sort of an issue, people became tolerant, people became addicted to it. And it was extremely difficult to convince people to get off it," says Dicks.

"This is an X-ray of all the procedures I've had done in the last 16 years to my back," says Kelly, 45, who didn't want to use his last name for this story.

Kelly says pain has ruined his life. He has had both hips replaced, and has suffered from degenerative disk disease since 1986. He freely admits he's addicted to OxyContin. He doesn't like it, but he has no plans to stop using the drug.

"Oxycontin works well. It's very addictive, but I don't know what I'd do without it," he says. "It's what makes me want to be alive and what takes care of my pain."

Kelly is a former patient of Dr. William Dicks in Bemidji. When Dicks became concerned Kelly was addicted, he refused to renew his OxyContin prescription.

"I don't inject it, I don't snort it. I take it religiously. He always says, 'Well, you're in it for the high and it makes you feel good,'" Kelly says. "Is there something wrong with feeling good, you know, when you're going through what I'm going through?"

When Kelly could no longer get OxyContin from Dr. Dicks, he went to another doctor, who continues to provide it.

OxyContin prescriptions have nearly doubled each year since its release in 1995. Its maker, Purdue Pharma, had more than $1.3 billion in sales last year. But the company also has faced numerous class-action lawsuits by users.

It's been accused of inappropriate marketing techniques, and some have called for OxyContin to be pulled from the market. Company spokesman Jim Heins says the commercial success of OxyContin is an outgrowth of a tremendous need.

"When you consider the existing problem of untreated pain, that's the real epidemic we have to keep in mind here," says Heins.

Purdue Pharma has created a plan to combat OxyContin abuse. It includes more doctor education and a committment to create a new, less dangerous version of OxyContin.

Meanwhile, earlier this month, a Minnesota committee that advices the state on drug policy, recommended a change. It wants the state to require that Medicaid patients get prior authorization before they're given OxyContin.

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