“Pain Killer: A ‘Wonder’ Drug’s Trail of Addiction and Death,” by Barry Meier (Rodale, 323 pages, $24.95)

Radio talk show host Rush Limbaugh’s public admission last month of his addiction to OxyContin, also called “hillbilly heroin,” confers a serendipitous relevance upon award-winning journalist Barry Meier’s penetrating examination of the history of that drug.

Of course, when Meier wrote “Pain Killer” he had no inkling that Limbaugh was hooked on OxyContin. In fact, his book was released before the commentator’s confession of his prescription drug abuse. Otherwise, Limbaugh’s predicament would have confirmed Meier’s assertions about the drug’s dangerous addictiveness.

Nevertheless, Limbaugh’s decision to go to a rehabilitation clinic to try to shake his addiction, and reports that he may face criminal charges for purchasing the drug illegally, may give Meier’s book new relevance – and a sales boost.

OxyContin, Meir notes, picked up the “hillbilly heroin” nickname because its abuse first proliferated in rural and suburban areas of Maine, Virginia, West Virginia, Kentucky, Pennsylvania and Massachusetts.

Meier begins his account of OxyContin’s introduction into society in southwestern Virginia’s Lee County, focusing on Art Van Zee, a local physician who becomes concerned about the problem when he is summoned to treat an overdose case, and Lindsay Myers, a teen-age girl from a well-to-do family who gets hooked on “Oxys.”

Van Zee had known Myers all her life, and he never suspected that she would abuse drugs. And, despite being told by a local drug abuse counselor and an area pharmacist about their growing concern that OxyContin was being sold on the streets, Van Zee hadn’t given it much thought.

“It had taken grown-ups like Art Van Zee a long time to even begin to suspect what teen-agers had known for nearly a year — that a tablet of OxyContin, or an Oxy, as they called it, was the ticket to a great high,” Meier writes.

Myers, whose drug problem provides a major narrative thread to Meier’s story, tried her first Oxy while riding in a car with a friend on the outskirts of Pennington Gap, Va. Meier gives this description of Lindsay’s initiation into the use of hillbilly heroin:

“Lindsay watched as her friend popped a small blue tablet into his mouth and let it sit there for a few minutes before taking it out and wiping it off on his T-shirt. He then dropped the pill onto a creased dollar bill and folded the bill so that it formed a tight, tiny envelope, which he shoved back into his mouth. Next he bit down on the package with his back teeth. Finally, the boy unfolded the bill and dumped the powdered contents onto a plastic compact disk holder so that he, Lindsay and another friend could snort it.”

That procedure was one of the ways to overcome OxyContin’s time-release property, which the drug’s manufacturer, Purdue Frederick, claimed would prevent its being abused to any significant degree.

“The company thinking was that to drug abusers the attractiveness of any particular substance is largely based on two factors; its strength and the speed with which it produces its effect. Given that OxyContin slowly released its oxycodone, officials of both Purdue and the Food and Drug Administration had thought that anyone seeking the euphoric rush of a narcotic would continue to favor traditional immediate-release painkillers,” Meier writes.

But for abusers, who figured out how to get an immediate rush from OxyContin, the drug was preferred, Meier maintains, because, unlike such painkillers as Percodan and Tylox, it contained no additional analgesics such as aspirin or acetaminophen. It was pure oxycodone, a powerful opium derivative.

“Heroin had never been a substantial part of the drug scene in Appalachia; places like Lee County were just too far away from big cities that were the hubs of heroin dealing or even the interstate highways that served as trafficking routes. Now a legal drug, OxyContin, which was almost a match for heroin in its addictive power, had moved in,” Meier writes.

As the popularity of the drug increased in Lee County, Meier points out, so did crime and overdose cases, a pattern that was replicated in similar communities in the eastern United States.

Meier traces the efforts of Van Zee and his associates and some Drug Enforcement Administration staff members to force Purdue to reformulate the drug, which had turned into a bonanza for the company, and to stop marketing it as abuse-resistant.

The author, however, does not confine himself to OxyContin’s susceptibility to abuse. He also delves into the more generalized subject of pain treatment. Meier traces the history of the pain management movement, crediting pioneers, such as Dr. Russell Portenoy, in the use of narcotic treatments for their contributions to relieving unnecessary pain for cancer patients and others enduring chronic suffering.

Meier portrays Purdue as a company that appears more concerned about protecting and expanding its market than about its responsibility to the public.

“Pain Killer”‘s message is that OxyContin and similar classes of painkillers are still needed to treat cancer patients and others with chronic, excruciating pain. But such drugs should be administered and controlled by pain specialists.

Self-medication, as Rush Limbaugh has admitted, is not a viable option. It’s also illegal.

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(c) 2003, Fort Worth Star-Telegram.

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AP-NY-11-13-03 0618EST