Hooks of ‘Hillbilly Heroin’

MACHIAS, Maine —  The Reid boys had bright futures mapped out. Brett, 19, loved animals. He was supposed to be the veterinarian. Jesse, a year older and a born litigator, would be the family lawyer. But now, these handsome small-town brothers are prescription drug addicts, serving jail time.

The two have been caught in an alarming wave of addiction triggered largely by the abuse of OxyContin, a prescription painkiller that produces a powerful, heroin-quality high. More than a year ago this tenacious synthetic opiate began ravaging poor, rural parts of New England and Appalachia, earning the nickname “hillbilly heroin.” Increasingly, its abuse is spreading to urban areas along the Eastern Seaboard.

Since April, more than 100 Boston-area pharmacies have been robbed of OxyContin. The robbers demand nothing else: not even cash, just OxyContin.

Federal officials say OxyContin abuse has not yet hit California because heroin remains cheap and plentiful. But in remote areas, OxyContin swept in because it is easier to get than heroin.

Perhaps nowhere is the prescription drug problem as bad as here in Washington County, on the northeasternmost tip of the United States, the first spot in America to see the sun rise each day.

Prosecutions for crimes involving OxyContin have gone up more than tenfold here since 1998, a state attorney said. In five years, county residents seeking treatment for prescription drug addiction increased by the same sharp number. Injection is a common way to abuse this drug, and in Washington County, the rate of hepatitis C--generally transmitted by shared needles--is twice that of the rest of the state.

Officials say that among the county’s 35,000 residents, there are certainly 1,000 addicts and possibly many more. Maine is a poor state, and officials lack resources needed to establish the exact number of prescription drug addicts. Washington County Sheriff Joe Tibbetts, a sturdy man with scant occasion for hyperbole, said 60% of his inmates go through prescription drug withdrawal. Ask around the county, Tibbetts said, and almost anyone will know someone who is hooked on OxyContin or another prescription drug.

“We’ve gone far beyond a problem, far beyond a crisis,” Tibbetts said. “We’re in the epidemic stage.”

Hugging the Canadian border, Washington County is about the size of Rhode Island, 500 square miles. It has limited employment possibilities and little in the way of diversion. Most people are poor, and almost all are white. They say prescription narcotics offer an escape from bleak, boring lives. Synthetic opiates such as Dilaudid, Ritalin and Percocet are easy to score and quick to provide a euphoric rush. But abusers say “Oxy,” as the drug is known on the streets, gives the finest high of all.

Crime is surging along with the drug explosion, said state prosecutor Matt Erickson, who has jurisdiction over Washington County. Prescription narcotics are involved in thefts, robberies and shoplifting--not to mention drunk driving, assault and domestic abuse, Erickson said.

“Once you are addicted to these opiates, you will do anything to get that fix,” said former U.S. Atty. Jay McCloskey, who notified the drug manufacturer, Purdue-Pharma, of the problem in Maine.

“You will steal and you will deal,” said McCloskey, who later joined the company as a consultant.

The social toll is immeasurable. Families in Washington County are falling apart. Health and law enforcement systems are stretched to their limits. And prescription drug abuse is rife in the workplace.

In the last 18 to 24 months, said McCloskey, “I believe it has become the greatest criminal problem and possibly the greatest social problem facing Maine.”

In Machias, Sheriff Tibbetts said he has watched schoolkids hold a finger to one nostril, pretending to snort OxyContin, just like mom or dad. He has seen mothers split a Ritalin tablet: half goes to her child, half gets sold on the street.

“Then the mother goes back to the doctor and says, ‘You’ve got to double the dose because it’s not working,’ ” said Tibbetts, whose own 23-year-old daughter is addicted to prescription drugs.

First approved in 1995, OxyContin has soared in popularity for managing severe pain for victims of cancer and other serious illnesses. According to federal government statistics, the annual number of OxyContin prescriptions has jumped from about 300,000 in 1996 to close to 6 million. The drug generated more than $1 billion in sales last year for its privately held manufacturer, Purdue-Pharma of Stamford, Conn.

Doctors must follow strict guidelines to prescribe OxyContin and similar controlled substances. Purdue-Pharma even has introduced tamper-proof prescription pads for Maine physicians. But addicts find a way around such constrictions. In pill form, OxyContin gradually releases oxycodone, an opiate found in many painkillers, over a 12-hour period. The slow release reduces both the risk of a rush and the opportunity for addiction.

Addicts cancel that out by crushing the pill, then snorting or injecting it. Because the drug is legal--and indeed, aggressively marketed--many abusers are surprised by the speed and intensity of the addiction.

OxyContin tablets are color-coded according to dosage, ranging from 10 milligrams to 80 milligrams. Purdue-Pharma recently suspended shipment of the 160-milligram dosage.

In a pharmacy, a 10-milligram pill costs less than $2. The 20-milligram costs under $3. On the street, OxyContin of any dosage inflates to at least $1 per milligram.

Initially, abusers say, a high will last for hours. But as they build tolerance, they crave more.

OxyContin has been linked to more than 100 deaths, according to the U.S. Food and Drug Administration, which recently strengthened the warnings on the drug and called on doctors to restrict its use.

Until state officials brought the abuse issue to the manufacturer’s attention, Purdue-Pharma spokesman Jim Heins said the company was unaware of the problem. Maine, said Heins, was “the first state to hit our radar screen.”

But the abuse problems are not limited to the Northeast. Lawsuits filed against Purdue-Pharma by the states of West Virginia and Virginia contend that forceful marketing of OxyContin has contributed to its widespread abuse in their states. Maine is considering similar action. Heins called the lawsuits “baseless, an unfortunate distraction.”

He said the company has launched education programs to train New England doctors to recognize “diversion and abuse.” He also said company scientists are trying to produce an abuse-proof OxyContin formula.

OxyContin, Heins said, “sort of is the lightning rod for this [abuse] issue, unfortunately for us.”

Isolated and economically depressed, Washington County is marked by a series of watery inlets and fields that each summer bear blueberries. Hand-picking the berries traditionally was guaranteed work here. But now, growers say local laborers are unreliable, so immigrants from Mexico and Nova Scotia are brought in to work the fields.

Lumbering and fishing also are labor staples here. Many of those jobs go begging too.

“We have a county with a lot of impaired people, and that’s not a recipe for good economic health,” said state Sen. Jill Goldthwait. “People don’t show up for job interviews, or they get hired and don’t show up for work.”

At the Sunrise County Economic Development Agency, executive director Diane Tilton said a local employer recently complained about workers shooting up with prescription drugs on the job. When Tilton suggested mandatory drug testing, she said the employer replied, “If I did that, half my people would be fired.”

Serving up fresh blueberry pie at Helen’s, this town’s most popular restaurant, owner Gary Hanscom said, “I have never, ever had trouble getting help here--until now.” His own 27-year-old son is hooked on OxyContin, unable, or unwilling, to work, Hanscom said. And “three of my waitresses, prettiest things you ever saw--everything going for them, husbands, kids, you name it--well, two of them are in the hospital right now, in withdrawal. The third one, I don’t know where she is.”

Long before prescription drugs took hold, alcohol abuse was widespread here. Towns are scattered, often more accessible by boat than by car. There is no mall, no movie megaplex, no mini-golf course. As a whole, the county displays what Tilton politely calls “low educational attainment.”

At the County Jail, 20-year-old Jesse Reid grew dreamy as he recalled his first encounter with OxyContin: “It was like nothing I had ever experienced before in my life. It seemed like this great, big euphoria. I was on top of the world. I just kept taking it. Now I know more people who are using it than not using it.”

Reid sold other drugs to support his OxyContin habit. He spent time in rehab, but his insurance benefits ran out. He stayed clean for a month, “if that,” before OxyContin lured him back.

“What this drug is doing to peoples’ lives is ruining them. People are spending their kids’ college money. They’re stealing. They’re holding up people in their own families. Old people are doing it. Young people are doing it. Basically, everybody here is doing it,” he said.

In an area like Washington County, said state prosecutor Erickson, enforcing the laws on prescription drug abuse poses special difficulties.

“If you have probable cause to think somebody has 30 bags of heroin and they are dealing it, you can get a search warrant. If you have probable cause to believe that somebody has 30 OxyContin tablets and they are selling them out of their house, it would be hard to get a warrant. The only case that’s really prosecutable is where you have some cooperative defendant go in wearing a wire, and make a purchase.”

In a county where “everybody knows each other and is fiercely loyal,” that cooperative defendant would be hard to locate, Erickson said.

Besides, law enforcement in rural Maine is definitely small-scale. Most towns have no police department, making Sheriff Tibbetts the primary constabulary. Just a few months ago, Tibbetts said, a local car dealer donated a 1984 station wagon for the department’s sole drug officer.

“Until then,” Tibbetts said, “we were fighting the war with a bicycle.”

The battle may be outpacing the foot soldiers, Tilton said. “It used to be you had people in County Jail that were drunk, sleeping it off. Now they’ve got people vomiting in the jail, flipping out and crying, and mothers slipping the drugs into them just to alleviate their misery. This is a whole new level.”

Everywhere in Washington County, the need for treatment is a persistent theme. Many people do not know where to get help, or how. The state’s two drug treatment facilities have waiting lists. Out-of-state rehabilitation is too expensive for most.

“What we need more than anything else is rehabilitation,” Tibbetts said. “A 6-by-10 cell with a doctor coming out every once in a while, that’s just hell. And you know, these people don’t want to be addicts. They’re very nice people.”

In the nearby hamlet of Lubec, Jane Hallett said depression drove her to a $200- to $300-a-day prescription drug habit that wiped out a generous family inheritance. Moving from Percocet to Ritalin to OxyContin, Hallett plowed through land, a business and other assets valued at about $300,000 in just a few years.

“I sold my washer and dryer for two pills one day,” she said. “I sold fuel for a pill. I went through cars, trucks, china, silver, diamonds. I’ve gone to jail because I stole every checkbook my sister had.”

Hallett, “39--but I feel 140,” said the prevalence of prescription drug abuse in Washington County seems to feed upon itself.

“You’ve got a small, close-knit community. One person’s using. Soon everyone’s using. That’s just the way it is,” she said.

In another part of the county, the mother of two prescription drug abusers saw firsthand just how far her sons would go. The mother asked that her name not be used.

But she talked freely about finding a syringe and other drug paraphernalia when she put one son’s laundry away. She talked about installing a lock on her bedroom door to keep her boys from stealing from her. Then, while she was at work, the youths brought a ladder to her second-floor window and went in to grab whatever they could sell.

“Being a mother, I didn’t want to even believe that my kids could get involved in stuff like that,” she said. “I thought they were rebellious and moody, like any teenager. I thought, you know, this too shall pass.”

Tibbetts has designated one lieutenant, Mike Riggs, to work full time tracking down prescription drug problems. Riggs said he worries that a drug plague in a remote part of northeastern Maine is easy to dismiss. He gets weary, trying to explain just how bad it is here.

“I’ll tell you who owns this problem,” Riggs said. “We all own this problem. Every one of us.”

Driving along a rough, pitted road, Riggs said: “Education, treatment and enforcement is going to be the answer. The money is there to spend. It’s just a question of how you want to spend it. You can build more prisons, buy more cops--well, that’s fine. Seems as if you treated the addiction problems, it would be much wiser.”

Riggs paused to point out a rickety trailer where he said a dealer was living. He gestured toward a shingled house with bright blue trim: another dealer. Teachers sell prescription drugs to students, he said. Deals go down in front of the hardware store. Not long ago, while an elderly woman was at her husband’s funeral, relatives rifled her medicine cabinet and made off with her dead husband’s OxyContin tablets.

“Hopefully, something will come to pass,” Riggs said. “Because what is happening right now is very sad. Very sad.”