COLUMBUS, Ohio – Sally Royster cried when her orthopedic surgeon said he would no longer prescribe OxyContin for the chronic back pain that leaves her unable to walk. She was told prescriptions for the drug were under too much scrutiny.
Sheila Lambert sent the medical history of her degenerative spinal disease to 25 doctors and phoned 100 others but all said they weren't taking new patients or didn't take pain patients.
"If they hear you have been on OxyContin they treat you like an addict," said Lambert of Jonesville, Va.
Across the country, chronic pain sufferers like Royster, 50, and Lambert, 41, are finding it increasingly difficult to obtain the powerful prescription painkiller, dubbed "Hillbilly Heroin" because of its burgeoning abuse as a narcotic in Appalachia.
They say that abuse — and the response to it by law makers and law enforcers — has made doctors increasingly unwilling to provide the drug, even to the cancer patients and chronic pain sufferers who need it.
Royster searched seven months before she found a specialist in late September near her Cincinnati-area home that would prescribe OxyContin. Until then, her primary care physician agreed to prescribe the drug, but only on an interim basis, she said.
While most strong pain medicines last only about four hours, OxyContin gives a steady 12-hour release and has fewer side effects. But to addicts who chew the pill or crush it and snort or inject the powder, OxyContin produces a quick, heroin-like high that can kill.
Since 1998, OxyContin and oxycodone, the narcotic's active ingredient, have been linked to more than 100 deaths nationwide.
The drug's maker, Purdue Pharma, pulled its strongest dosage off the market in May and issued tamperproof prescription pads. But pharmacies are still being robbed for OxyContin and the drug is still being abused. One pharmacy in St. Albans, Vt., stopped stocking the painkiller after thieves broke in four times this summer looking for OxyContin.
"The problem is not with the drug ... it is with our society," said Dr. Gladstone McDowell, director of the Grant Pain Management Center in Columbus.
He agrees that there are people who try to con OxyContin, but he said doctors who properly document their work shouldn't have to worry. Still, he sees fewer doctors willing to write OxyContin prescriptions and says those who do often have waiting lists.
Several states have tightened control over OxyContin. At least nine have limited Medicaid patients' access to the drug.
"I have seen abuse reach epidemic proportions in other states and I don't want that to happen in Vermont," said Vermont Gov. Howard Dean, a physician.
Dean suggested that doctors find substitutes for OxyContin and that pharmacies remove it from their shelves. He said his state won't pay for the drug unless patients have terminal cancer or sickle cell anemia.
South Carolina has the same restrictions, but it will pay for the drug for AIDS patients. Alabama, Florida, Maine, Michigan, Mississippi, North Carolina and West Virginia all restrict the amount of OxyContin a patient on Medicaid can receive in a month without approval.
Louisiana and Virginia adopted resolutions to study the use and abuse of OxyContin, and Massachusetts and Kentucky have legislation pending that would restrict distribution of the drug, according to the National Conference of State Legislatures.
Police and prosecutors across the country have also been cracking down on OxyContin abuse: A Virginia man was convicted of murder last month for selling OxyContin to a friend who later died; a Florida doctor was charged in July with murder and drug trafficking after four of his patients died from overdoses.
In Virginia, police have provided fingerprint kits to pharmacies for customers wanting OxyContin.
"They're treating everyone who is sick enough to be prescribed OxyContin as if they were a criminal suspect," said Kent Willis, a spokesman for the Virginia chapter of the American Civil Liberties Union.
Purdue Pharma spokesman James Heins said the states' restrictions on OxyContin and their targeting of Medicaid recipients are unfair. The company is working on a new version of OxyContin that would be harder to abuse but it will take time to produce.
"Anything that restricts a patient's access to what their physician feels is the appropriate amount or level of treatment has the potential to interfere with medical care," Heins said.
But in areas where abuse is prevalent, some doctors say they worry that even patients who need the drug might be selling the pills for money.
"We had a 92-year-old lady that legitimately needed these drugs but there was none in her system because she was selling them," said Dr. Fred Evans, of Lawrenceville, N.J., a founding board member of the American Pain Society.
That concern can be frustrating for patients like Bob Goodburn, of Columbus, who need the medication to fight pain.
Goodburn, 44, said he changed pharmacies after being reprimanded by a pharmacist for using OxyContin to treat pain caused by a spinal disease.
"The pharmacist who doesn't know anything about me told me he, too, has back pain and that I should learn to live with it," Goodburn said. "If a doctor who knows your medical history is prescribing you the medicine ... you don't need the pharmacist putting in his two cents."