CLEVELAND -- While most people live in a world where the local pharmacists prescribe the drugs needed to make them well, others dwell in an underworld where those same drugs are bought, sold and stolen.

Welcome to the street pharmacy and its nationwide chain of franchises.

Though its phone numbers and pill peddlers can't be found in the phone book, its network of quacks and dealers supply the prescription pills to the nation's young and old.

Unfortunately, most police and law enforcement agencies are light years behind the problem, according to John Burke, a 27-year police veteran who now serves with the National Association of Drug Diversion Investigators and as commander of the Warren County Drug Task Force in southwest Ohio.

Burke says many people don't realize there are prescription drugs being diverted for abuse everywhere, from urban ghettos to rural villages.

Burke was with the Cincinnati Pharmaceutical Diversions Squad since its inception in 1990. The department only made 20 arrests in its first year.

''When we started really focusing on it, we quickly got up in the neighborhood of 250 to 300 arrests in a year,'' said Burke. ''Very quickly I began to see just how big of a problem this has become.''

Law enforcement departments from across the country are finding themselves on the frontlines of these 'script' skirmishes in the larger war on drugs.

Because of these drugs' medicinal origin, these battles are often fought under the radar, while illegal drug battles and raids receive most of the press.

Nevertheless, officials try to take as many chunks out of the line of distribution as possible while on the job.

Street pharmacy shelves, which are often no more than dealers' bedrooms or kitchen cupboards, are stocked with the same medications you'd find at CVS or Walgreens. Ritalin, Vicodin, Lortab, you name it.

However, their names change when they hit the streets. Xanax, OxyContin and Percocet tablets become Zannys, Oxies and Perks. Their prices rise, too, at a sped up rate of inflation to capitalize on the overwhelming demand for the pills.

The latest National Household Survey on Drug Abuse said that nearly 9.3 million Americans reported having abused prescription drugs.

''It probably makes up 25 to 30 percent of America's drug problem, at least,'' said Burke. ''I began to see very quickly how big of a problem this is.''

But why prescription drug abuse isn't considered a bigger national problem eludes him.

According to the Drug Abuse Warning Network, 13 of the nation's top 20 most abused drugs are prescription medications. It's one of the nation's most serious, least understood, most under-reported problems, said Rod Colvin, author of the book ''Prescription Addiction: The Hidden Epidemic.''

The patrons -- like patients -- come in all shapes and sizes. Most stereotype these people as Generation-X angst filled youth, but they can be anyone, and most likely someone you probably know, he added.

''It's the minister's wife, it's the school secretary, it's the bank executive, it's the lawn worker. It just cuts across all economical and social barriers,'' said Colvin. ''It's hidden under the aegis of medical care, unless they get (it) from an underground source.''

According to the latest statistics, Xanax and other sedatives containing benzodiazepine are the most widely abused drug. Hydrocodone products, such as Vicodin and Lorcet, followed close behind.

In the last 12 years there has been a 500 percent increase in the number of emergency room visits attributed to hydrocodone abuse, with 19,221 visits estimated in 2000.

But abuse of oxycodone-based pain killers, such as OxyContin, Percodan and Percocet, has exponentially increased in recent years. Trips to emergency rooms in 2000 involving oxycodone totaled 10,825.

The Substance Abuse Mental Health Services Association found from 1998 to 2000, the mentions of oxycodone in emergency rooms increased 108 percent. Hydrocodone mentions increased only 31 percent, and benzediazapine numbers have remained stable.

Maine, Virginia, West Virginia, Ohio, Kentucky and Maryland have reported dramatic increases in abuse, according to the U.S. Drug Enforcement Association. Recently, the abuse has spread to other states and Pennsylvania and Florida have seen a recent surge.

On the street OxyContin sells for 50 cents to $1 per milligram. A 40 mg tablet is sold for $25-$40, and the 80 mg tablets are being sold for $65-$80, according to the DEA.

''Joe,'' a former OxyContin user from Cleveland, spent nearly two years on the underground prescription circuit, and knows firsthand about addiction. Joe asked that his real name not be used.

As a former dealer, he also knows it's a powerful and euphoric buzz many are willing to pay through the nose for.

''These days it's a buck a milligram. It used to be 50 cents, but in a year it doubled because it got so popular and cops started cracking down,'' Joe said in a calm voice over the phone. ''You pay a hundred bucks for the script. Sixty (pills) times 40 (milligrams)? You're makin' a few bucks there.''

Dealers use forged prescriptions to get drugs from health care workers, who are willing to bypass ethics to make a profit. Another method is to fake an injury in the hopes of finding unsuspecting doctors willing to fill multiple prescriptions.

Joe usually took the first route.

''There are a lot of people in the health care field willing to serve as the point man,'' said Burke.

In Burke's 10-year stint with Cincinnati's pharmaceutical diversions squad, they would arrest a health professional every 5.5 days.

''You'd really be surprised. It was usually nurses who would steal them from the hospitals, and in some cases, patients,'' he said.

''That's usually where you get it, through a crooked doctor pretty much,'' Joe said. ''People just know the right guy and everybody'll get it from them pretty much. I mean, everybody knows how much those drugs are worth on the street.''

As a former user, Joe knows the rush the pills can deliver.

His first experience came long before his dealing days. He had a tooth pulled and was given Percocet to ease the pain; he eventually began snorting them.

Eventually, Joe graduated to OxyContin, the most powerful pain-killer in the oxycodone family. The drug is used to treat cancer patients and one pill is supposed to last 12 hours. Users crush the drug and snort it to get the dosage in one powerful hit.

The Oxy experience can resemble the high of heroin, and can be just as addictive, Joe said.

''I used to do Percocets, but the Oxies man, they blew that away,'' said Joe.

In recent years several police forces have created squads similar to the one in Cincinnati. San Diego, Jacksonville, Charlotte, Louisville, Indianapolis and others all have people working on the prescription drug issue, said Burke.

But, he added that cities such as Chicago and Atlanta don't have anyone focusing on the problem, and Los Angeles -- a city of 3.5 million people -- only has one part-time person looking into the situation.

''They obviously have a lot on their plate, but if you don't get at the problem, it appears not to exist,'' said Burke. ''But it's everywhere, and it's more prevalent than people realize. Now, it's really a matter of the department taking the time, money and energy to address the problem.''

Many well-meaning doctors are not willing to report these cases of fraud when they find out what has happened, according to Cindy Mogil, a former health care worker from Atlanta. She's a 47-year-old mom and a former prescription drug abuser.

She wasn't a dealer. She wasn't a suspicious individual.

There were no back-street alleys in her neighborhood.

The doctors she tricked kept silent because they would have to admit they contributed to the problem in some way, she said.

''You'd go to a health care professional, and when they got suspicious, you'd move on to the next one,'' said Mogil. ''I'd go to different doctors and emergency rooms with fake migraines. Then sometimes I would raid cabinets. Where there's a will, there's a way.''

Four years clean, she travels to different colleges universities around the country lecturing about her abuse and what led to it. She handled her addiction privately for 25 years, and included it all in her new book, ''Swallowing a Bitter Pill.''

''I knew that I needed help when I took so much, that my heart began to race and my hands went numb,'' said Mogil. ''That was when I stopped deciding when to take the drugs, and they started telling me when to take them.''

Mogil said she was fortunate she caught her addiction in time. For many others, help was too late.

Only two years ago, the Florida Department of Law Enforcement tracked the numbers of OxyContin-related deaths and reported that the death toll related to hydrocodone and oxycodone abuse alone was 660. That count was more than twice the number of heroin-related deaths that year for the state.

Mogil said she had no prescription drug preference, but in the street pharmacy, some drugs stand out above others. For the companies that actually make them, the bad press can negate the millions of dollars spent on marketing and good press. When the black market's affiliation with a prescription becomes more notable than its intended use, millions can be lost.

Purdue Pharma -- the maker of OxyContin and other oxycodone products -- has been in that position for at least two years now. Since its creation in 1995, OxyContin has been advertised strictly to doctors. Despite the company's claims of its benefit to cancer patients, many doctors shy away from it.

For many, the issue is the drug's high potential for addiction and the salivating underground market.

''From the first full year of sales in 1996, the number of OxyContin prescriptions has risen 18 fold, to approximately 5.8 million prescriptions in 2000,'' Terrance W. Woodworth, deputy director of the DEA's Office of Diversion Control told the House Committee on Energy and Commerce last year.

''While OxyContin diversion and abuse appears to have begun in more rural areas of the United States, particularly Appalachia, it has now spread into urban areas. To date, at least 14 states have experienced increased abuse and diversion of OxyContin,'' he later added.

Dr. Andrew Thomas, with the American Medical Association working commission on ethics, said he won't prescribe OxyContin unless it's the last resort.

''People are risking getting their houses broken into. Pharmacies are getting held up,'' said Thomas. ''It's just not worth the risk.''

But Dr. J. David Haddox, Purdue's senior medical director for health policy, said that the addictive quality of the drug is overblown.

''It concerns me as a physician that has treated more than 1,000 patients with OxyContin that a doctor would say that kind of thing,'' said Haddox. ''What that tells me is there are patients with legitimate needs being denied what could be the best medicine for them.''

In two years, the company has faced at least four lawsuits by groups of former abusers -- from Virginia to New Jersey -- claiming Purdue downplayed OxyContin's addictive qualities and exaggerated its usefulness. Timothy Bannon, a Purdue spokesman, said they intend to fight the cases out in court.

The company is looking for ways to repair the drug's image, including the recently-launched ''Painfully Obvious'' message campaign. The campaign is geared to inform the community of the dangers of OxyContin abuse and prescription abuse in general.

But as campaigns are funded, newer drugs are created, and dealers are arrested, one thing remains certain: There is a market for both the ill and addicted, and both pharmacies will remain open for business.

''The sad part about it is the real victims here,'' said Bannon. ''The patients and the people that need the drug aren't getting the drug because of the wackos out there that choose to use them illegally."
  • Drug Facts
  • When injected, 120mg of codeine phosphate produces an analgesic response equivalent to that from 10mg of morphine.
  • This alkaloid (codeine) is found in opium in concentrations ranging from 0.7 to 2.5 percent.
  • Codeine products are diverted from legitimate sources and are encountered on the illicit market.
  • Codeine can be converted to morphine.
  • The human body converts codeine into morphine during digestion.