The Alchemy of OxyContin: From Pain Relief to Drug Addiction: “Part of what makes the spread of OxyContin abuse so difficult to track,

let alone to stop, is that the drug moves not physically but conceptually.

When crack cocaine spread from the big cities on either coast toward the

center of the country, it traveled gradually, along Interstates, city by city.

OxyContin abuse pops up suddenly, in unexpected locations.” One of the privileges of practicing psychiatry is the intimate glimpses of the lives of people more different than one would otherwise often meet. This week, a patient in my hospital with whom I have a candid relationship because I’ve treated him as more than “just an addict” (the way the profession often sees them when they come in for psychiatric admission), offered me a sociological treatise on the recent eruption of oxycontin onto the urban, Boston-area drug scene. Looks to me we are not going to stop this epidemic. A pain patient on Medicaid pays 50 cents for a month’s prescription of the drug, which may be as many as 60 or 100 80-mg tabs. S/he can immediately get $2000-3000 cash for the pills, because the man who buys them will turn around and sell them — within the day — for current street value, which is $1 per mg. That amounts to a $5000 profit on that one prescription, and the dealer is doing similar deals with dozens of recipients each month. As long as the price stays at or near current levels (which is partly driven by public hype, I realize…), the financial incentives make this trade virtually unstoppable.