A Killer Painkiller

A few months ago, Jake Epperly was at a country club wedding in suburban Illinois when he overheard a female voice scream, "Give me that lollipop!" This was no petulant child demanding candy but a woman in her 50s yelling at her husband. And Epperly, clinical director and president of three rapid detox clinics and Chicago's New Hope Recovery Center, knew what she was craving: Actiq, a fentanyl-based painkiller that comes in the form of a berry-flavored lozenge on a stick.

Though Actiq was designed for cancer patients whose pain can't be managed by the usual drugs, doctors have prescribed the pops to people with migraines and other types of pain. Cephalon, the company that makes the drug, says that it markets Actiq only for its intended use in cancer patients, but government investigators say Cephalon has targeted a variety of doctors, such as internists, neurologists, and sports medicine specialists. That could explain why, in the first half of 2006, oncologists wrote only a reported 1 percent of the 187,076 Actiq prescriptions filled at U.S. retail pharmacies. Last November the Connecticut attorney general announced that Cephalon had set "high sales quotas...that couldn't be reached without promoting the drug beyond its approved use." The attorney general began investigating the company after a Southington, Connecticut, woman overdosed on Actiq she had purchased from a drug dealer. In 2004 police in Philadelphia discovered that the drug had shown up on the black market under the street name perc-o-pop, and narcotics experts worry that illicit use will soon increase because Actiq has just gone generic, cutting its price by half.

So far the pops have been associated with 127 deaths, two of them children who may have mistaken the medicine for candy. In 2004 alone, illegal use of fentanyl (which is also administered by transdermal patch) accounted for 8,000 U.S. emergency room visits, a third more than codeine and two and a half times more than amphetamines.

Most Actiq addicts in Epperly's detox clinics got the drug through a legitimate prescription because they were in real pain. "But several didn't have cancer," he says. And Epperly suspects that in most cases their pain could have been managed with a less powerful medicine—fentanyl is 80 times more potent than morphine. "This stuff acts directly on endorphins, the pleasure system," he says. "If you tried it, in two weeks, you'd be hooked, too."