PURDUE PHARMA, a division of Purdue Frederick, a 100-year-old pharmaceutical company that relocated from New York City to Norwalk a quarter-century ago, bought the vacant GTE building in Stamford on March 27 for $77 million.

In doing so it will eventually take some 513,000 square feet of first-class office space off the market in a city where the vacancy rate for such space is at a 10-year low of about 6 percent.

The glass-sheathed GTE building, resembling an inverted ziggurat, has stood at 201 Tresser Boulevard as an icon of the city's rebirth since it was completed in 1973. It was the first owner-occupied corporate headquarters to be built in downtown Stamford during the urban renewal period.

Newmark & Company Real Estate of Manhattan represented the seller, the Zurich Reinsurance Company, in the sale and in the purchase of the building from GTE in January of this year. Zurich Reinsurance had contracted to buy the building in 1997, planning to occupy it after the last of GTE's employees left last fall. But late last year, Zurich Reinsurance changed its mind and never moved in.

The company's decision to abandon its plans and sell was based on ''a gradual shift in our business to complex financially driven products that we expect to accelerate; we thought it advisable to stay close to the financial community in Manhattan,'' John Cross, its chief financial officer, said from its Manhattan headquarters.

Stephen Banker, executive managing director for Newmark's Fairfield County operations, said: ''This is a milestone for Stamford. The city was at a point where no new construction projects could go forward until GTE was spoken for. Now developers-in-waiting can more aggressively formulate plans to go into the ground.''

According to Robin Stein, a land use planner for the city, ''there is nothing else like GTE left in the city, not even 100,000 square feet available for any user looking for a large space.''

But because Purdue Pharma will not initially occupy the entire GTE building, 70,000 to 100,000 square feet of space will go back on the market, with Newmark as the leasing agent.

Without substantial preleases in hand, lenders are still extremely cautious about making financial commitments for speculative office buildings, but it now appears likely that one of three potential projects will proceed first -- a 480,000-square-foot tower that was approved by the city's zoning board in 1997 for Hines Interests L.P.

The site, at 425 Atlantic Street, within walking distance of the Metro North-Amtrak railroad station and one block north of the new Warburg Dillon Read building, is viewed as ''an exceptional setting,'' said Kenneth W. Hubbard, executive vice president at Hines. At present, he said, ''we are very concentrated on preleasing to two financial services tenants who would fill half the building and could assure financing.''

A second entry, the Louis Dreyfus Property Group, based in Manhattan, expects to submit an application for a 508,000-square-foot building on Washington Boulevard this month, said David Friedman, a vice president in the developer's Stamford office. The site is across the boulevard from the Warburg Dillon Read property.

A third project, by the Toombs Development Company of New Canaan in partnership with Howard Milstein, a New York developer, ''is the quietest,'' Mr. Stein said. It involves a vacant, excavated parcel that the partners have owned for two years. It lies behind the Town Center mall at Greyrock Place. Scott Toombs, president of the company, said, ''we have been talking to prospective tenants on a regular basis and remain optimistic.''

Reactions to the Purdue Pharma purchase among Stamford's real estate professionals have been mixed. ''We could have had a scenario where Zurich sold it to a less-than-full-building user and more space would have hit the market,'' said Ed Tonnessen, an executive vice president at Albert B. Ashforth, real estate brokers in Stamford. ''With space so tight, we need a new building, something to set the musical chairs in play again. Nobody significant is moving out -- there is no juggling for space. New construction will give us some backfill operations.''

On a more conservative note, Owen J. Brown 3d, a senior director at Cushman & Wakefield, said: ''One new building would lease in a heartbeat in the mid-$30's a square foot. The need and demand are there. But not all three buildings. They are all about the same size and tenants requiring 100,000 to 200,000 square feet are few and far between these days.''

That may be changing. The number of companies in the area that are expanding, like Purdue Pharma, is growing. The Thomson Corporation, for example, an international publisher of newspapers and educational and technical publications based in Stamford, now occupies more than 175,000 square feet of space spread over five locations in Fairfield County. ''We are exploring alternative space opportunities,'' said Ray Meglio, vice president for real estate, indicating that a consolidation might be coming.

Purdue Pharma now owns or leases 240,000 square feet of space in five Norwalk locations, and in the last three years it added 200 of the 600 people that make up its current headquarters staff, all of whom will be transferred to Stamford. In addition, it has manufacturing and chemical research facilities in Totowa, N.J., and in Ardsley in Westchester County.

Strong growth in the last three to five years was attributed by Howard R. Udell, vice president and general counsel for the company, to the introduction of two highly successful products: OxyContin for the relief of chronic pain and MS Contin, a morphine-based, controlled-release substance, to relieve cancer pain.

''Starting in the spring of next year we will move in in phases,'' Mr. Udell said, ''after facade repairs, some reconfiguration of office space, and upgrading of the mechanical systems and windows are completed.'' He gave the building high marks for being well maintained, for the beauty of its terrace and ground level gardens, and the elegance of its cafeteria and other interior spaces.

''We've been looking for new quarters for several years,'' he said. ''We had a building designed by Skidmore, Owings & Merrill to be constructed on our present site at 100 Connecticut Avenue in Norwalk, but shortly before we were to break ground last year we realized that we had outgrown it.''

After dropping construction plans, Purdue bought a 10,000-square-foot building at 200 Connecticut Avenue from the Davis Companies of Boston and Wilton, a company that has been providing Purdue with an overall program of asset management. ''Now we are negotiating to buy the building back,'' said David Fiore, a Davis senior vice president in Wilton. As part of its service, Davis made Purdue aware of the availability of the GTE building last December. Purdue bought it without a broker.

Jeffrey Dunne, a senior vice president at CB Richard Ellis in Stamford, has been hired by Purdue Pharma to sell both of its Connecticut Avenue buildings. Regarding the GTE sale, he said: ''It takes away potential competition for developers who want to do spec projects, but the problem is that rental rates are still not quite high enough at the low- to mid-$30's. You need mid- to high-$30's, and I don't think rentals will rise quickly. There are still more than three and a half million out of a total of 14 million square feet of office space available, including older buildings around the city that are very hard to lease.''

Purdue Frederick was founded in 1892 by John Purdue Gray, a doctor, and W. W. Frederick. By 1952, it had become a small pharmaceutical manufacturer in Greenwich Village that was in serious financial difficulty.

It was bought by two doctors, Mortimer and Raymond Sackler, brothers who had a psychiatric practice on Manhattan's Upper East Side. The company was expanded through acquisitions and the development of new products, eventually moving to Yonkers and then to Norwalk in 1973, where the headquarters was built. The company is still owned privately by the the Sackler family of Greenwich.

Its relocation to Stamford may have some beneficial tax consequences. Connecticut gives companies that move their headquarters to municipalities with state-designated enterprise zones a five-year 80 percent abatement on real estate and personal property taxes, plus a 10-year 25 percent credit against state corporate income taxes. Personal property is made up of office, manufacturing and other business equipment.

If the company goes into a vacant or underutilized building outside the enterprise zone, the benefits are somewhat reduced. Stamford's enterprise zone was established in 1994 south of Interstate 95 and the railroad tracks to bring new business and industry into that depressed area. GTE is north of the highway, outside the enterprise zone but still eligible for the lesser benefits, according to James Heckman, a spokesman for the state's Department of Economic Development.

''We've had discussions with the state that are not yet resolved,'' Mr. Udell said.

• A version of this article appears in print on April 18, 1999, Section 11, Page 9 of the National edition with the headline: In the Region /Connecticut; Drug Maker Buys Vacant GTE Building in Stamford. Order Reprints | Today’s Paper | Subscribe

MENAR, India -- Beside a thick carpet of plants cloaked in white flowers, Laxmi Lal Lohar sits cross-legged in the dirt, scraping brown gunk off his palms into a plastic pail. If all goes well -- and he prays and burns incense each morning so it will -- the stuff in the pail will earn him a lot more than the wheat, cauliflower and tomatoes he normally grows.

Opium does tend to pay better.

Mr. Lohar isn't doing anything illegal. He is one of 159,000 peasant farmers licensed by the Indian government this year to grow opium poppies and help meet rising international demand for strong painkillers.

After thousands of years and an often-tragic history, opium and its derivatives remain the ingredients of choice for pain-relief medications. Sales of medicines derived from opium poppies rose 32% in the U.S. last year to more than $2 billion, according to IMS Health, a research firm. Demand for one opium derivative, known as thebaine, is especially strong, up sixfold since 1996 according to an importer.

Much of the raw material comes from India, and that's no accident. Under an obscure U.S. regulation known as the 80/20 rule, importers of opiate raw materials in the U.S., the world's largest buyer, must get 80% of their supplies from India and Turkey.

They end up buying mostly from India because it's the only place on earth where farmers are legally permitted to lance ripe seed pods and extract gum opium, a latexlike substance that is easier to process than the dried pods known as poppy straw produced in Turkey and elsewhere.

But India's unique place in the legal trade in narcotic raw materials no longer is assured. The rising demand is shaking up the secretive business, prompting importers to seek new sources, breed new varieties, invest in new technologies and even try to alter foreign policy.

Lobbying for Change

The only two companies licensed to bring opium and its derivatives into the U.S., Mallinckrodt Inc. and the Noramco unit of Johnson & Johnson , have been lobbying the U.S. government to change the 80/20 rule. They contend the rule, adopted by the Drug Enforcement Administration two decades ago at a time of excess production, is outdated.

Besides citing growing demand for morphine, which is made from gum opium, they say India and Turkey can't supply enough of the thebaine derivative. It is turned into oxycodone, an ingredient in some popular painkillers. Sales of one such drug, OxyContin from Purdue Pharma LP in Norwalk, Conn., leapt 95% last year to about $600 million, according to IMS Health.

The importers want the DEA to change the 80/20 rule to 60/40 over three years. That would allow them to buy more from places like the Australian island of Tasmania, where poppies especially rich in thebaine are being bred by two producers, one a Noramco affiliate and one owned by drug giantGlaxo Wellcome PLC. France also is developing thebaine-rich poppies.

"Our overwhelming concern in wanting to change the rule is the possibility of shortage," says a Noramco official, Michael Kindergan.

Pushing Back

But the Indians and Turks don't fancy the idea of changing the 80/20 rule, and the proposal has erupted into a contentious trade issue with the U.S. "You just don't break your commitment unilaterally," says Reva Nayyar, joint secretary of India's Ministry of Finance, who says India is lobbying "very strenuously" to keep the rule intact. So is Turkey. And the United Nations' International Narcotics Control Board in Vienna warns that changing the rule could "destabilize the world licit market for opiate raw materials."

Nonetheless, the DEA, with input from the State Department, has been reviewing the rule for about a year, weighing proposals that include changing the rule to 60/40 or exempting thebaine altogether. Meanwhile, even as the two legal importers fight that battle, they have been trying to keep others out of their business. At least two other companies say they are seeking licenses to become U.S. importers.

Opium's roots in history are deep. Thebaine takes its name from the ancient Egyptian city of Thebes, and the harvesting method used in India today originated with the Assyrians, according to a book on opium by Martin Booth. In India's history, opium has been a nefarious player. British rulers established gum opium as India's biggest cash export in the 19th century and smuggled it by boat into China to supply addicts, sparking the Opium Wars that led to the colonization of Hong Kong.

In later times, the addictive nature of opiates caused many doctors to think twice before prescribing them. But that is changing now, especially in the U.S., where pain treatment has emerged as a medical specialty and safer means of administering opiates, such as patches and slow-release tablets, have arisen. About 3,000 U.S. doctors now specialize in treating pain, says J. David Haddox, Purdue Pharma's medical director and a past president of the American Academy of Pain Medicine, who says opiates remain one of the most effective means.

Opium-poppy production is strictly controlled under international treaties and national laws. The U.N. is supposed to ensure that enough poppies are grown to meet medical needs, without any excess that would end up with drug traffickers. In the late 1970s, output began rising too fast. A U.N. commission asked supplier countries to limit production and importing nations to help out by supporting "traditional supply countries."

After much debate, the U.S. DEA instituted the 80/20 rule in 1981. Turkey was included partly for foreign-policy reasons. The U.S. had helped persuade Turkey to ban poppy production in the early 1970s because it was a source of the "French connection" heroin flowing into the U.S. But Turkish officials, upset over farmers' lost income, later reauthorized production. The 80/20 rule provided a reliable commercial market for Turkish poppies.

Turkey did agree to bar farmers from harvesting gum opium, which can easily be turned into heroin. Instead, farmers in Turkey slice off the bulbous poppy heads, which are dried, crushed and processed in a U.S.-built factory into a potent substance called concentrate of poppy straw. About 100,000 Turkish farmers now legally grow poppies. The bulk of their output goes to the U.S.

India was allowed to continue producing gum opium, even though the U.S. knew there was leakage to drug traffickers, says an official at the State Department's Bureau of International Narcotics and Law Enforcement Affairs. Since most of the diverted opium stayed in India, the U.S. attitude was "to some degree, it's their problem," the official says.

As with any crop, production depends heavily on weather, and it was lousy for the 1998 harvest. India had to exhaust nearly all of its backup inventory, and global stocks of gum opium fell to their lowest in two decades, about an 18-week supply. To meet demand, Noramco and Mallinckrodt say, they bought morphine reserves from the U.S. military.

Cash Crop

The next year, India licensed 156,000 farmers to grow poppies, up from 92,000. The increase was welcomed in poor villages such as Menar, a place of rutted dirt roads and no running water in west-central India. Growing ordinary food crops, most farmers here earn the equivalent of about $350 a year. Those who are allowed to plant opium poppies on a half-acre or so of their land -- 102 farmers this year, up from a dozen in 1997 -- can earn $150 or more just from that small plot. And since the poppy season runs from December to March, they can raise something else on this patch the rest of the year, while still planting the rest of their land in food crops.

Mr. Lohar, a 35-year-old who doubles as a stonemason to support his wife and five children, jumped at the chance for an opium license, which cost him 57 cents. His first season was disastrous; the crop was ravaged by a fungus.

This year was much better. In early March, thousands of dark-green seed pods, many the size of tennis balls, stood erect in his plot, amid a sea of white flowers. It was time to begin the weeks-long harvest, now nearing completion.

Mr. Lohar begins the day at 6 a.m. He starts by placing his tools before a "god stone" at the edge of the field, burning incense, brushing a few poppy leaves with orange dye and praying to a goddess. The purpose, he says, is "to get more production."

Then he, his wife and several hired hands begin the lancing process. They carefully apply a small, four-bladed wooden stick to each seed pod and slice the surface once from top to bottom. White, milky drops ooze out through the four parallel, shallow cuts. Twelve hours later, the liquid has turned brown and gummy and is ready to be scraped off the pods with a curved blade and deposited in a pail. Pods are lanced again and again until no more milk flows.

Off to the Lambardar

Each night, Mr. Lohar and the other poppy farmers of Menar take their output to the village's head opium man, known as the lambardar, for weighing and entry into the official Opium Collection Daily Record. They bring it back home and, because even minute amounts of gum opium are valuable, scrape the residue off their hands and into the bucket.

The lambardar is whichever village farmer produced the most gum opium in the prior season; this year, the role went to Fulchand Jain, a leather-faced 55-year-old who has been growing poppies since 1972. The 3.6 kilograms (7.9 pounds) of gum opium he harvested last year helped him move into his own house in his extended family's crowded complex.

As lambardar, he earns a 1.5% commission on the village's production. But he isn't thrilled to have the job. He must measure every farmer's plot and destroy any poppies found outside the boundaries, making him unpopular with some.

At the end of the harvest, the farmers bring their gum opium to government weighing stations. If they don't meet the minimum qualifying yield, they lose their licenses -- a rule designed to deter diversion, since a farmer delivering too little opium might be selling some to traffickers, for far more.

But it's an inexact science, and last year, the government reduced the yield requirement after many farmers didn't meet it. U.S. drug-enforcement officials, concerned that a significant part of last year's Indian crop may have been diverted and smuggled abroad, have offered to help devise more-precise yield calculations.

Sun-Dried

Mr. Jain and Mr. Lohar shrug when asked what they think happens to the gum opium the government buys. In fact, it is trucked in sealed plastic containers to the Government Opium and Alkaloid Works in Nimach, one of two such plants in India. There, workers empty the moist gum opium into aluminum-lined wooden trays, dry it in the sun for two to three weeks, mold it into lumps, wrap it and pack it in wooden chests. These travel by truck and train to Bombay, where they are shipped to the U.S. for processing and eventual sale to pharmaceutical companies.

Last year, Indian farmers were paid $13 to $32 per kilogram, depending on yield and moisture content. After drying, India sells it to U.S. importers for $77 a kilo, maybe one-tenth the value it will have by the time it reaches American consumers in painkillers.

The rising market hasn't escaped notice. Seeking to join Mallinckrodt and Noramco as U.S. importers are two companies, Penick Corp. in Newark, N.J., and Johnson Matthey Pharmaceutical Materials in West Deptford, N.J., a unit of London-based Johnson Matthey PLC.

Mallinckrodt and Noramco are challenging the application by Johnson Matthey, saying the company lacks technical expertise; Johnson Matthey declines to comment on that.

As for Penick, it used to be an importer but went into receivership and let its license expire. Recently it emerged from bankruptcy after attracting new investors who hope it can regain its license and re-enter the now-thriving business. Penick plans to apply soon and says it expects opposition from Mallinckrodt and Noramco, which objected when Penick tried unsuccessfully to regain the license one other time.

Their argument: There's already enough competition for the limited supply of legal opium.

• • • Write to Steve Stecklow at steve.stecklow@wsj.com and Jonathan Karp atjonathan.karp@wsj.com

Harried police detectives in dozens of rural areas in Eastern states are combating what they say is a growing wave of drug abuse involving a potent painkiller prescribed for terminal cancer patients and other people with severe pain.

Illicit dealers have used suffering patients as well as fakers, the authorities report, to ''doctor shop'' to obtain the drug, OxyContin, for resale. Addicts favor the drug because they have learned to circumvent its slow time-released protection and achieve a sudden, powerful morphine-like high.

OxyContin is often covered under health care plans. Police say that when dealt illicitly on the street it can cost as much as heroin or more. The abuse of the drug, which has been tracked over the last 18 months, has set off a wave of pharmacy break-ins, emergency room visits and arrests of physicians and other health care workers.

In addition to Kentucky, law enforcement officials have cited a troubling number of cases in Maine, Maryland, Ohio, Pennsylvania, Virginia and West Virginia.

''Heck, we already know it's pretty epidemic down here,'' said Capt. Minor Allen of the Hazard Police Department in southeastern Kentucky, where federal, state and local police rounded up scores of purported dealers and users this week.

The authorities say dozens of deaths may be laid to OxyContin abuse, but this is strongly disputed by the manufacturer, Purdue Pharmacoei of Norwalk, Conn.

''Abuse of this drug has become unbelievable in the last year, with probably 85 to 90 percent of our field work now related to oxys,'' Captain Allen said, using street shorthand for the drug.

The drug's active ingredient is oxycodone, a morphine-like substance also found in drugs like Percodan and Tylox. But while painkillers like Tylox contain five milligrams of oxycodone and require repeated doses to achieve pain relief, OxyContin contains 40 to 160 milligrams in a time-released formulation that controls pain over a longer period. Chewing or crushing the prescription pill foils its time-release protection, delivering an instant potent euphoria. Once crushed, the drug can be snorted by addicts or dissolved for injection. And this new addiction has occasioned a telltale bit of fresh paraphernalia among teenage abusers, Captain Allen said.

''We find them carrying pill crushers that are sold in drugstores to help elderly people swallow their prescriptions,'' he noted of a growing drug culture in which the Perry County park has come to called Pillville.

The abuse first drew alarm in Maine 18 months ago in rural eastern areas not previously considered drug problems, Jay P. McCloskey, the United States attorney for Maine, said.

''What is most unusual and disturbing is the number of high school kids and those in the early 20's who got addicted,'' Mr. McCloskey said.

''We are talking about some of the best students, some of the best athletes,'' he said, noting that his small state was among the nation's largest consumers of OxyContin per capita.

In Kentucky, the problem became so urgent that Joseph L. Famularo, the United States attorney for the eastern district of the state, directed the roundup of 207 suspects this week in Operation Oxyfest 2001, a nine-month investigation that produced the biggest drug-abuse raid in state history.

''I personally counted 59 deaths since January of last year that local police attributed to addicts using the drug, and I suspect that's pretty conservative,'' Mr. Famularo said, noting that cancer patients build a tolerance for the drug while a neophyte abuser may try it and be lethally stricken.

Mr. Famularo's number of deaths was disputed by the drug's maker, with Dr. J. David Haddox, medical director for Purdue Pharma, saying, ''I'm concerned about inflammatory statements like that.''

Dr. Haddox said that overdose deaths typically involved multiple factors like alcohol and that exaggeration of abuses might cause doctors to deny the drug to suffering patients.

Why so many current abuses seem focused across stretches of Appalachia and other rural areas is an open question. But the authorities note that the prevalence here of retirees and mining workers with health care plans and prescription cards invites exploitation of the elderly and others by illicit brokers.

There have been reports of dealing in New Orleans. But the authorities said there was no evidence of large-scale OxyContin abuse in major drug markets in New York or other urban areas. The authorities said one mark of the new addiction was its rootedness in areas that have had no previous heavy criminal drug traffic to compete against.

Dealers shop for doctors who may be busy, slipshod or quietly cooperative, and then they obtain multiple prescriptions in several areas using the same ailing or not-so-ailing patients, the police say.

For their efforts, dealers realize a tenfold profit over the painkiller's prescription cost. Addicts have been paying about $1 a milligram for the drug. The top of the line is a powerful 160-milligram tablet intended to work for up to 12 hours.

The authorities expressed little doubt that the abuse of OxyContin was spreading.

Sgt. Kerry Rowland of the Cincinnati police pharmaceutical diversion squad, said: ''It's becoming the prescription drug of choice from greater Cincinnati to rural Ohio. It's become rampant because it offers such a pure high with less risk of arrest or overdose, and many times health care is picking up the cost.''

Sergeant Rowland said his squad's average arrests lately included one health care worker a week caught dealing in prescription drugs.

Another concerned area is the region surrounding Roanoke in southwestern Virginia. On Wednesday, 100 local, state and federal law enforcement officials met to discuss mounting overdoses, pharmacy break-ins and other problems associated with OxyContin abuse there, Robert Crouch, the United States attorney in Roanoke, said.

''The graph is spiking,'' Mr. Crouch said.

Rick Moorer, an investigator with the state medical examiner's office in Roanoke, said that in 1999 there were 16 deaths in southwestern Virginia attributable mainly to OxyContin in combination with other drugs or alcohol. There was just one such death in 1997, he said.

Federal data shows that while emergency room visits involving oxycodone remained stable from 1990 to 1996, such visits doubled from 3,190 in 1996 to 6,429 in 1999, the period that corresponds with OxyContin's introduction and marketing. That data indicated that deaths attributed to oxycodone products also grew in that period. Drug company officials insisted, however, that they had not been aware of any significant instances of OxyContin abuse until about a year ago when they began hearing the first news reports concerning the drug's abuse.

The new bulletin by the National Drug Intelligence Center warns that abuse of OxyContin appears for now to be concentrated in the East. But officials said instances of abuse had surfaced as far west as California.

Chuck Miller, a spokesman for the intelligence center, said, ''It's showing up elsewhere,'' and noted that the bulletin warned that continued abuse of OxyContin was likely.

Roy W. Hatfield, the police chief of Harlan, Ky., said: ''In the last year, this drug has really shown up around here, pushing out all the old stuff, marijuana, barbiturates. People think it's a legal way to stay high. But now they're discovering how easy it is to get addicted.''

Mr. Famularo, the United States attorney here, said his investigation would continue.

''We caught 207,'' he said. ''We didn't catch half of them; that's how pervasive this thing is.''

Law enforcement officials from eight Eastern states will meet in Richmond on Thursday to discuss ways to stem the abuse of OxyContin, a powerful synthetic morphine blamed for dozens of deaths.

The meeting was called by Attorney General Mark Earley of Virginia, where at least 32 deaths have been attributed to the prescription painkiller in the last four years. At least 59 overdose deaths have been reported in Kentucky in the last year.

Several states, including Virginia, said they had seen a crime surge as addicts robbed to get the drug. On Monday, a federal grand jury indicted five people from Virginia and one from Ohio on charges of running an illegal OxyContin ring.

Indiana, Kentucky, Maryland, Ohio, Pennsylvania, Tennessee, Virginia and West Virginia are sending representatives to the meeting.

OxyContin, made by Purdue Pharma of Norwalk, Conn., was approved by the Food and Drug Administration in 1996. A company official plans to speak at the meeting.

Dr. Peter Leong recalls the day when he finally snapped at a drug company salesman pressing him to prescribe a powerful narcotic painkiller called OxyContin.

The drug's producer, Purdue Pharma, had already failed to persuade Dr. Leong with repeated offers of free weekend trips to Florida to discuss pain management. But when the salesman suggested that OxyContin -- which is as potent as morphine -- was safe enough to treat short-term pain, Dr. Leong exploded.

''We threw him out of my office,'' said Dr. Leong, who runs a pain clinic in Bangor, Me. He thinks OxyContin is potentially too dangerous to use for anything but chronic, severe pain. ''OxyContin is a good drug,'' he said. ''But the problem was, they were pushing it for everything.''

If Dr. Leong was not a convert, many others were. In a little over four years, OxyContin's sales have hit $1 billion, more than even Viagra's. Although the drug has helped thousands of people in pain, its success has come at a considerable cost. An official of the Drug Enforcement Administration said no other prescription drug in the last 20 years had been illegally abused by so many people so soon after it appeared.

OxyContin has been a factor in the deaths of at least 120 people, and medical examiners are still counting, according to interviews with law enforcement officials. And doctors like Dr. Leong, pharmacists and law enforcement officials say part of the problem is that Purdue Pharma often oversold OxyContin's benefits without adequately warning of its potential for abuse.

The company also used an often criticized but increasingly common marketing strategy: currying the favor of doctors in private practice with free trips and paid speaking engagements. Purdue Pharma, based in Norwalk, Conn., paid the transportation and hotel costs for hundreds of doctors to attend weekend meetings in spots like Florida to discuss pain management, a company consultant said. Doctors were then recruited and paid fees to speak to other doctors at some of the 7,000 ''pain management'' seminars that Purdue sponsored around the country. Those meetings stressed the importance of aggressively treating pain with potent, long-acting painkillers like OxyContin.

Purdue also contributed to foundations supporting research on pain, to pharmacy schools and to Internet sites aimed at educating consumers.

As OxyContin's marketing message spread, the drug caught on with many doctors who medical experts said had little experience in prescribing powerful narcotics. As a result, they often could not spot those who intended to abuse the drug or who did not need it in the first place.

OxyContin, introduced in December 1995, has offered patients something different: a tablet that slowly releases its powerful pain medication, permitting patients, for example, to sleep through the night. ''It's a good drug in the right situation,'' said Dr. Art VanZee, a physician in St. Charles, Va.

Purdue officials say they have promoted the drug responsibly and would have disciplined any sales representative who did not. They also said that in informing doctors about the drug, they told them how to spot potential drug abusers, and they have responded quickly to reports of spreading problems.

''We don't have strong medicines that don't have abuse potential,'' said Dr. J. David Haddox, the company's senior vice president for health policy. ''What we have to do is walk the balance between helping the greater good, knowing there are always some people who will divert drugs.''

Abuse and addiction involving OxyContin have spread quickly in the last two years, flaring up in at least a dozen states. And while the illegal use of OxyContin took root in rural areas along the East Coast, it has begun moving into cities like Philadelphia. ''Nobody is immune from this,'' said Brantley Bishop, a narcotics investigator in Alabama. ''I'm seeing housewives; I'm seeing loggers, nurses, mechanics.''

OxyContin was originally thought to be less prone to abuse because its narcotic was locked in a time-release formula. That meant it would not produce the quick spike of euphoria that drug abusers crave. But abusers quickly discovered how to disarm the time-release formula; they simply crushed the tablet, then swallowed, inhaled or injected the powder to give themselves a high as powerful as heroin's.

Getting OxyContin was often easy. A person simply had to find the right doctor, claim great pain and get a prescription. Others just stole prescription pads and wrote their own.

Illegal use of OxyContin mushroomed even though no drug in this country is more tightly regulated. Unlike illegal drugs like cocaine or heroin, OxyContin is monitored by state and federal health officials in its production, marketing and distribution. Now, many of those regulators are trying to figure out how the outbreak occurred and what they might have done to prevent it.

The Food and Drug Administration, for one, is reassessing how it reviews prescription narcotics for potential abuse. ''We've learned something from this,'' said Dr. Cynthia McCormick, director of the F.D.A.'s division of anesthetics, critical care and addiction drug products. Dr. McCormick acknowledged that the F.D.A. had failed to research all the ways abusers might tamper with OxyContin, an oversight she said her agency did not want to repeat.

Last Thursday, officials of five states met in Richmond, Va., to discuss ways to halt illegal traffic in OxyContin. In recent months, Purdue has also stepped up its efforts to halt the drug's abuse, including working with law enforcement officials.

Selling a 'Miracle' Drug

OxyContin came to market amid a sea change in how doctors treated pain. For years, terminally ill patients suffered needlessly because doctors resisted prescribing frequent, potent doses of narcotics, fearing that patients might become addicted.

But with new studies showing that doctors undertreated pain, OxyContin provided a breakthrough opportunity for Purdue Pharma. Until then, the company's biggest drug was MS Contin, which had limited appeal, partly because it contained morphine. OxyContin had broader appeal because it contained a synthetic version of morphine called oxycodone, which, among other things, carried less of a social stigma.

''If Grandma is placed on morphine it's like, 'Oh, my God,' '' said Dr. Howard A. Heit, a pain specialist in Fairfax, Va., and a Purdue consultant. ''But if Grandma comes home placed on OxyContin -- that was O.K.''

Although other pain medicine had long contained oxycodone, OxyContin differed in two key respects: it had a time-release formula, and it could be delivered in larger doses because it did not contain the type of nonprescription pain relievers that in larger quantities could cause liver damage.

The F.D.A. approved OxyContin for those with moderate to severe pain lasting more than a few days.

OxyContin is often prescribed for people in chronic pain, like those with back problems or severe arthritis, as well as patients with cancer and other painful diseases.

For Robert E. Mitchell, OxyContin proved nothing short of a wonder drug. A victim of Guillain-Barré syndrome, a rare nerve disorder that can cause paralysis, Mr. Mitchell said his pain had become so severe he could not walk. But with OxyContin, he can now wear shoes and has learned to walk again.

''To me, it's like a miracle,'' he said.

Seeing great potential in the drug, the company hatched an ambitious marketing plan. To reach consumers, Purdue financed an Internet site called Partners Against Pain, where OxyContin is promoted. It also contributed to groups like the American Pain Foundation, which championed the need for better pain treatment.

Still, most of Purdue's marketing dollars were aimed at doctors. In recent years, Purdue brought in 2,000 to 3,000 doctors to three-day retreats in California, Arizona and Florida, estimated Dr. Heit, the Purdue consultant. At those meetings, doctors were lectured about treating chronic pain, while being recruited to serve as paid speakers at medical meetings sponsored by Purdue.

Dr. Susan Bertrand, who treats chronic pain in Princeton, W. Va., became a Purdue speaker. She said that for her, recent studies showing the undertreatment of pain had been ''almost a religious experience,'' making her realize how poorly she and others had been trained to deal with the problem.

To help change that, she said, she gave about a dozen paid speeches sponsored by Purdue. The company also helped her start the Appalachian Pain Foundation, an educational group on pain management.

Purdue's marketing campaign quickly began to pay big dividends, with OxyContin sales almost doubling every year, according to IMS Health, a firm that tracks drug sales. OxyContin now earns more in sales than any other narcotic. It also now accounts for 80 percent of Purdue Pharma's revenue, according to court documents filed by Purdue in connection with a patent dispute.

Some doctors and pharmacists said they were put off by the company's sales tactics.

''All companies market,'' said Dr. Diane Meier, a pain specialist at the Mount Sinai School of Medicine in New York. ''But these people were in your face all the time.'

Others criticized the way Purdue recruited doctors. ''Essentially, they bought the doctors' prescriptions,'' said Steve Schondelmeyer, a professor of pharmaceutical economics at the University of Minnesota. ''It says to consumers that every time you paid for this drug, you sent your doctor to a nice meeting somewhere.''

A Growing Concern

Purdue Pharma's critics agree that doctors must learn how to manage pain better. But Dr. Ted Parran, an associate professor at Case Western Reserve University School of Medicine in Cleveland, says doctors, in their rush to find a remedy, may have been blinded to another problem: addiction.

''Pain medicine docs are on a mission,'' said Dr. Parran, who teaches doctors how to use narcotics. ''In the process, they tend to trivialize addiction.''

In this regard, pharmacists play an important backup role for doctors. They provide the last medical defense for preventing addictive drugs from getting into the wrong hands. For instance, they can choose not to fill suspect prescriptions.

Some pharmacists said they, too, found Purdue's safety claims overblown.

John Craig, a co-owner of Hancocks Drug Store in Scottsburg, Ind., remembers a Purdue salesman walking into his pharmacy several years ago with reassurances that OxyContin was safer than other narcotics.

''They were going around to doctors promoting that this was the answer to all abuse,'' said Mr. Craig, but he already knew that local people were using OxyContin to get high. Since then, the abuse has become worse.

Another pharmacist, Samuel A. Okoronkwo, refused to fill an OxyContin prescription for someone he thought might be an abuser. He said a Purdue salesman suggested he could get into trouble for arbitrarily not filling prescriptions. ''I told him I didn't have to fill a prescription that I didn't feel was medically necessary,'' he said.

Another druggist, Joseph Yates in Grundy, Va., said simply, ''The problem with this drug is the company.''

Purdue did not comment when asked about such anecdotes.

Concern about Purdue's marketing practices has also reached the D.E.A. An agency official said its investigators had recently interviewed doctors and druggists about their dealings with Purdue.

That official said the agency was worried that Purdue was not clearly communicating the drug's serious potential for abuse. ''It may take years to repair the damage that this drug has done,'' said that D.E.A. official, who declined to be identified.

Told of the D.E.A. comment, Purdue responded with a statement that said in part: ''In 15 years of marketing narcotic analgesics, Purdue Pharma has never been questioned by the Drug Enforcement Administration regarding our marketing practices.''

In May, however, the F.D.A. did question a company advertisement for OxyContin, saying Purdue had improperly implied that OxyContin could be used to treat arthritis patients without first trying milder drugs. A company spokesman said that it disagreed with the F.D.A. but had voluntarily withdrawn the ad.

Dr. VanZee, in St. Charles, Va., has seen the destruction the drug has caused in the valleys and small mining towns of the southwestern part of that state. He said he was treating OxyContin overdoses in youngsters he had vaccinated as infants.

In the past two years, OxyContin has been a factor in the overdose deaths of 28 people in the area, said an official of the state medical examiner's office. It is difficult to tell the precise cause of an overdose, however, because more than one drug is often involved and OxyContin's active ingredient is in other drugs.

One area clinic, the Life Center of Galax, expected to treat 20 patients in its new methadone program but must now find a way to treat 300, most of them addicted to OxyContin, a clinic official said.

To stem this abuse, Dr. VanZee said, he met last fall with Purdue representatives in a bid to persuade them to cut back on their marketing and to issue a nationwide alert about the drug's hazards. The officials, Dr. VanZee said, appeared sympathetic, but said they viewed the problem as being limited to just a few areas of the country.

''They are either very naïve about the extent of the problem,'' Dr. VanZee said, ''or they don't understand what it means to have 300 people in your county addicted -- the type of pain that causes in a community and in families.''

Addressing the Problem

Purdue officials said they were as surprised as anyone that OxyContin could be abused. Dr. Haddox of Purdue said he thought the time-release formula would make the pill ''less desirable to addicts.''

That is not the case now. Last September, the company gathered 20 consultants to look for better ways for doctors to spot potential abusers, said Dr. Heit, the consultant. Four months later, Purdue asked its sales force to remind doctors that drugs like OxyContin ''are common targets for both drug abusers and drug addicts.''

Purdue said it was now planning to reformulate OxyContin, making it less appealing to abusers. The company is also helping to educate students on the dangers of prescription drugs.

Moves like this have recently earned the company praise from some law enforcement officials.

Some health officials think OxyContin abuse might have been more quickly identified had more states closely tracked the prescribing patterns of narcotics; some 17 states do that now.

Hospitals are addressing the problem in different ways. Mercy Hospital in Portland, Me., gives OxyContin patients urine screens to verify that they are not taking too much, or that they are obtaining the drug but not taking it and then selling it on the street.

A Cincinnati-based hospital chain, the Health Alliance, decided last month to limit OxyContin to just a few types of patients, like those with cancer, after determining that another painkiller was just as effective, cheaper and less prone to abuse.

Purdue Pharma -- and some doctors -- now worry that media reports on OxyContin abuse are scaring away patients who need the drug. ''The publicity, of which you are a part, is causing patients to call us in tears because their physicians are taking them off therapy,'' said Robin Hogen, a company spokesman. ''This is becoming a sad case of patients being abused by drug abusers.''

Three Founders Of Purdue Pharma

Unlike many drug companies that are publicly traded, Purdue Pharma is privately held and part of a network of concerns founded by three brothers, Arthur, Mortimer and Raymond Sackler, all of whom were trained as research psychiatrists and have illustrious ties to the arts and sciences.

A wing of the Smithsonian Institution in Washington bears the name of Dr. Arthur M. Sackler, who died in 1987. He and his brothers also financed a wing at the Metropolitan Museum of Art that houses the Temple of Dendur. In 1995, Dr. Raymond R. Sackler was knighted by Queen Elizabeth in recognition of his contributions to the sciences, arts and astronomy.

The company is now run by the son of Dr. Raymond Sackler, Dr. Richard Sackler, a surgeon who has served as a director of the foundation of the American Medical Association. A Purdue Pharma spokesman declined to make the Sackler family members available for interviews.

Medicine Merchants

Earlier articles in this series have examined the financing of a blockbuster drug, how lower-costing generic drugs can be kept off the market, alliances between drug companies and patient groups and the production of inexpensive copycat drugs in nations like India.

Federal officials have urged the maker of a widely abused narcotic painkiller to limit how it distributes and markets the drug, which has played a role in more than 100 fatal overdoses in several states.

Federal officials have also been in talks about withdrawing or modifying a claim that the painkiller, OxyContin, may be less prone to abuse than similar narcotics.

The moves come as the officials at the Drug Enforcement Administration start what they describe as the agency's first effort to curb misuse of a specific prescription drug. Previously, the agency had sought to reduce abuse of classes of drugs, but officials of the drug enforcement agency said the abuse problem involving OxyContin was so grave that it required unique action.

Terry Woodworth, a top official at the agency, said it was concerned that the promotion and distribution of OxyContin by its manufacturer, Purdue Pharma L.P., to doctors like general practitioners might have led to its wide misuse. The government has said that no prescription drug in the last 20 years has been so widely abused so soon after its release as OxyContin.

Mr. Woodworth said the agency had recently asked Purdue officials to volunteer to limit the drug's distribution to only those specialists who regularly treat patients for chronic or severe pain.

''D.E.A. is extremely concerned that many doctors are prescribing this strong narcotic as an initial treatment for many types of pain and that is a result of how it has been promoted,'' said Mr. Woodworth, the deputy director of the agency's office of diversion control.

In a statement responding to questions, officials of Purdue, which is based in Stamford, Conn., acknowledged the agency's request but declined to elaborate on how the company would respond.

''We expect to have ongoing, constructive dialogue with the D.E.A. on this subject,'' the statement said. ''We do not think it would be appropriate to go into any specifics at this time.''

Separately, Purdue officials have said they have taken voluntary steps in the past year to combat abuse of OxyContin and are working to reformulate the product.

OxyContin, which was approved by the Food and Drug Administration in late 1995 for treating moderate or severe pain, is the leading narcotic painkiller sold in tablet form in the United States. Last year, its sales in this country exceeded $1 billion.

Medical authorities and law enforcement officials agree that the drug can be highly effective in treating severe or chronic pain because its time-released form enables its active ingredient to work over many hours. It was first thought that such slowed release would deter illicit use of the drug because abusers prefer the quick euphoric rush that immediately released narcotics provide.

But in just a few years, abuse of OxyContin has become rampant, officials say. The treatment's users quickly discovered that they could defeat the time-released design by crushing or dissolving the tablet. That gave them immediate access to the drug's active ingredient, a synthetic form of morphine called oxycodone, which could then be snorted or injected.

Abusers and others have also been able to obtain OxyContin by going around to doctors and feigning pain. Experts have said that many family doctors and general practitioners have little experience in spotting drug abusers or monitoring how their patients use narcotics.

In recent years, OxyContin has been a factor in more than 120 drug overdose deaths, the authorities report. Communities in Maine, Kentucky and Virginia have been devastated by crime waves involving OxyContin addicts. The treatment has an extremely high street value of a dollar a milligram; a single 40-milligram pill would cost $40.

Purdue, a privately held company, has aggressively marketed the drug in recent years by paying the hotel and travel expenses of hundreds of doctors who attended weekend ''pain management'' seminars in vacation spots like Florida.

The company has also held roughly 7,000 seminars around the country for doctors, including many general practitioners, that advocated the use of powerful long-lasting narcotics like OxyContin in pain treatment.

Purdue officials say they have responsibly marketed and promoted OxyContin. In addition, they say they have moved swiftly to combat misuse of the drug, which they say has brought relief to thousands of patients who otherwise would suffer needlessly.

Also, the company said, in December it stopped sponsoring trips to seminars for doctors, after the United States attorney's office in Maine, where numerous cases of OxyContin abuse have occurred, asked it to stop doing so.

Mr. Woodworth of the drug enforcement agency said it was still trying to determine what percentage of OxyContin prescriptions were medically necessary. But he emphasized that the agency did not want to prevent those who needed the drug from getting it.

He added, however, that the agency believed the drug had been frequently prescribed by doctors who could have recommended less powerful drugs before turning to OxyContin. He said he believed that part of the reason doctors prescribed OxyContin so readily was their belief that it was less prone to abuse.

''Your family practitioner and pediatrician don't have a speciality in the treatment of chronic and severe pain,'' Mr. Woodworth said. ''When you couple that with the marketing that the drug is less prone to abuse, you have contributed to some of the problems here.''

Officials of both Purdue and the F.D.A. declined to comment on any contemplated changes to the product's labeling, citing the confidentiality of discussions between the agency and the companies it regulates.

WASHINGTON -- The Food and Drug Administration, concerned about a rash of abuse cases and several deaths, is boosting the warnings on the popular prescription painkiller OxyContin.

Federal drug officials, as well as drug maker Purdue Pharma LP, have been alarmed in recent months by persistent reports of OxyContin's being diverted to the black market, where it has become highly prized on the streets in some poor communities. The pill is designed so the active pain-killing ingredient is released slowly over time. But abusers are crushing up the tablets and snorting or injecting the contents, thus getting the entire dose at once.

The FDA and Purdue worked together to come up with significant changes to the drug's label, including the insertion of a so-called black-box warning, the strongest alert for an FDA-approved drug. The FDA informed users that OxyContin's effects resemble those of morphine, and that its misuse can be fatal. The new warnings are also aimed at reducing the chance that OxyContin will be inappropriately prescribed for patients with relatively low levels of pain.

At the same time, Purdue, based in Stamford, Conn., has sent a letter to doctors and pharmacists around the country noting the new warning and urging health-care workers to be aware when prescribing the drug that it can be abused in a manner similar to illicit drugs. That comes on top of a program in which Purdue said it sent abuse and diversion brochures to nearly 500,000 physicians and more than 60,000 pharmacists giving them tips on how to prevent the drug's abuse.

Approved by the FDA in 1995, OxyContin is a major seller, with retail sales in 2000 topping $1 billion, according to the National Institute for Health Care Management, an organization based in Washington that analyzes drug-spending trends.

Wall Street analysts doubted that the new warning would have a significant impact on OxyContin sales for privately held Purdue, in part because the use of OxyContin and similar painkillers is growing so rapidly. The drug is attractive for patients and doctors because it doesn't have to be taken as often as older painkillers.

Purdue has also been targeted in lawsuits alleging the company has been marketing the drug too aggressively.

• • • Write to Chris Adams at chris.adams@wsj.com

Paula is taking me on a driving tour of Man, the tiny West Virginia town where she has spent her entire life. Because I don't know my way around the hollows and gullies and creeks that carve through these hills, Paula is at the wheel. And because Paula isn't a morning person, we've set out on our tour at midnight. It's dark; the only illumination comes from our headlights cutting through the mist that rolls down from the hills.

The tour Paula is leading isn't sanctioned by the local chamber of commerce; there are no stops at Civil War plaques or scenic vistas. It's a pillhead tour: an addict's-eye view of the radical changes that a single prescription drug, called OxyContin, has brought to the town of Man. OxyContin abuse started in remote communities like this one more than two years ago; more recently, it has spread beyond its origins in Appalachia and rural Maine to affect cities and suburbs across the eastern United States. I came to Man to try to understand how America's latest drug problem started, to see its roots and trace how it has spread.

''That's my best friend's trailer right there,'' Paula says, pointing out a comfortable-looking single-wide across the creek. ''She's somebody that you couldn't

look at and know she was an oxy addict. She was a cheerleader in junior high. She's married. You can't just look at somebody and tell.''

A few years ago, Paula says, Man was like any small town in America: you could buy a variety of illegal drugs, as long as you knew the right person to talk to. Pot was big; there was occasionally some cocaine around and a few pills for recreational use. Fads would come and go. But these days, she says, the only drug for sale in Man is OxyContin, a narcotic painkiller that users crush -- to disable its patented time-release mechanism -- and then snort or inject for a powerful and immediate opiate high. Legally, it's sold only by prescription for the treatment of chronic pain. In practice it's available just about everywhere around here, immediately, for cash. The going rate is a dollar a milligram, or $40 for a 40-milligram pill.

Paula is a thoughtful, good-natured 24-year-old with wispy blond hair, serious eyes and faded jeans. She's fidgety; as she drives with one hand, she's rummaging through her handbag with the other, looking for her pack of Marlboro Lights. She finds them, removes one and stabs the dashboard lighter. ''I'll show you some places over here,'' she says, as she turns her car off the main road, over a short bridge and down into a rough indentation that holds a couple dozen trailers and prefab homes. ''This is Green Valley. We just call it the valley. It's a pretty good neighborhood,'' she says, then interrupts herself. ''Well, except that's a dealer there.''

She points to a trailer with a Chevy pickup out front and a light burning inside. I crane my neck to get a look at a real-life drug den, but the tour has already moved on. Paula is pointing out a trailer on the other side of the road: ''That's a small-time dealer there, nothing big,'' she says. Then she points to another one, and then another: ''That's a dealer. . . . That's a small-time dealer. . . . That's a dealer. . . . Her son's a dealer, but I don't know if he lives there. . . . He uses, that boy in there. . . . They use really, really big.''

We're driving slowly around the circular dirt road that is the only path through Green Valley. The neighborhood doesn't feel dangerous -- no graffiti, no pit bulls, no broken bottles lying around. Still, Paula is pointing out criminal activity in every second home, peering through the front windshield and gesturing left and right: ''They used to deal, too, but they don't no more. . . . They deal. . . . There's some dealers up through there, one or two, nothing big. . . . This boy that lives here deals. . . . They deal, in that trailer there.''

The first time Paula did an oxy (as she calls the pills), in the summer of 1999, it didn't do much for her. ''That first 10-milligram pill, I didn't really feel nothing off it,'' she says. ''But the second time I did it, I did two 20's, and I was high.'' She liked the effect. ''When you get that oxy buzz,'' she says, ''it's a great feeling. You're happy. Your body don't hurt. Nothing can bring you down. It's a high to where you don't have to think about nothing. All your troubles go away. You just feel like everything is lifted off your shoulders.''

What Paula calls ''that oxy buzz'' comes from OxyContin's only active ingredient: oxycodone, an opioid, or synthetic opiate, developed in a German laboratory in 1916. Chemically, it is a close relative of every other opium derivative and synthetic: heroin, morphine, codeine, fentanyl, methadone. The narcotic effects that Paula is describing are the exact same ones that have drawn people to opiates for centuries. And just as every opiate does, oxycodone creates a physical dependence in most of its users and a powerful addiction in some of them. ''At first you do them to get high,'' Paula says, ''and then after you're addicted to them you don't do them to get high; you do them to survive. You do them to feel normal.'' At her peak, she says, she was snorting four or five 80-milligram pills a day.

The earliest reported cases of Oxycontin abuse were in rural Maine, rust-belt counties in western Pennsylvania and eastern Ohio and the Appalachian areas of Virginia, West Virginia and Kentucky. The problem traveled through these regions, as friends told friends and the word spread from town to town, county to county, up and down the Appalachians. There are a few defining characteristics that the first affected regions share: they're home to large populations of disabled and chronically ill people who are in need of pain relief; they're marked by high unemployment and a lack of economic opportunity; they're remote, far from the network of Interstates and metropolises through which heroin and cocaine travel; and they're areas where prescription drugs have been abused -- though in much smaller numbers -- in the past. ''There's always been a certain degree of prescription drug abuse in this area,'' says Art Van Zee, a physician in Lee County, Va., ''but there's never been anything like this. This is something that is very different and very new, and we don't understand all the reasons why. This is not just people who have long-term substance-abuse problems. In our region this is young teenagers, 13- and 14-year-olds, experimenting with recreational drug use and rapidly becoming addicted. Tens of thousands of opioid addicts are being created out there.''

In Man, Paula said, it was like OxyContin came out of nowhere. One day no one had heard of oxys, and a month later, the pills had become a way of life for hundreds of locals. It became so easy to buy OxyContin in and around Man, Paula said, that until recently, she never really thought about the fact that everyone involved was breaking the law. ''Buying pills never seemed illegal,'' she said. ''It just didn't feel like it was wrong.'' There aren't lookouts involved, or secret passwords or elaborate drop sites: when Paula wants to buy an OxyContin pill, she simply drives to a dealer's house and knocks on the front door in broad daylight. If she knows the dealer well enough, she'll go on in and snort the pill there, just to be neighborly. If not, she'll hand over the cash, put the pill in her pocket and drive away. Sometimes she'll be the only person there; other times, there will be a dozen cars lined up out front.

The dealers have the benefit of a captive market: OxyContin, like any opioid, is very difficult to quit abusing. And given the pill's ubiquity here in Man, and the fact that the nearest rehab clinic is two hours away, this is an unusually hard place to quit using it. Nonetheless, Paula is trying. Six months ago, she and her best friend decided they were going to quit cold turkey. They took a couple of days off work, locked themselves in her friend's trailer and started to detox. ''That was the worst three days of my life,'' Paula said. ''Honestly, I prayed to God to let me die. That's how bad it is. Your stomach hurts, you get really bad headaches, you get diarrhea. You want to throw up. You get really depressed. If you can get past the third day or the fourth day, you're pretty much fine, but most people don't make it.'' Paula and her friend didn't make it: at the end of the third day, they went out and got a pill.

A few months ago, OxyContin abuse was considered a regional problem, labeled ''hillbilly heroin'' and confined to areas far from the nation's population centers. This year, though, abuse of OxyContin has started to move away from its backwoods origins and into metropolitan areas on the East Coast, into the Deep South and parts of the Southwest and into suburban communities throughout the Eastern United States. In Miami-Dade County, there have been 11 overdose deaths so far this year in which oxycodone was the probable cause, according to the county medical examiner. There have been 11 more in Philadelphia, according to the medical examiner there. Police in Bridgeport, Conn., arrested a local doctor in July for prescribing tens of thousands of OxyContin tablets to patients, often, they say, without any medical examination at all. And in the suburbs of Boston, police say more than a dozen pharmacies have been held up by a gang of young men wearing baseball caps and bandannas, looking for OxyContin.

In many ways, the spread of Oxycontin abuse closely resembles another recent drug epidemic. In the early 1990's, the Medellín and Cali cartels controlled cocaine and heroin distribution in the United States. Cocaine was selling well, but there was a marketing problem with heroin: it could only be injected, and many people, even frequent drug abusers, are reluctant to stick needles in their arms.

Sign up for The Ethicist newsletter, for Times subscribers only.  Advice on life’s trickiest situations and moral dilemmas from the philosopher Kwame Anthony Appiah. Get it sent to your inbox.

The Colombians' solution to this problem was to increase the purity of the heroin they were bringing into the United States until it was potent enough to snort. They were then able to use their existing cocaine-trafficking network in the Eastern United States to get heroin onto the street in powder form. Cocaine users, who were used to the idea of buying and snorting a white powder, experimented and became addicted. As their tolerance increased, these new heroin snorters overcame their aversion to needles and soon turned into heroin injectors.

Similarly, there were plenty of oxycodone users in Appalachia before OxyContin came along. Many of the OxyContin addicts I spoke to in Kentucky and West Virginia used to snort or chew a mild oxycodone-based painkiller called Tylox. They said they found the pills somewhat euphoric and not very addictive -- each Tylox contains just 5 milligrams of oxycodone, along with 500 milligrams of acetaminophen. When OxyContin arrived on the scene, in pills containing 20, 40 and 80 milligrams of oxycodone, it marked a jump in purity similar to that of early-90's heroin -- and again, casual users started snorting, and then shooting, a powerful opioid.

Although heroin and OxyContin have a similar unhappy effect on the lives of people addicted to them, there is a critical and simple difference between the two: heroin is illegal; OxyContin, when used as directed, is legal. More than that: the pill is government-approved. It is made by Purdue Pharma, a successful and well-regarded pharmaceutical company headquartered in Stamford, Conn. It is prescribed to a million patients for the treatment of chronic pain, and it is closely regulated at every stage of its manufacture and distribution by the Food and Drug Administration and the Drug Enforcement Administration.

This fact has meant a major conceptual shift for law-enforcement officials, who are used to combating narcotics produced by international drug lords, not international corporations. Terry Woodworth, the deputy director of the D.E.A.'s office of diversion control, says the spread of OxyContin has posed a challenge to the D.E.A.'s traditional methods: ''Instead of using the normal law-enforcement techniques -- like going to the source and attempting to eradicate or destroy the criminal organization producing the drug and immobilize its distribution networks and seize all its assets -- you have a very different situation in a legitimate industry, in that your manufacture and distribution is legal.''

Scott Walker, the director of Layne House, a drug treatment facility in Prestonsburg, Ky., puts it more concisely: ''You don't have the Coast Guard chasing OxyContin ships,'' he says. ''This isn't something you can stop at the border. It's growing from within.''

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: Kenai, Alaska; Tucson; West Palm Beach, Fla. At the Gateway Rehabilitation Center in Aliquippa, Pa., a suburb of Pittsburgh, Jay, a recovering OxyContin addict and a former small-time dealer, offered an explanation for OxyContin's sudden geographical shifts. ''It's the idea that passes on,'' he told me. ''That's how it spreads. There aren't mules running the drug across the country. It's dealt by word of mouth. I call a friend in Colorado and explain it to him: 'Hey, I've got this crazy pill, an OC 80, an OC 40. You've got to go to the doctor and get it. Tell him your back hurts.'''

Jay is 26, a college graduate and former nurse. He started doing oxys in 1999, and his consumption quickly rose to 240 milligrams a day. He was clean when we met and trying to stay that way. But when he talked about the drug's potential as a small business, he couldn't help getting excited. ''I could go to California or Las Vegas and say, 'Hey, I was getting OC's prescribed to me in Pennsylvania; I'm going to get them in Las Vegas,''' he said. ''And then if I wanted to sell them, I could sell them there. I'd start out and sell them for 10 bucks apiece. Get people hooked on them, then sell them for 50 bucks apiece. It's experienced word of mouth. I've experienced the drug, therefore I know how to describe it to you.''

Unlike heroin, Jay explained, OxyContin doesn't require investment or muscle or manpower to move across the country. OxyContin abuse is a a contagious idea -- a meme, if you will. Because OxyContin, the medicine, is readily available in pharmacies everywhere, all it takes to bring OxyContin, the drug, to a new place is a persuasive talker like Jay. A powerful recreational narcotic can now travel halfway across the country in the course of a phone call.

In order to understand the particular dilemma of OxyContin, you need to understand the long-fought war among doctors over pain and addiction. For centuries, opium and its derivatives have been considered a double-edged sword -- the most effective painkiller on earth and also the most addictive substance. For most of the 20th century, opiates were considered too dangerous to use in all but the most critical pain treatments. The assumption was that their medical use would inevitably lead to addiction. In the late 1980's, for the first time, public and medical opinion began to swing decisively in the other direction. Patient advocates and pharmaceutical companies, bolstered by studies showing that there were vast numbers of cancer patients whose pain was being undertreated, encouraged the medical community to rethink its approach to opioids, especially in the management of cancer pain. Their campaign was persuasive. Between 1990 and 1994, morphine consumption in the United States rose by 75 percent, and in 1994, the Department of Health and Human Services issued new clinical guidelines encouraging the use of opioids in the treatment of cancer pain.

Purdue Pharma was a leading player in the pro-opioid campaign. The company contributed generously to patient-advocacy organizations, including the American Pain Foundation, the National Foundation for the Treatment of Pain and the American Chronic Pain Association, and underwrote dozens of scientific studies on the effectiveness of opioids in the treatment of pain. In 1985, the company began marketing MS Contin, a time-release morphine pill that was used to treat cancer pain. As attitudes on opioids shifted, Purdue began to promote MS Contin for noncancer pain as well.

Dr. Russell Portenoy is chairman of pain medicine and palliative care at Beth Israel Medical Center in New York City, and the co-author of a groundbreaking 1986 study that supported the long-term use of opioids to treat noncancer pain. ''Between 1986 and 1997, within the community of pain specialists, there was increasing attention on the role of opioids,'' Portenoy says, ''but there was relatively little diffusion of that idea to family doctors and other nonspecialists.'' That began to change, Portenoy says, with the F.D.A.'s approval of OxyContin in 1995. ''There was a sea change that occurred with the release of this drug,'' Portenoy says. For the first time, general practitioners began to prescribe strong, long-acting opioids to treat chronic noncancer pain. Portenoy says the change was due to four factors that came together at about the same time. ''The reasons were partly cultural -- the attitudes of the medical and regulatory communities had been gradually shifting for a decade. They were partly medical -- studies had been coming out showing that patients with low back pain, chronic headaches and neuropathic pain might benefit from long-term opioid therapy. They were partly pharmacological -- OxyContin made it easier and more convenient for patients to receive long-term opioid therapy. And they were finally related to marketing, because Purdue Pharma was the first company to advertise an opioid pill to general practitioners in mainstream medical journals.''

In addition to those doctor-directed ads in magazines like The Journal of the American Medical Association, the company began an innovative indirect-marketing campaign just before OxyContin's release. Because of F.D.A. regulations on the marketing of narcotics, the company was unable to use direct-to-consumer advertising, as other pharmaceutical companies were beginning to do for antidepressants and prescription allergy medications. So Purdue decided to concentrate on what they call ''nonbranded education.'' Just as Nike advertises the concept of sports instead of shoes, so Purdue would market the concept of pain relief to consumers, but not OxyContin. In 1994, the company launched Partners Against Pain, a public-education program that at first concentrated on cancer pain and later expanded to include other forms of long-term pain. Through videos, patient pain journals and an elaborate Web site, Purdue promoted three ideas to doctors and patients: that pain was much more widespread than had previously been thought; that it was treatable; and that in many cases it could, and should, be treated with opioids. Partners Against Pain didn't promote OxyContin specifically; the company's marketers knew that simply expanding the total market would also increase their bottom line.

OxyContin was seen by many doctors as the solution to the long rift between pain specialists and addiction specialists. Purdue Pharma believed that OxyContin's time-release function would mean a much lower risk of addiction than other opioid medications. According to a principle known as the ''rate hypothesis,'' the rate at which an opioid enters the brain determines its euphoric effect, and also its addiction potential. This is why injecting a narcotic produces a more powerful high, and addiction risk, than snorting it or swallowing it. Because OxyContin, taken whole, provides a steady flow of oxycodone over an extended period, the high it produces is diminished, as is the risk of addiction.

Before OxyContin, narcotic painkillers were prescribed mostly by oncologists and pain specialists. Purdue believed that OxyContin's time-release safeguards made it appropriate for use by a much broader array of medical professionals. The company began promoting OxyContin to family doctors and local pharmacists nationwide through a network of hundreds of field reps who emphasized, in their office visits, the idea that OxyContin presented a lower addiction risk than other opioid medicines.

Over the next few years, sales of OxyContin exploded. OxyContin prescriptions have more or less doubled in number each year since its release; the company's revenues from the pill jumped to $1.14 billion in 2000 from $55 million in 1996. Last year, doctors wrote more than six and a half million OxyContin prescriptions, and OxyContin ranked as the 18th best-selling prescription drug in the country (as measured by retail sales) and the No. 1 opioid painkiller. The company grew along with its main product's sales; between 1998 and 2000, the Purdue work force expanded to nearly 3,000 employees from 1,600.

Purdue's attempt to expand the opioid marketplace beyond cancer patients was also remarkably successful. Five years ago, cancer patients were still the main market for long-acting opioids, but oncologists accounted for only 3 percent of the OxyContin prescribed last year. The largest single group of OxyContin prescribers is now family physicians, who account for 21 percent of the total.

According to Portenoy, this change in the number and kinds of doctors prescribing OxyContin is fundamentally linked to the spread of OxyContin abuse. ''It's not the drug, per se,'' Portenoy says. ''It's rapidly expanding access, plus the reality of doctors prescribing it who may not have the skill set required to prescribe it responsibly.''

Purdue's field reps were the first wave of OxyContin apostles, spreading word of the pill's effectiveness door to door -- doctor by doctor, pharmacist by pharmacist. But Purdue's officially sanctioned word-of-mouth marketing campaign was followed by another, unsanctioned one. This time the news was that the miracle pill had an Achilles' heel, that its time-release matrix could be eliminated completely in a matter of seconds by the simple act of crushing the pill with a spoon, a lighter, even a thumbnail, and that the resulting powder, when snorted or mixed with water and injected, produced a very potent high. The apostles this time were not Purdue's field reps but casual drug abusers throughout the Eastern United States. And just like Purdue's, their marketing campaign was enormously successful.

In a steel-mill suburb northwest of Pittsburgh, the leader of the second wave of OxyContin apostles was Curt, a young man who in 1998, at the age of 23, found himself kicked out of the Air Force and living back in his hometown. He worked the midnight shift running cranes at the mill, and he dealt a little marijuana during the day. He was part of a ''drug community,'' as he calls it, 20 or so people who worked together, hung out together, went to parties and concerts and smoked a lot of pot. Every couple of months someone would land a prescription for Percocet or Vicodin, and they'd sell the pills to friends for $5 apiece, a cheap and mild high.

In April 1999, someone in his circle was prescribed OxyContin. Curt assumed that it was just like any other pain pill. ''Everybody thought at first that they were like a Percocet,'' Curt says. ''Nobody understood how many milligrams were really in these things. People were selling them like an expensive Percocet'' -- for $10, in other words, instead of $5 -- and swallowing them whole. At a party, Curt figured out the trick of crushing the pill and snorting the powder, and he quickly spread the word. ''I showed a lot of people,'' Curt says. ''At first they were like, 'You're crazy.' But then they'd do it, and that would be it. People tell me now, Yeah, you're the one who showed me how to snort this thing.''

Oxys quickly became very popular in Curt's circle of friends, and Curt found a comfortable niche for himself between supply and demand. ''I knew people all over the county that were getting prescriptions,'' he says. ''They'd call me and say, I'm getting OC's now and I want to get rid of them. They knew there was money there, but they didn't know who to sell to. They usually gave me a heck of a deal. I'd get them all for maybe $10'' per 40-milligram pill. ''I'd sell them for $20, so for every one I sold, I made one. And then I'd give them their money and the next month I'd get their scrip again.'' At that rate, he could make $900 off a 90-pill bottle. But he wasn't in it for the profit; he was in it for the pills. ''I didn't need money,'' he explains. ''I worked at the mill. I was always doing it just for the free drugs.''

Before long, he had 10 people giving him their pills to sell, mostly women in their 30's and 40's on welfare or disability. (Patients on Medicaid pay just a dollar for a $250 OxyContin prescription.) ''It's so weird the people that got into this,'' Curt says. ''Some of them were innocent mothers. I had one that was in her 60's. She never did drugs. She'd sell every last one of her pills, and it would pay for all her other medication.'' Curt would keep careful track of which day of the month each of his suppliers filled her prescription. ''A lot of times I would drive them to the pharmacy,'' he says. ''I'd always get a couple of pills for that.''

One of the most valuable -and closely guarded -- resources in the local OxyContin economy was a doctor who was willing to write an OxyContin prescription without asking too many questions. ''It's a slow process, breaking a doctor in,'' Curt explains. ''You've got to know how to work him. I'd say: 'I can't take the Vicodins and the Percocets because they're hurting my stomach. Do they have anything that's, like, time released?' The doctor goes, 'Oh, you know what, they've got this new stuff called OxyContin.' And I'd say: 'Oh, yeah? Wow, how's that work?''' Some local doctors, Curt says, knew exactly what was going on, but they needed the business. One started handing out monthlong OxyContin prescriptions every two weeks.

On the demand end, Curt had between 25 and 50 steady customers. ''I had a cell phone at that time, so I was doing a lot of driving,'' he says. ''People would gather at their houses, and they'd bring all their friends over, 10 of them that'd use it. They'd all gather when they knew I was coming, because they wanted the pill immediately.''

Curt has been in recovery for a few months now; since he got out of rehab, he's been cut off from almost all his old friends, and he fills his spare time fixing up his sister's house, fishing and reading up on psychology, which he plans to begin studying this fall. He's a man of boundless energy and focus, and he has taken to the 12-step process with an unusual intensity; in his first 60 days clean, he told me, he attended 138 Narcotics Anonymous meetings. That same energy served him well back in his oxy days, when he was cutting steel at the mill all night and driving around making pickups and deliveries all day. The pills themselves, he says, helped him keep going. ''I could go get two hours of sleep, wake up, do a pill and continue on from there,'' he says.

It was only a couple of months after OxyContin arrived in town that Curt and most of his customers realized they were addicted. At first, they were happy just to take a pill whenever one was around, for fun, but soon they found themselves experiencing severe withdrawal symptoms if they didn't have a pill every day. Everyone's tolerance built up quickly -- one week they were able to get by on a 20 a day, the next week they'd need a 40, and a couple of weeks later, it had to be an 80. ''No one knew what was going on,'' Curt says. ''These are a bunch of pot smokers, drinkers, just mellow people. This drug just took us by storm. A whole community, at least a hundred people I know around here. They're all into the addiction. These are guys I used to smoke pot with and drink beer with in the woods. I grew up with them all, having parties and that. And now there's not one of them -- not one of them -- that don't use pills.''

Purdue Pharma wasn't aware of significant problems with OxyContin abuse until April 2000, when a front-page article in The Bangor Daily News, claiming that OxyContin ''is quickly becoming the recreational drug of choice in Maine,'' landed on the desk of Purdue's senior medical director, Dr. J. David Haddox. In the summer of 2000, the company formed a response team, made up of medical personnel, public relations specialists and two of the company's top executives, which has guided the company's OxyContin campaign ever since.

It's fair to say that in public relations terms, Purdue's reaction to the OxyContin problem has been less than successful. As recently as six months ago, the company had a considerable supply of good will in the media, the government and the affected communities; it is now facing 12 separate potential class-action suits from former patients, as well as one from the attorney general of West Virginia; formerly sympathetic community leaders in Appalachia and Maine have grown increasingly skeptical of the company's approach; and in separate Congressional testimony, Attorney General John Ashcroft called OxyContin a ''very, very dangerous drug,'' and Donnie Marshall, then head of the D.E.A., said in May that unless he received ''more cooperation'' from Purdue, he was ''seriously considering rolling back the quotas that D.E.A. sets . . . to the 1996 level,'' which would have meant a 95 percent cut in production.

Purdue's P.R. problems seem rooted in the company's deep-seated belief in the inherent safety of and public need for its product. It is an article of faith for the company that illegal traffic in its drug is the work of ''bad guys'' and ''professionals,'' in Haddox's words. In fact, Purdue says that its internal data indicate that the levels of OxyContin abuse in the country are no greater than expected. ''We have had increased numbers in the last year or so,'' I was told by Robert Reder, Purdue's vice president of medical affairs and worldwide drug safety, ''but our estimation is that they're commensurate with the distribution of the drug.'' The abuse situation, according to Reder's numbers, is normal. (Government statistics indicate that as of 1999, 221,000 Americans had abused OxyContin.) The real victims, the company says, are their ''legitimate patients,'' who would be denied OxyContin if its distribution were restricted.

In March, Purdue announced a 10-point plan to combat OxyContin abuse. The plan includes tamper-resistant prescription pads for doctors, antidiversion brochures and educational seminars for doctors and pharmacists in affected areas, an initiative to combat smuggling of OxyContin from Mexico and Canada and a donation of $100,000 to a Virginia group for a study of prescription-monitoring programs. To Purdue, the plan is generous and well focused; to people in the communities where abuse is widespread, it seems like a way for the company to avoid the real problem. I spoke several times this spring and summer to Debbie Trent, a professional counselor in Gilbert, W. Va., who runs the local antidrug community group called STOP (Strong Through Our Plan). In our first conversation, she was scrupulously cautious and polite when she spoke about Purdue Pharma, saying, ''I don't want STOP to be seen as fighting OxyContin.'' During STOP's first few months, Haddox addressed her group twice.

When we spoke in April, though, Trent told me that she had come to believe that the company's 10-point plan was addressing the wrong problems -- prescription fraud and international smuggling, for example, when what Gilbert really needed was a way to get immediate treatment for its many addicts. ''I read about the tamper-proof prescription pads and I think, Give me a break!'' she said. ''That seems like such a little thing. It seems so minute in comparison to the scope of the problem. It's almost intentionally missing the point. Rather than prescription pads, I would like to see something done in rehab, something where they're making an effort to help these folks get better.''

Similar sentiments were expressed in Maine in July, when Purdue announced its latest solution to the OxyContin problem: a $100,000 grant to start a ''mini-M.B.A.'' program in high schools. This fall, Purdue will send 20 teachers from some of the most affected counties in Appalachia and Maine to New York for training by the National Foundation for Teaching Entrepreneurship. When they return to their schools, they will teach students how to formulate a business plan and invest in the stock market. The idea is to ''provide these kids with a sense of hope,'' according to a Purdue spokesperson. A Maine school administrator was quoted in The Boston Globe asking why the company ''wouldn't have come up here and asked us what we want''; if anyone had, she said, she would have asked for money for the treatment of addicts rather than entrepreneurial training.

Again and again, Purdue has apparently been blindsided by criticism. At a news conference in Alabama attended by parents whose teenage children had died from OxyContin overdoses, Gov. Don Siegelman interrupted a Purdue doctor who was going point by point through Purdue's 10-point plan. ''I find this very offensive, and I want you to stop,'' he said as the doctor stood open-mouthed in front of the television cameras. ''We've had enough public relations and enough sugar-coating of this issue and quite frankly, as governor, I am fed up.'' In March, Haddox had what he thought was a cordial and cooperative meeting with Attorney General Darrell V. McGraw of West Virginia to discuss the company's plan to combat drug abuse. Less than three months later, McGraw filed a lawsuit against Purdue, charging the company with ''highly coercive and inappropriate tactics to attempt to get physicians and pharmacists to prescribe OxyContin and to fill prescriptions for OxyContin, often when it was not called for,'' and seeking millions of dollars in compensation for state medical costs.

In the meantime, the lack of co-ordination between Purdue and the government agencies that regulate it has had serious repercussions in affected communities, as local police, small-town mayors and individual doctors and pharmacies have been forced to make up their own policies on the fly. Six states -- Florida, Maine, Vermont, West Virginia, Ohio and South Carolina -- have introduced regulations making it harder for Medicaid recipients to receive OxyContin. After the recent spate of pharmacy robberies near Boston, dozens of drug stores in Massachusetts pulled OxyContin from their shelves -- only to be ordered by the state pharmacy board to begin carrying the drug again. In the small town of Pulaski, Va., the police have instituted a program in which patients picking up OxyContin prescriptions from local pharmacies must give their fingerprints, a development that has alarmed civil liberties advocates. Doctors in many states, sometimes fearing reprisals from the D.E.A., have refused to prescribe OxyContin even to patients clearly in need.

Purdue's executives see the company as an unwitting victim of criminal activity -- not unlike Johnson & Johnson in 1982, when seven people were killed by Extra-Strength Tylenol tablets that had been laced with cyanide. The company's critics prefer to compare Purdue to tobacco companies and handgun manufacturers, who are increasingly likely to be found liable for deaths caused by their products. Clearly, the company failed to anticipate the growing chorus of public sentiment against it. And as OxyContin incidents move closer to Washington and New York, pressure may increase on the D.E.A. and the F.D.A. to take regulatory action against Purdue.

When I returned to the Gateway rehabilitation Center outside Pittsburgh earlier this month, I got a clearer sense of the way in which OxyContin is taking hold in urban and suburban America. I also learned about an unexpected secondary effect of OxyContin abuse: in cities like Pittsburgh, the crackdown on OxyContin is resulting in a sharp rise in heroin abuse.

I sat for an afternoon in a glassed-in conference room, looking out on Gateway's parking lot and groomed grounds, and talked with Andy and B., two addicts and former low-level dealers. Before trying OxyContin, they had used their share of recreational drugs, but they didn't consider themselves part of a hard-core drug community. Aside from the track marks on his arms, B., 21, looked like every disaffected college kid in America. He was a professional sloucher, dressed in an orange T-shirt, Army shorts and sneakers, with a mop of brown hair. Andy wore a sparse goatee, a hooded Ecko sweatshirt and a baseball cap with a Japanese character on it. I asked him what it meant, and he said he didn't know.

B. began using OxyContin in 1998, when a friend told him about the pills. He soon started dealing to support his habit, buying pills from a dozen or so people and then selling them from his apartment to friends and friends of friends. His sources were all legitimate pain patients, sick with cancer, carpal tunnel syndrome, lupus or chronic back problems. But, as B. explained, they would often supplement their OxyContin prescriptions with something weaker and cheaper, like Vicodin, then sell the OxyContin and struggle through the month on Vicodin. ''Some of them were old sick ladies who've never done drugs,'' B. said. ''They didn't understand what oxy can do to people. They just knew they were getting $20 for each pill -- $1,800 a month off something they can do without. They just wanted that money.''

Andy laughed. ''Old people are supposed to keep young people off drugs,'' he said.

B. described for me the casual feel of his drug deals. For the first several months that he was selling OxyContin, he said, everything was friendly when he'd go to pick up pills from his suppliers. ''Most of them would say, 'Hi, honey, come on in.' You go into their house and sit down and have something to drink and talk for a while and see how their family's doing, and they see how mine's doing. They were nice people. I don't think they think of themselves as drug dealers.'' Nonetheless, B. said, his suppliers kept most of the profits; he'd generally buy their pills for $20 apiece and then sell them for $25.

About six months ago, B. said, as the police and news media began to sound the alarm about OxyContin abuse, local doctors grew anxious. Many switched their patients to harder-to-abuse fentanyl patches and morphine, and B. lost most of his connections. The supply dried up, prices rose and people started ripping each other off.

A friend told him that shooting heroin was just like shooting OxyContin, only cheaper. He'd never imagined that he might take heroin, but the expense of OxyContin was killing him. ''I was spending a hundred bucks a day on oxy,'' B. said. ''That's why I switched to heroin. You get really high off two bags, which is 30 bucks a day. That's a big savings.''

Andy agreed. It took him only a month and a half to go from using OxyContin for the first time to shooting heroin, he said. ''I've always said that I'd never ever touch heroin. But then oxys came along and that's the same thing, just cleaner. And that got me into shooting dope. If I'd never touched OxyContin, I wouldn't have done heroin.''

In Pittsburgh and its suburbs, Andy and B.'s stories aren't unique. Gateway's doctors report a sharp increase in admissions of young heroin addicts who started out on OxyContin. ''Ninety percent of my friends that were addicted to oxys are now addicted to heroin,'' B. said. ''I know probably 30 or 40 heroin IV drug users now because of OxyContin.''

OxyContin entered the lives of casual drug users as a Trojan horse, disguised as something it is not. It has never become a popular drug among existing heroin or crack addicts, who already have a cheaper and at least as intoxicating mechanism for getting high. OxyContin does the most damage when it enters a community of casual drug users -- Curt's pot smokers and beer drinkers -- who think of pain pills as just another interesting diversion for a Saturday night. In networks like Curt's or Paula's, before OxyContin, no one ever did heroin or crack; those were seen as an entirely different category of drug: something that will take over your life.

When you hold it in your hand, an OxyContin pill doesn't seem any different than a Tylox or a Percocet or any of the mild narcotic preparations that have for years seeped out of the pharmaceutical pipeline and into the lives of casual drug users. What B. and Andy and Paula and Curt failed to realize is that despite appearances, OxyContin actually belongs on the other side of the drug divide; it might look like a casual Saturday-night drug, but it's a take-over-your-life drug. Rehab centers across the country are filling up with young people who discovered that fact too late.

To Art Van Zee, the doctor who has seen his small community in western Virginia ''devastated'' by OxyContin abuse, the answer to the crisis is to take OxyContin off the market. Van Zee is circulating a petition asking the F.D.A. and Purdue to withdraw the pill until a safer formulation can be found. ''The bottom line is, there's much more harm being created by this drug being available than good,'' he says. ''There are very good medicines available that are equally effective. We can certainly meet people's pain needs without OxyContin.''

But for many people, ''drug communities'' like Curt's are not worthy of a whole lot of official sympathy or regulatory concern -- especially not when their interests are considered next to those of patients in pain, who are using OxyContin the way it is meant to be used and whose lives have been improved as a result. For doctors who have seen their patients transformed by OxyContin, there is something mystifying, even infuriating, about the suggestion that it should be withdrawn or even restricted, just because a bunch of kids in Kentucky didn't know what they were snorting.

''There is no question that increasing opioid consumption for legitimate medical purposes is going to lead to some increase in the rates of addiction,'' Portenoy of Beth Israel says. ''But the fact is, the trade-off is worth it. At the moment, the attitude is that if one housewife in Alabama becomes addicted, then the drug must be pulled and the company shut down. But we're talking about millions of people whose lives can be brought back from total disability by the proper use of opioids. Any actions taken by law enforcement or the regulatory community that increase the stigma associated with these drugs, or increase the fear of physicians in prescribing these drugs, is going to exacerbate an already terrible condition and hurt patients.''

The 10th point in Purdue Pharma's 10-point plan to reduce OxyContin abuse is reformulation. The company says that it is spending millions of dollars to create a new version of OxyContin, or perhaps a whole new medication, that would have all the benefits of OxyContin and none of its dangers. Of all the initiatives under way, this is the one that has received the most attention and created the most hope in Appalachia and other affected areas.

In some interviews, Purdue's representatives sound downright enthusiastic about this idea. Earlier this month, they put a price tag -- $50 million -- on the project for the first time. But when pressed, Haddox admits that what Purdue's scientists are looking for is a ''holy grail,'' a drug that will activate the receptors in the brain that control pain relief and leave alone those that control euphoria. And this isn't a new initiative, it turns out, but one that the company has been working on for many years. Scientists and doctors as far back as Hippocrates have tried to find a way to separate the benefits of opiates from their dangers.

There are often suggestions from Purdue that this reformulation may take ''a few years''; it's also entirely possible that it will never happen. Opioids, including OxyContin, may remain the double-edged sword they have always been. And regulators may simply decide to accept a certain amount of unintentional damage in the treatment of pain, and leave local police chiefs and drug counselors -- as well as individual addicts -- to find solutions to the OxyContin problem on their own.

ABINGDON, Va., May 10 — The company that makes the painkiller OxyContin and three of its current and former executives pleaded guilty Thursday in federal court here to criminal charges that it had misled doctors and patients when it claimed the drug was less likely to be abused than traditional narcotics.

The company, Purdue Pharma, agreed to pay $600 million in fines and other payments to resolve the criminal charge of “misbranding” the product, one of the largest amounts ever paid by a drug company in such a case.

The three executives, including its president and its top lawyer, also pleaded guilty to misdemeanor charges of misbranding the drug. Together, they agreed to pay $34.5 million in fines.

The guilty plea — by Purdue Frederick, an affiliate of Purdue Pharma — is the latest of a number of cases brought by the Justice Department against pharmaceutical makers that accuse them of misbranding, a broad statute that makes it a crime to put false or misleading information about a drug on its label or in ads, or to promote it for unapproved use.

Another company, Bristol-Myers Squibb, pleaded guilty Thursday to making false statements to the government involving its anti-clotting medicine Plavix. [Page C3.]

The Purdue plea underscores the growing pressure on the drug industry over its marketing. On Wednesday, the Senate passed a bill to give the Food and Drug Administration power to oversee drug advertising and labels, and to restrict the distribution of risky medicines.

OxyContin is a powerful, long-acting narcotic that provides relief of serious pain for up to 12 hours. Initially, Purdue Pharma contended that OxyContin, because of its time-release formulation, posed a lower threat of abuse and addiction to patients than traditional, faster-acting painkillers like Percocet or Vicodin. 

That claim became the linchpin of an aggressive marketing campaign that helped the company sell over $1 billion worth of OxyContin a year.

Purdue Pharma, based in Stamford, Conn., heavily promoted OxyContin to doctors like general practitioners, who often had little training in treating serious pain or in recognizing signs of drug abuse.

But experienced drug abusers and novices, including teenagers, soon discovered that chewing an OxyContin tablet — or crushing one and then snorting the powder, or injecting it with a needle — produced a high as powerful as heroin. OxyContin is a pure, high-strength version of a long-used narcotic, oxycodone.

By 2000, parts of the United States, particularly rural areas, began to see soaring rates of addiction and crime related to use of the drug.

At a news conference Thursday in Roanoke, Va., John L. Brownlee, the United States attorney for the Western District of Virginia, said the impact of Purdue’s marketing of OxyContin had resulted in rising crime rates, teenage drug addiction, deaths and other problems.

“The results of Purdue’s crimes were staggering,” he said.

In a statement, the company said the three executives were not aware of the wrongdoing by other company employees. Misdemeanor charges of “misbranding” can be brought against corporate executives even if they are unaware of such crimes. 

The three men — Michael Friedman, the president; Howard R. Udell, its top lawyer; and Dr. Paul D. Goldenheim, its former medical director — led Purdue at the time of the crimes.

The developments marked a sharp reversal for Purdue Pharma, a privately held company. Its executives had defeated hundreds of lawsuits from patients claiming that they became addicted to OxyContin. They also rebuffed critics, including some in Congress, who said that the company’s aggressive marketing of OxyContin may have spurred its abuse. 

The company’s defenders included the former New York mayor, Rudolph W. Giuliani, whose firm was hired in 2002 by Purdue Pharma as part of a crisis management strategy and to improve security at its manufacturing plant.

More recently, Mr. Giuliani, acting as a lawyer for Purdue, took part in several meetings last year between Justice Department officials and defense lawyers for the company and individual executives.

Melanie Hillis, a spokeswoman for the Bracewell & Giuliani law firm, which is based in Houston, said that Purdue Pharma was a client of the firm. She said Mr. Giuliani had not been involved in representing the company for several months. 

The company and the three executives pleaded guilty at a small courthouse in this small city at the edge of Appalachia, a region where OxyContin abuse became so widespread that the drug was dubbed “hillbilly heroin.” Mr. Brownlee and other prosecutors decided to investigate Purdue Pharma after bringing cases against drug addicts as well as local doctors accused of illegally prescribing the drug.

“I think we had a responsibility to bring cases against everyone who was making money,” Mr. Brownlee said.

The crimes to which the company and its executives pleaded guilty took place between late 1995, when the federal Food and Drug Administration approved OxyContin for sale, and mid-2001, when Purdue Pharma, facing public criticism and regulatory scrutiny, dropped all “reduced-risk” claims related to the drug.

During that period, OxyContin produced $2.8 billion in revenue for Purdue Pharma. 

Federal officials said that internal Purdue Pharma documents showed that company officers recognized that, even before the drug was marketed, they would face stiff resistance from doctors concerned about the potential of a narcotic like OxyContin to be abused by patients.

As a result, prosecutors charged, the company effectively started a fraudulent and deceptive marketing campaign aimed at convincing doctors that OxyContin, because of its time-release formula, was less prone to abuse, and that it was less likely to cause addiction or to produce other narcotic side effects than competing drugs. In its plea agreement, the company acknowledged doing so. 

“We accept responsibility for those past misstatements and regret they were made,” the company said. 

According to prosecutors, some Purdue Pharma supervisors and employees used fraudulent techniques to promote OxyContin to doctors.

For instance, when the painkiller was first approved, F.D.A. officials allowed Purdue Pharma to state the time-released nature of a narcotic like OxyContin “is believed to reduce” its potential to be abused. 

But some Purdue sales representatives falsely told doctors that the statement meant that OxyContin was less likely to lead to addiction or abuse than traditional, fast-acting painkillers like Percocet.

In addition, some company sales officials gave doctors misleading scientific charts to support such fraudulent claims. Also, Purdue Pharma trained its sales representatives on how to overcome concerns by doctors that OxyContin could be easily abused, according to the transcript of a training tape made for Purdue Pharma sales official that was released by Mr. Brownlee.

Purdue Pharma also knew, prosecutors charged, that large quantities of oxycodone could be easily extracted from OxyContin so the drug could be intravenously injected by drug addicts.

Of the $600 million in payments, Purdue Frederick will pay $470 million in fines and payments to a variety of federal and state agencies. 

It also agreed to pay at least $130 million to resolve civil lawsuits brought by pain patients who claimed they became addicted as a result of having OxyContin prescribed to them. A lawyer for one company executive said that much, if not all, those funds have been paid out in the process of settling lawsuits. There are still claims against the company by private plaintiffs.

This week, Purdue agreed to pay $19.5 million to 26 states and the District of Columbia to settle complaints that it encouraged physicians to overprescribe OxyContin.

Some drug industry critics said Thursday that while the fines sent an important message, the amounts were far too low, given the vast profits from OxyContin sales and the problems caused by the drug.

“The damage to the public from these white-collared drug pushers surely exceeds the collective damage done by traditional street drug pushers,” Dr. Sidney Wolfe, the director of the health research group at Public Citizen, an advocacy group in Washington, said.

Mr. Friedman, Purdue’s president, agreed to pay $19 million in fines; Mr. Udell, its lawyer, $8 million; and Dr. Goldenheim, $7.5 million. A Purdue Pharma spokesman said that Mr. Friedman planned to leave the company this year but that his departure was not related to his guilty plea.

Picture : Giuliani Partners in 2004, with Rudolph Giuliani at top center and Bernard B. Kerik, the former New York City police commissioner, on his right.

Credit..   Librado Romero/The New York Times

In western Virginia, far from the limelight, United States Attorney John L. Brownlee found himself on the telephone last year with a political and legal superstar, Rudolph W. Giuliani.

For years, Mr. Brownlee and his small team had been building a case that the maker of the painkiller OxyContin had misled the public when it claimed the drug was less prone to abuse than competing narcotics. The drug was believed to be a factor in hundreds of deaths involving its abuse.

Mr. Giuliani, celebrated for his stewardship of New York City after 9/11, soon told the prosecutors they were wrong.

In 2002, the drug maker, Purdue Pharma of Stamford, Conn., hired Mr. Giuliani and his consulting firm, Giuliani Partners, to help stem the controversy about OxyContin. Among Mr. Giuliani’s missions was the job of convincing public officials that they could trust Purdue because they could trust him. 

So it was no small success when, after the call, Mr. Brownlee did what many people might have done when confronted with such celebrity: He went out and bought a copy of Mr. Giuliani’s book, “Leadership.” 

“I wanted to be prepared for my meetings with him,” Mr. Brownlee said in a recent interview.

Over the past few weeks, Mr. Giuliani’s consulting business has received increasing scrutiny, at times forcing him to defend his business as he campaigns for the Republican presidential nomination.

But his work for Purdue, the company’s first and longest-running client, provides a window into how he used his standing as an eminent lawyer, a Republican insider and a national celebrity to aid a controversial client and build a business fortune. 

A former top federal prosecutor, Mr. Giuliani participated in two meetings between Purdue officials and the head of the Drug Enforcement Administration, the agency investigating the company. Giuliani Partners took on the job of monitoring security improvements at company facilities making OxyContin, an issue of concern to the D.E.A.

As a celebrity, Mr. Giuliani helped the company win several public relations battles, playing a role in an effort by Purdue to persuade an influential Pennsylvania congressman, Curt Weldon, not to blame it for OxyContin abuse.

Despite these efforts, Purdue suffered a crushing defeat in May at the hands of Mr. Brownlee when the company and three top executives pleaded guilty to criminal charges. 

Mr. Giuliani, who declined to discuss his work for Purdue for this article, has refused to talk in detail about his firm’s clients. He has said that he is no longer involved in the day-to-day management of the firm, which still represents Purdue.

Giuliani Partners would not say how much Purdue had paid it, but one consultant to the drug maker estimated that Mr. Giuliani’s firm had, in some years, earned several million dollars from the account. 

“Everything I did with Giuliani Partners has been totally legal, totally ethical,” Mr. Giuliani recently told The Associated Press. “There’s nothing for me to explain about it. We’ve acted honorably, decently.”

In the OxyContin case, Mr. Giuliani’s supporters suggest that as a cancer survivor himself, he was driven by a noble goal: to keep the company’s proven pain reliever available to the widest circle of sufferers. 

“I understand the pain and distress that accompanies illness,” Mr. Giuliani said at the time. “I know that proper medications are necessary for people to treat their sickness and improve their quality of life.”

To drive OxyContin’s sales, Purdue, beginning in 1996, set in motion what D.E.A. officials described as perhaps the most aggressive promotional campaign for a high-powered narcotic ever undertaken. It promoted the drug not only to pain specialists, but to family doctors with little experience in treating serious pain or recognizing drug abuse. 

As a result of the expanded access, critics charged, OxyContin wound up in the high schools and street corners of rural America where curious teenagers crushed the pill, defeating the time-release formula, and ended up addicts, or in some cases, dead.

Dennis Lee, the Virginia state prosecutor for Tazewell County, an area hard hit by OxyContin abuse, said he was stunned several years ago to learn that Mr. Giuliani was working for Purdue. He had a favorable impression of Mr. Giuliani, he said, and a poor opinion of the company, which he said had played down and dissembled about its drug’s problem.

“I was shocked,” Mr. Lee said, “that he would basically become a mouthpiece for Purdue.”

Denials and Lobbying

Giuliani Partners served clients with a range of needs. The firm helped large accounting firms fight computer hackers and promoted Nextel’s efforts to expand its access to public airwaves. But some of the 55-person firm’s clients, like Purdue Pharma, were facing more difficult legal and public relations problems. 

There were, for instance, the backers of a planned natural gas terminal in Long Island Sound who were facing stiff environmental opposition. Another client was a former cocaine smuggler hoping to win federal contracts for a computer system to track down terrorists. 

On the business of these clients and others, Giuliani Partners carved out a lucrative niche in corporate consulting, crisis management and security. 

In the process, Mr. Giuliani, a Brooklyn native whose legal career had largely been spent in government, became a corporate trouble-shooter with homes in the Hamptons and on the Upper East Side. According to financial disclosure forms filed in May, his net worth was more than $30 million.

The crisis that brought Purdue to Mr. Giuliani in 2002 involved OxyContin, a time-released form of the narcotic oxycodone, which had turned into a blockbuster product with annual sales of more than $1 billion. 

But along the way, the pain medication had also become a popular drug for abuse. Among the company’s critics were officials at the Drug Enforcement Administration who said OxyContin had been a factor in hundreds of overdose deaths. Some D.E.A. officials and others also charged that Purdue had hyped the drug’s resistance to abuse and then failed to act swiftly when its misuse became apparent. 

Purdue Pharma, which is owned by the Sacklers, a New York-area family who are known as museum benefactors, denied it had done anything wrong. But facing a growing number of investigations and lawsuits, it spent millions on public relations experts, lobbyists and top-tier law firms.

One piece, however, was missing: a highly credible and well-connected political figure to serve as its point man. Purdue Pharma executives saw Mr. Giuliani as that person, said a former company spokesman.

“He was just on the cover of Time Magazine, Man of the Year,” that former official, Robin Hogen, said. “Everyone was talking about his extraordinary leadership in 9/11.”

Giuliani Partners became involved in every aspect of the company’s problems, from the ballooning investigation by Mr. Brownlee to repairing its battered image. Mr. Giuliani personally took on some tasks, but a half-dozen members of his firm, including Bernard B. Kerik, the former New York City police commissioner, were also involved.

Mr. Giuliani’s most important liaison to the company was Daniel S. Connolly, who had been a top lawyer in his administration. He spent so much time at Purdue that he was issued a security pass.

“His judgment was always sought on almost any topic,” said Mr. Hogen, who now works for a public relations agency in San Francisco.

Mr. Connolly regularly attended Monday morning crisis management sessions to develop programs that would shift the public spotlight away from OxyContin. The issue, the company said, was not its conduct but the larger question of prescription drug abuse. 

To help draw attention to that issue, Mr. Giuliani became the public face of a program called Rx Action Alliance, a consortium of drug makers, physicians and law enforcement authorities working to curtail such abuse.

“He was America’s mayor,” Mr. Hogen said of Mr. Giuliani’s role as a catalyst for the company’s efforts. “People were drawn to him.”

One person attracted by Mr. Giuliani’s star power was Mr. Weldon, who was upset because young people in his Pennsylvania district were abusing OxyContin. Mr. Weldon, who lost his seat in 2006, said in a recent interview that he had told the company he planned to publicly speak out against it.

“This is really kind of outrageous,” Mr. Weldon recalled telling a Purdue representative. “You have got to do something more than say you are concerned about it.”

At Mr. Weldon’s urging, the company agreed to finance a program aimed at curbing prescription drug abuse. It also sent Mr. Giuliani to an inaugural press conference for the program, held at a high school in Mr. Weldon’s district. With Mr. Giuliani at his side, Mr. Weldon opted not to criticize the company.

“I am proud to be in Pennsylvania today standing with Curt Weldon — a true leader,” Mr. Giuliani said at the event. “I applaud the efforts of Congressman Weldon and of Purdue Pharma in taking this battle in the right direction.”

Credit for Damage Control

Asa Hutchinson, the director of the Drug Enforcement Administration in 2002, hardly needed an introduction to Mr. Giuliani. So it was perhaps not surprising that Purdue chose Mr. Giuliani as the person to meet with Mr. Hutchinson at a time when the drug maker was under intense scrutiny by the D.E.A. 

“You need to have somebody who has clout to get in the door to legitimately make your presentation,” said Jay P. McCloskey, a former United States attorney in Maine who until recently worked for Purdue as a consultant.

By 2002, Mr. Giuliani was already helping to raise money for a D.E.A. museum, and his firm was part of a $1 million Justice Department consulting contract to advise it on reorganizing its major drug investigations.

The D.E.A. was not only critical of how OxyContin had been marketed, its inspectors had found widespread security and record-keeping problems at the company’s manufacturing plants. 

Several top D.E.A. staffers were recommending that the agency impose severe sanctions against the drug maker, including possible restrictions on how much OxyContin it could make.

At two meetings, the first at Giuliani Partners in early 2002, Mr. Giuliani and Purdue’s executives argued that they were already taking steps to eliminate any problems.

Mr. Kerik had been sent to Purdue’s manufacturing plants to revamp internal security, they assured Mr. Hutchinson. The federal investigators, they argued, should back down and give them a chance to prove they could handle the problem on their own.

After the meetings, Mr. Hutchinson, who generally did not get involved in individual investigations, asked D.E.A. officials several times to brief him on the inquiry, Laura Nagel, the official in charge of it, has said in previous interviews. She declined to comment for this article. 

D.E.A. officials say Mr. Giuliani ultimately did not affect the inquiry’s course. But Purdue Pharma did succeed in favorably resolving the matter. In 2004, it paid a $2 million fine to settle the D.E.A. record-keeping charges without admitting any wrongdoing. The sum was far smaller than the amount first recommended by Ms. Nagel, which one former D.E.A. official said was $20 million.

By the time of the 2004 settlement, it appeared that Purdue, with Mr. Giuliani’s help, had averted any significant damage. As the tide was turning, the drug maker’s top lawyer, Howard R. Udell, gave credit to Mr. Giuliani.

“We believe that government officials are more comfortable knowing that Giuliani is advising Purdue Pharma,” Mr. Udell said in a promotional brochure put out by Giuliani Partners. “It is clear to us, and we hope it is clear to the government, that Giuliani would not take an assignment with a company that he felt was acting in an improper way.” 

Parents Not Persuaded

The limits of stature, though, were evident in Mr. Giuliani’s dealings with Mr. Brownlee, the federal prosecutor from Virginia, whose case against Purdue had been viewed by the company more as a nuisance than a threat.

It is easy to see how lawyers for Purdue might have underestimated the prosecutor. He ran a small office with 24 lawyers to cover 52 far-flung counties. But two of those lawyers, working out of a satellite office in the tiny town of Abingdon, Va., near the Tennessee border, had been investigating Purdue since 2002. 

They had issued some 600 separate subpoenas and collected millions of company documents. The case stretched the office’s resources so thin that state prosecutors had to be deputized to handle other federal cases. 

By comparison, Purdue’s defense team comprised all-stars, including Mr. Giuliani, Mr. Connolly and Mary Jo White, a former United States attorney in New York.

Mr. Giuliani had been advising Purdue about how to respond to Mr. Brownlee’s inquiry since its start in 2002, including reviewing documents the company had released in response to his subpoenas. And he shared the defense team’s view that Mr. Brownlee did not have any evidence to link the company to crimes, several of those lawyers said.

Early last year, however, Mr. Brownlee told Purdue that he was prepared to indict it and three top executives, including Mr. Udell, the lawyer. The company then handed Mr. Giuliani his most crucial assignment, to talk Mr. Brownlee down. 

His selection was not by chance, company representatives said. They figured Mr. Brownlee, a younger federal prosecutor, would look up to Mr. Giuliani, who became a legend as a United States attorney in New York.

Between June and October 2006, Mr. Giuliani met or spoke with the prosecutor on six occasions. During those conversations, Mr. Giuliani was cordial but pointed in arguing against what he felt were flaws in the case.

Mr. Brownlee would not change course, though, even when the Purdue legal team appealed, unsuccessfully, at the 11th hour to his superiors at the Justice Department in Washington.

In October 2006, Mr. Brownlee told Mr. Giuliani and Purdue that he expected to ask for a grand jury indictment by the end of the month. Plea discussions ensued and Mr. Brownlee ultimately agreed that the three executives would not have to do jail time. 

By this time, Mr. Giuliani was actively planning his presidential bid, as well as tending to other clients. On the day the legal team completed the plea deals with Mr. Brownlee, Mr. Giuliani was in Germany, giving a talk to business leaders.

He had a conference call with prosecutors for about a minute, but there really was not much left to discuss, except the weather.

“He said that it was raining,” Mr. Brownlee recalled.

In May, Purdue and its executives, after spending tens of millions of dollars to repair the company’s image, agreed to plea deals to avoid a trial. Together, they paid $634.5 million in fines and payments.

After years of denial and a high-profile public relations campaign, the company was forced to admit that it had misled doctors and patients. But to the parents of young people who had died getting high on OxyContin, the absence of jail time was evidence of Mr. Giuliani’s influence.

They voiced that view inside and outside the packed courtroom in Abingdon where the men were sentenced in July.

Mr. Giuliani was 360 miles away at the time, campaigning in Myrtle Beach, S.C., where he met with local firefighters and talked about 9/11. But his role in the case had been so substantial and sustained, the presiding judge felt compelled to address the parents’ concerns.

“It has been implied that because Mr. Giuliani is a prominent national politician, Purdue may have received a favorable deal from the government solely because of politics,” said the judge, James P. Jones of United States District Court. “I completely reject this claim.” 

Even today, some of those parents are not persuaded. Ed Bisch, whose son died of an OxyContin overdose, said that he believed that Purdue got a free pass for years thanks to Mr. Giuliani.

“It was all because of Giuliani,” said Mr. Bisch. “And he got to take the money.”

In the most recent installment of our series, “The Long Run,” about life-changing events in the individual lives of the presidential candidates, Barry Meier and Eric Lipton wrote of Rudolph W. Giuliani’s involvement in the battle between the government and the makers of OxyContin. To recap, Giuliani Partners, and in particular, Mr. Giuliani, were engaged in helping Purdue Pharma, the drug’s manufacturer, deal with controversy over OxyContin’s side effects, including deaths. 

Mr. Giuliani, the former New York mayor, has just asserted that he had nothing to be embarrassed about over his firm’s dealings with Purdue. And his Republican rival Fred Thompson, who has himself faced questions about clients from his law-lobbying career, declined to criticize Mr. Giuliani over the issue.

“Well, what we did for them was more effective safety and security in dealing with their product so it wouldn’t be tampered with, it wouldn’t be taken, it wouldn’t be misused and many other things that I believe helped and improved the situation,” Mr. Giuliani said in an interview with CNBC television. “And the work was done very honorably, very well and I think it was positive work. When you’re in private law practice, private security practice, you represent a lot of people and you help them with your problems as best you can. The question is do you do it ethically, do you do it well, and there’s no question that that was the case in this situation as with the others.

“I think actually it was a positive role that my company and my law firm played because that’s what security companies do. They help in situations where there are issues and they help their clients. And they did that honorably and they did it well.”

Asked about the matter in a separate interview, Mr. Thompson displayed the forbearance of one who has been there. “Obviously, someone representing a client should not be held to everything that client has ever done if they didn’t know about it,” Thompson told CNBC. “But we’re all subject to that scrutiny nowadays because of what we’re involved in. So I’m sure the facts
will come out as to what they are and we’ll see then, but until then, I’m not in a position to comment on it.” 

For years, Purdue Pharma has maintained that it can’t be blamed for the overdose crisis that unfolded after its introduction of OxyContin—but a trove of new evidence suggests that the company was instrumental in laying the groundwork for the opioid epidemic.

As early as 2000, Purdue collaborated with pain patient advocacy groups and professional pain management organizations to create what former president Richard Sackler called a “pain movement.” The company also allegedly worked with competitor and opioid maker Johnson &  Johnson, which was recently found liable for contributing to the opioid crisis in Oklahoma, in an effort to create a “pain management franchise.” In addition, company executives appear to have met with the Robert Wood Johnson Foundation to discuss possible collaborations.

These revelations come from new exhibits in the federal litigation bundling roughly 2,000 cases against opioid makers and distributors that is set to go to trial in October. The plaintiffs allege that the pharmaceutical companies worked together in a conspiracy to sell more opioids, an allegation that the defendants vigorously deny. Under the terms of a recently-leaked settlement proposal, Purdue and its owners, the Sackler family, may soon settle all the claims brought against the company by thousands of state and federal lawsuits.

Here are some highlights from the recently unsealed exhibits:

“They are going to have to learn to live with ‘industry’ reps on their board”

In order to promote opioids, pharmaceutical companies funded a number of professional and patient advocacy organizations to serve as “front groups,” according to the plaintiffs, including the now defunct American Pain Foundation and the American Pain Society. Some of the groups went on to issue guidelines minimizing the risks of opioid addiction, lobby to change laws aimed at curbing opioid abuse, and protect doctors sued for overprescribing painkillers, according to an investigation by former Missouri Sen. Claire McCaskill (D).

The new exhibits suggest Purdue’s motives in collaborating with these organizations. In a 2001 email conversation with colleagues about meeting with patient advocacy groups, Purdue president Richard Sackler wrote, “Our goal is to bind these organizations more closely to us than heretofore, but also to align them with our expanded mission and to see that the fate of our product(s) are inextricably bound up with the trajectory of the pain movement.”

Purdue executive Robin Hogen allegedly stated in a 2000 memo that if the American Pain Society “want our bucks (and they honestly cannot survive without industry support) they are going to have to learn to live with ‘industry’ reps on their board. I don’t think they can expect huge grants without some say in governance.” (Hogen said that the memo showed “some naiveté on my part and a little bravado…from a new employee.” He added that Purdue did not heed his advice, and, in an email to Mother Jones, Purdue denied controlling the organizations it sponsored. The American Pain Society filed for bankruptcy in July.)

Collaborating with Johnson & Johnson to create a “Pain Management Franchise”

According to the court documents, as early as 2000, Purdue began working with Johnson & Johnson, whose pharmaceutical subsidiaries sold opioids Duragesic and Ultram, on a “co-promotion agreement” in which sales representatives would promote both companies’ opioid products. The ultimate goal, according to a J&J presentation, was to “Build a partnership between Purdue Pharma LP and J&J that leverages each partner’s assets and capabilities to create a Pain Management Franchise that is significantly larger and more profitable than that which the partners could build on their own.”

The co-promotion agreement never came to fruition, but evidence suggests that the companies instructed their sales representatives not to attack the others’ brands. In 2001, after an executive from J&J subsidiary Janssen complained that Purdue’s sales representatives were telling doctors about the abuse of Janssen’s opioid, Duragesic, a Purdue executive instructed Purdue’s sales force not to discuss abuse and diversion of OxyContin or Duragesic. If they did, the letter stated, there would be consequences: “Janssen Pharmaceuticals and Purdue have agreed that should either company have representatives who promote product out of label or out of policy, the name of the representative will be provided to the other company for investigation and disciplinary action if needed.”

A J&J spokesman told Mother Jones, “Janssen and Purdue were and remained competitors.”

“It would be much better if the advocacy came from outside of the drug company”

In 2001, shortly after the first media reports of widespread abuse of OxyContin, Dr. [Kathleen M. Foley (born 1944)], a neurologist at Memorial Sloan Kettering Cancer Center in New York and a former paid speaker for Purdue, emailed Richard Sackler urging the company to collaborate with other pharmaceutical companies. “I’m thinking of an alternative strategy of bringing together all of the members of the pharmaceutical industry, who have analgesic drugs out there and try to come together as a sort of cohesive voice recognizing that your particular drug has been recently identified in the newspapers as a drug issue,” she wrote. “I think that there is a tightrope that you need to walk, because you are a drug company and it would be much better if the advocacy came from outside of the drug company and even better without much in the way of support from you.” 

In 2005, Purdue lobbyist Burt Rosen allegedly organized the Pain Care Forum. Purdue, J&J, and the American Pain Foundation were among the group’s early participants, but, according to court documents, the forum soon included virtually every major opioid maker and distributor. “I think this could fill the vacuum of leadership in the community at large, and provide for some unified direction on issues of importance to the pain community,” Rosen allegedly said. The forum—which has no public website, meeting notes, or member list—served as a platform for industry to discuss issues related to opioid supply and coordinate media and policy campaigns. 

When the CDC proposed guidelines urging doctors to limit opioid prescribing, the group mounted a coordinated, seemingly-grassroots effort to criticize the guidelines using “media efforts and recruiting patients and provider experts,” according to court documents. Though Rosen denied that the forum itself hires lobbyists, the forum’s members allegedly spent nearly $900 million to influence government between 2006 and 2015.

Purdue’s Work with the Robert Wood Johnson Foundation

Among the unsealed exhibits is a memo submitted by Purdue’s Robin Hogen describing a July 2000 meeting between Purdue executives and Robert Wood Johnson Foundation president Dr. Steve Schroeder. The foundation, started by and named after J&J’s former leader, is the nation’s largest philanthropic organization focused solely on public health. At the time, about 60 percent of the foundation’s holdings were in J&J stock.

Hogen wrote,

• They were impressed with the scope of our programs and invited Purdue to join the national coalition they are forming to improve care and caring at the end of life (called the Last Acts Partnership). We would be the only for-profit company in that category. Dr. Steve Schroeder, President of the RWJ Foundation, indicated that they rarely sit down with pharmaceutical companies to discuss areas of mutual interest. He was impressed when we described the unbranded, non-promotional aspect of our speakers bureaus and symposia and seemed quite interested in keeping the lines of communications open for possible future partnerships.”

The memo notes that “areas of possible future collaboration” include setting up “Purdue Faculty Fellowships,” “help in identifying pain management advocates,” and “sponsorship of a session on pain management” at an annual foundation meeting. The memo ended, “I believe this is a relationship that could yield many happy returns to both Purdue and RWJ.”

Hogen, who later worked in communications for Yale and the RWJ Foundation, told Mother Jones that the meeting was part of a company effort to reach out to organizations “who shared our interest in treating chronic pain patients humanely.” 

None of the collaborations mentioned in the memo came to be; the foundation “subsequently declined opportunities to collaborate with Purdue on programs related to pain assessment and pain management,” according to RWJ spokesman Jordan Reese. “We are working alongside others—and across disciplines—to address the many factors that lead to addiction, as well as to advance policies and practices that will prevent another such crisis from occurring,” he said. Today, about 15 percent of the foundation’s holdings are in J&J stock.

“Make the whole pie bigger, not only for us but for our competition as well”

In 2000, Purdue held a sales meeting in Palm Beach, at which an executive named Mark gave a speech welcoming the sales representatives. Below is part of Mark’s script, included in the unsealed exhibits:

• (MARK SHOULD ENTER WEARING SUNGLASSES)

• … You know, it’s always hot here in Palm Springs. That’s why it’s a perfect place to have our meeting … because we’re hot … we’re burning up the competition with our sales of OxyContin! Do you know it’s now the number one prescribed opioid brand in the U.S.?

“Now, you’re probably wondering what else can be done to sell even more OxyContin,” Mark went on. “There are also some things we’re cooking up for the coming year to help you and OxyContin and the whole pain market as well.” These initiatives allegedly included collaborating with the American Pain Society to develop materials that would “be distributed to hospitals across the country” and “weekly feature stories about pain and its management in newspapers.” The goal, said Mark, is to “raise awareness of undertreated pain” and to “Make the whole pie bigger, not only for us but for our competition as well.”

Mark concluded,

• • • I hope you enjoy your stay here in Palm Springs, I know I will. Enjoy the weather … because let me tell you, OxyContin’s continuing success, is going to make every part of this country from Seattle to Detroit to New Orleans as hot as it is here in Palm Springs this winter for every one of you. You are the force for the future … let’s make it happen! (PLAY SONG HOT, HOT, HOT)

• This article has been updated.