TAMPA — Frank Culpepper used to crush oxycodone tablets into a fine powder that he would snort so he'd get high faster than he could by swallowing the pills.
Then a friend showed him how to inject the narcotic painkiller directly into his bloodstream for a high that was still quicker, stronger — and more dangerous.
Injecting the drug landed the Temple Terrace man in a hospital emergency room in July with a heart infection that nearly killed him.
"I'm lucky to be alive," Culpepper, 24, said last week at Pepin Heart Hospital, where he underwent open-heart surgery to replace a valve that was on the verge of rupturing.
Cardiologist Asad Sawar said Culpepper is one of six patients in the past six months at the hospital who developed a heart infection known as endocarditis from injecting oxycodone. All were men in their late teens to early 30s. Four of them died.
State reports estimate that prescription drug abuse kills an average of almost eight people a day in Florida. They do not quantify how many of these deaths are due to crushing and injecting drugs, though the practice has been reported for years among addicts.
Law enforcement officers see the trend on the streets, where they report that more abusers are carrying syringes. It's so rampant that pharmaceutical companies have been developing tamper-proof oxycodone pills that lose their potency if they are crushed in order to be chewed, snorted or injected — all efforts to defeat the pills' time-release formulations.
"It's the mentality of the addicts, always seeking the bigger high, the quicker high," said Capt. Robert Alfonso, who heads the narcotics division of the Pinellas County Sheriff's Office. "We're not surprised any more by what we see."
Oxycodone is a synthetic opiate that is supposed to be taken orally for the relief of severe pain. The time-release tablet dissolves slowly so that the drug is absorbed in small amounts over a 12-hour period.
But habitual users develop a resistance to it over time, and require more of the drug to achieve the same effect. Addicts can't wait for the pills' gradual impact, so they chew, snort or inject it.
All of these methods are dangerous, and heighten the risk of overdose, but injecting poses additional health risks, including serious infections. Even if users manage to crush and dissolve pills under entirely sanitary conditions, Sawar said, pills contain starch, which if injected directly into the bloodstream can inflame the veins and infect just about any part of the body, including the brain, lungs and heart.
Manufacturers of brand-name versions of oxycodone have developed pills with an additive that turns the drug into a gel that can't be injected if water is added to a crushed pill. But the generic form of oxycodone isn't tamper proof.
Culpepper was 18 when he started crushing oxycodone pills and snorting them. Within a few years, he was crushing pills, adding water and filtering the result through a piece of cotton into a syringe.
"It's all you think about. It's all you want to do," said Culpepper, who is on probation for theft and drug-related offenses.
In early July, he developed a fever that worsened over several days. He called 911 and was taken to University Community Hospital, where tests revealed he had endocarditis.
In early stages, the condition usually can be treated with antibiotics. But Sawar said a tumor-like growth had developed on one of Culpepper's heart valves and was about to rupture. An open-heart procedure was performed at adjacent Pepin Heart Hospital to replace the valve.
Sawar said Culpepper's prognosis is good, providing he attends follow-up appointments, eats a healthy diet, exercises and — most importantly — stays away from drugs.
Culpepper said the experience has been a wake-up call. He says he hasn't taken drugs since July and has attended Alcoholics Anonymous and Narcotics Anonymous meetings. He also hasn't seen many of the people with whom he used to do drugs.
"You realize who your true friends are," he said.
Culpepper wants to pursue the goals he had before his addiction. He wants to become a veterinarian or pursue some other medical field.
Sawar called Culpepper a success story, but lamented the four young men who died.
"You're seeing these young kids with promising futures being led astray," he said. "It breaks your heart."
Times researchers Caryn Baird and Natalie Watson contributed to this report. Richard Martin can be reached at firstname.lastname@example.org or (813) 226-3322.