Doctor-governor Howard Dean moved decisively last week to curb abuse of the powerful painkiller OxyContin, but the steps he took are only the beginning of what's needed.

Dean imposed a requirement that the state review and approve, in advance, all OxyContin prescriptions written for the 128,000 patients covered by Medicaid and the Vermont Health Access Program. The state spends more than $1 million a year on OxyContin prescribed to about 1,200 of those patients.

Dean's was a drastic step, but one fully justified by the drug's dangers.

OxyContin, properly prescribed and taken, can transform the lives of people suffering severe pain from cancer, back problems or other disabilities, but the drug can destroy lives as well as improve them. Abuse of OxyContin has devastated rural communities in places like Maine and West Virginia where it turns recreational drug users into addicts.

The pill is a synthetic opiate that slowly releases its morphine-like pain relief into the patient's bloodstream. Drug abusers crush the pill to destroy the time-released mechanism, then snort or inject the powder for a heroin high. Casual experimenters soon find themselves grabbed by a powerful addiction.

Ten years ago, OxyContin didn't exist. Now the drug is the 18th best-selling prescription drug in the country and generates $1.1 billion a year for Purdue Pharma, its manufacturer. Vermont ranks 14th in the nation for consumption of oxycodone, the active ingredient of OxyContin.

On the street, addicts will pay $20 to $40 for a $4 pill. The illegal street supply comes from pharmacy hold-ups, prescription fraud and poor, legitimate patients who sell their pills to pay other bills.

OxyContin abuse occurs in Vermont, but hasn't reached epidemic levels. All the more reason to take preventive steps such as prior approval of prescriptions.

That review won't suffice, though. Government, doctors and pharmacists should be discussing further actions, including physician and patient education.

State lawmakers can help by passing a prescription monitoring law, now in draft form, that would allow Vermont to track every prescription for a controlled drug dispensed by pharmacies. That would allow the state to spot patterns; one patient filling the same prescription at 10 pharmacies, for example, that would reveal abuse.

Like so many marvels of 20th-century science, OxyContin hides the potential to destroy beneath its promise of potent benefits. Government's challenge is to balance the two, as Dean's prior-approval order does.