Pubdate: Tue, 26 Mar 2002
Source: Christian Science Monitor (US)
Copyright: 2002 The Christian Science Publishing Society
Contact:  http://www.csmonitor.com/
Details: http://www.mapinc.org/media/83
Author: Patrik Jonsson
Note: Special To The Christian Science Monitor

DOCTORS UNDER SCRUTINY AS PAINKILLER ABUSE RISES

A North Carolina Doctor Is The Latest To Be Held Accountable For 
Overprescribing Narcotics.

RALEIGH, N.C. - Broad jowls and wisps of white hair only accent Joseph 
Talley's visage as a gentle country doctor, a soft-spoken man who soothes 
folks in need.

In fact, by handing out large quantities of painkillers to his patients, 
Dr. Talley claims that he was only doing what he was trained to do - 
helping people suffering from painful ailments.

But authorities say that Talley's over-the-phone prescriptions of OxyContin 
and other painkillers from his Grover, N.C. office, went too far. He was 
giving over-the-counter drugs to patients as far away as Oklahoma, earning 
him a reputation as a Mayberry-esque "Dr. Feelgood."

Last week, the North Carolina State Medical Board deemed Talley's behavior 
"unprofessional" and, as a result, is likely to yank his medical license. 
The Drug Enforcement Administration (DEA) is on his trail, too: Agents say 
that 23 people whose deaths may be due to overdoses had ties to him, though 
no criminal charges have yet been filed.

The Talley case is the latest attempt by authorities to crack down on what 
they believe is a growing nationwide problem of overprescribing painkillers.

Only six years ago, medical regulators began assuring doctors that they 
would not be prosecuted for liberally prescribing medicines like OxyContin, 
Percocet, and Codeine, as long as the treatments were closely monitored.

But today the National Institute on Drug Abuse estimates that 4 million 
Americans are using painkillers simply to get intoxicated. Consequently, 
both medical boards and drug-enforcement agencies are closely monitoring 
doctors' prescription records.

In turn, more doctors are staying their prescription pens, afraid that they 
might be perceived as contributing to the "drugging of America."

The result is a budding debate over the fundamental role of doctors and the 
degree to which Americans should and shouldn't be using painkillers.

"I don't think there are a lot of doctors out there going out of their way 
to intoxicate people," says Dr. Barry Cole, a policy expert at the American 
Association of Pain Management in Sonora, Calif. "But today, it's easier 
for physicians to say, 'I'm going to get in trouble if I write too much.' 
These cases are scaring off good doctors."

Investigators say doctors can bear responsibility when people overdose, 
especially if patients aren't diagnosed or monitored correctly. The AG's 
office is not commenting on the Talley case, but Chris Brewer, a Medicaid 
investigator at the North Carolina Attorney General's Office, confirms that 
authorities across the US have stepped up investigations.

On Friday, Florida doctor James Graves was sentenced to 63 years in jail 
after four people overdosed on his perscriptions. Some of his OxyContin 
prescriptions also ended up being sold illegally on the street. Last year, 
a doctor in Virginia lost his license for prescribing too much Oxycontin - 
and, in Utah, a similar punishment was meted out to a doctor after he was 
tied to the overdose deaths of five people.

According to testimony to the North Carolina Medical Board on Friday, many 
of Dr. Talley's patients were drug addicts. One of them has relied on his 
prescriptions for 16 years. She would call him up and beg to be taken off 
the drugs, only to call back five minutes later, pleading for him to 
prescribe more or she'd "commit suicide."

"That favor will be granted with enthusiasm by me, despite my skepticism," 
Dr. Talley wrote in his notes.

After a two-day hearing that ended Friday, the North Carolina Medical Board 
agreed that Talley didn't examine patients closely enough, and seemed to 
just take them at their word. "Pain management needs to be thought of as 
not just covering it up with medications," says Dr. Richard Rauck, a 
Winston-Salem, N.C., specialist. "In this case, adherence to control was 
woefully absent."

In the past two years, 171 Americans have died from prescription overdoses, 
the majority using self-administered doses.

Talley and others argue that it's not a doctor's fault if a patient dies, 
knowing the risks of overuse. "It makes no sense that we should establish a 
public policy based on trying to prevent drug addicts from killing 
themselves, and make it so people who need narcotics for legitimate 
purposes can't get [them]," says Dr. C. Stratton Hill, a pain-management 
expert at the University of Texas at Houston.

Dr. Talley, his supporters say, may have made mistakes, but they say that 
many of his patients couldn't afford, or didn't have access to, 
alternatives such as surgery. Talley used his intuition, according to 
testimony, to gauge the patient's problems, rather than ordering extensive, 
and expensive, tests.

"He may have gotten drawn into just the way some patients will take 
advantage of a compassionate person, a man who's a little too easy," says 
Dr. Cole.

Others worry that further prosecutions of doctors may make some medical 
practitioners skittish about prescribing certain kinds of drugs.

"The situation is stacked against the doctor," says Dr. Hill. "Now, that 
doctor is going to say, 'Ma'am, you need pain medicine. The DEA's office is 
down on 6th street. Go down there and work it out with them.' "
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