Pubdate: Tue, 05 Jul 2005
Source: Advocate, The (LA)
Copyright: 2005 The Advocate, Capital City Press
Contact: http://www.2theadvocate.com/help/letter2editor.shtml
Website: http://www.theadvocate.com/
Details: http://www.mapinc.org/media/2
Author: Penny Brown Roberts, staff writer
Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone)

PRESCRIPTIONS FOR PAIN GET CLOSER SCRUTINY IN LOUISIANA

Prescriptions for pain pills -- and the doctors who issue them -- are
getting closer scrutiny in Louisiana.

Just weeks after one Baton Rouge physician admitted writing illegal
prescriptions and another was arrested, federal and local
law-enforcement authorities say they are investigating more such cases
in the community.

At the same time, state regulatory agencies are developing a database
to track prescriptions -- making it easier to investigate physicians
and identify patients who may be "doctor shopping," or getting
medicine from multiple physicians and pharmacies.

And next month, a new law sets criminal penalties for any doctor,
nurse or other health-care provider who writes a fake prescription or
helps someone get one.

"It's been troubling issue in health care for a number of years and it
seems to be getting worse," said F. Lamar Pritchard, dean of the
University of Louisiana at Monroe School of Pharmacy. "A lot of
legitimate physicians may be skeptical of this and feel like Big
Brother is now watching, but that's not the intent at all. The intent
is to move illegal drugs off the street."

The crackdown comes as narcotic prescriptions have reached an all-time
high in Louisiana. U.S. Department of Justice retail drug distribution
reports show, for example, sales of 219,472 grams of the popular
painkiller hydrocodone for all of 1997, compared to 343,057 grams in
just the first six months of 2004.

The state Board of Medical Examiners has found that Louisiana
physicians prescribed drugs without medical justification -- sometimes
to themselves -- 237 times since 1984.

Among the most recent cases:

. Last month, Baton Rouge family physician Dr. Mark Cotter admitted
prescribing Adderall to a female patient who met him for dinner and
visited him in his home on at least three occasions because he was "so
fond of her." Cotter, who ran the Wellness and Rejuvenation Clinic at
5215 Essen Lane, pleaded guilty to unlawfully dispensing that drug --
routinely prescribed for hyperactivity and attention deficit disorder
- -- as well as cocaine distribution and possession of marijuana,
methadone and hydrocodone. He is scheduled for sentencing next month
before U.S. District Judge James Brady.

. In May, Baton Rouge Police retrieved Mary Kathleen Crossley Miller
from the Jefferson Parish Prison to book her with dispensing
controlled substances without a license. The Hammond doctor
surrendered her license after Tangipahoa Parish deputies arrested her
upon discovering 21 emaciated and sick cats in a hotel room she booked
and another 19 of them in a trailer on her property. However, warrants
filed in state District Court in Baton Rouge allege she was running a
clinic here called Comprehensive Medical Solutions at 11853 Bricksome
Ave., and prescribed Roxicodone, a pain medication, to at least one
patient just days after she surrendered her license.

. In April, federal agents raided three Scherer's Medical Center
cash-only clinics and four pharmacies in the New Orleans area,
arresting three doctors and a nurse and seizing $10 million in assets.
A criminal complaint filed in the case claims some patient visits
lasted only 11 seconds and routinely resulted in the same prescribed
regimen of hydrocodone, the anxiety reducer alprazolam and the muscle
relaxer carisoprodol. Authorities contend it's a combination street
users dub "the holy trinity."

Both U.S. Drug Enforcement Administration Diversion Program Manager
Donald Hickman of New Orleans and Baton Rouge Police Department
spokesman Sgt. Don Kelly said authorities are investigating additional
illegal prescription cases in Baton Rouge, but declined to elaborate.

"We are likely to see more of these kinds of cases -- primarily
because of the increase in the number of offenses being committed.
Much of that is due to the widespread availability of illicit
pharmaceutical medications, especially via the Internet," Kelly said.
"Obviously, law enforcement tries to react quickly to whatever the
current 'hot' activity is, so our diversion efforts have increased as
the popularity of the crime has grown."

Eye on drugs

But police aren't the only ones with a suspicious eye on prescription
narcotics.

A committee of representatives from state regulatory agencies, law
enforcement and medical associations is developing a program for
monitoring prescriptions in Louisiana. The measure will be introduced
in the Legislature next spring.

Louisiana Board of Pharmacy Executive Director Malcolm Broussard said
the database will record transactions involving certain controlled
substances except those dispensed in hospitals. The data will be
stored on secure computers, but accessed by regulatory agencies,
doctors and pharmacists, law enforcement and substance-abuse treatment
professionals to spot illegal or unethical activity.

"There's been a tremendous increase in the utilization of controlled
substances, and some people have suspicions that not all of that
activity is for legitimate medical purposes," Broussard said. "These
products are safe when used properly, but there are some prescribers
who have misused those products."

Twenty-five other states, including Alabama and Texas, have mandated
prescription monitoring programs. The average start-up cost is $350,000.

State legislators also took steps this year to rein in illegal
prescriptions. Gov. Kathleen Blanco signed a bill by Rep. Pete
Schneider, R-Slidell, making it a crime for a doctor, nurse or other
health-care provider to knowingly write fake prescriptions or allow a
patient to get one through fraudulent means.

The law, which goes into effect Aug. 15, shuts down clinics that do
so, sending violators to jail for up to five years and fining them up
to $5,000.

Even local authorities are taking up the issue. City councils in Baker
and Slidell and parish councils in St. Tammany and Tangipahoa are
considering or have approved bans on pain-management clinics in recent
months.

Although doctors always have been subject to oversight, the recent
onslaught of arrests and new laws has many of them taking a closer
look at their prescription practices, said Louisiana Board of Medical
Examiners Executive Assistant Rita Arceneaux.

"There seems to be a misconception that physicians who treat for pain
may be bad doctors," she said. "But there are more good doctors
treating legitimate pain than bad doctors treating illegitimate pain.

"There is increased concern among good physicians about what might
happen to them," Arceneaux added. "They're now questioning what
they're doing, making sure they're following proper procedures and
requesting a copy of our pain rules. Before, they would just use their
own judgment to make sure they were following guidelines."

Making cases

Despite the latest legal measures targeting illegal prescriptions,
those who investigate such cases contend getting them to court is no
simple task.

Physicians are licensed by the DEA to prescribe controlled substances.
The law requires only that the medication be prescribed for a
"legitimate medical purpose by an individual practitioner acting in
the usual course of his professional practice." In Louisiana, doctors
also are guided by the so-called "pain rules" enacted in 1997 that
detail prerequisites for prescribing narcotics.

Said U.S. Attorney David Dugas: "Doctors are authorized to prescribe
controlled substances. The challenge is determining whether their
prescriptions were legally written or illegally written."

Dugas, the chief federal prosecutor for East Baton Rouge and eight
other parishes, said criminal cases in Louisiana typically target
physicians who don't perform any physical examination of their
patients to diagnose an ailment before issuing a prescription.

"The criminal prosecutions we've done historically have been of
doctors prescribing outside the doctor-patient relationship," Dugas
said. "I don't know of any U.S. attorney who's tried to second-guess a
doctor's medical judgment. That's not our job. From a criminal
standpoint, we're looking for doctors abusing the position and public
trust they hold because they are authorized to prescribe controlled
substances."

Hickman said his DEA agents most often get tips from "addicts on the
street who are tired of their addiction," as well as family members of
those addicted to pain medication and pharmacies that spot
questionable trends.

From there, Kelly said Police Department narcotics detectives have to
"overcome the 'medical necessity' clause to prove that a physician is
recklessly endangering a patient's life by prescribing to someone that
has no medical need for the medications. That's often a very gray area
and a subjective call."

Detective Joe Rawls, one of the Baton Rouge Police Department's
leading investigators of illegal prescriptions, consults the Louisiana
Board of Medical Examiners on a case-by-case basis.

"Ask three different physicians with three different backgrounds about
one scenario in treating the same patient and you will probably get
three different types of treatment plans," Rawls said. "Therefore, it
has become a gray area in regard to the 'medical necessity' treatment
approach. Who is to draw the line?"

Lt. Todd Compton, commander of the East Baton Rouge Parish Sheriff's
Office Narcotics Division, said undercover operations can also be tricky.

"In a crack cocaine case, you have someone selling to strangers all
day long off a street corner and it's easier for us to go in there and
make an undercover buy," Compton said. "In this situation, the doctor
knows his patients somewhat and it's harder to go in there and
initiate the investigation without an employee on the inside or a
patient who's willing to work with us."

Kelly agreed, saying there exists a "symbiotic relationship between
the illegitimate pain management physician and the drug-addicted
patient -- they need each other and will try to protect one another."

A chilling effect?

Nationwide, the increased targeting of pain prescriptions has been
controversial.

A paper issued last month by the libertarian Cato Institute, a
non-profit public policy research foundation in Washington, D.C.,
concludes the "painkiller campaign has cast a chill over the
doctor-patient candor necessary for successful treatment" and
"resulted in the pursuit and prosecution of well-meaning doctors."

In January, Louisiana Attorney General Charles Foti and 29 other state
attorneys general sent a letter to federal drug enforcement
authorities, arguing that "adequate pain management is often difficult
to obtain because many physicians fear investigations and enforcement
actions if they prescribe adequate levels of opioids or have many
patients with prescriptions for pain medications."

Compton, commander of the Sheriff's Office Narcotics Division, agreed
that recent arrests could have a chilling effect in Louisiana as well,
ultimately hurting patients who truly need the medication.

"If you have doctors getting arrested for doing this, the good doctors
may be more gun-shy about prescribing needed medication to a person
with legitimate pain," Compton said. "Legitimate patients are going to
be hurt due to the fact that there are bad doctors prescribing
medication to those who don't need it."

Dr. Trent James, a Baton Rouge family physician who helped write the
pain rules for Louisiana, said doctors have a responsibility to
prevent their patients from "needlessly experiencing pain."

But he contends they also have a responsibility to ensure those same
patients aren't becoming addicted to medication or misusing it.

"A pharmacy can turn in a doctor any time," James said. "But if you're
a good doctor, you've followed the pain rules, you've examined the
patient and determined the medication is medically necessary, you'll
have nothing to answer for. As long as you're doing right by your
patient, you don't have anything to worry about."
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MAP posted-by: Larry Seguin