Pubdate: Sun, 11 Aug 2013
Source: Los Angeles Times (CA)
Copyright: 2013 Los Angeles Times
Contact:  http://www.latimes.com/
Details: http://www.mapinc.org/media/248
Authors: Scott Glover and Lisa Girion
Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone)

A CLOSELY GUARDED LIST

As sales surpass the $27-billion mark, OxyContin's maker has 
privately identified about 1,800 doctors who may have recklessly 
prescribed the drug to addicts and dealers, yet it has done little to 
alert authorities.

Over the last decade, the maker of the potent painkiller OxyContin 
has compiled a database of hundreds of doctors suspected of 
recklessly prescribing its pills to addicts and drug dealers, but has 
done little to alert law enforcement or medical authorities.

Despite its suspicions, Purdue Pharma continued to profit from 
prescriptions written by these physicians, many of whom were prolific 
prescribers of OxyContin. The company has sold more than $27 billion 
worth of the drug since its introduction in 1996.

Purdue has promoted the idea that the country's epidemic of 
prescription drug deaths was fueled largely by pharmacy robberies, 
doctor-shopping patients and teens raiding home medicine cabinets. 
The database suggests that Purdue has long known that physicians also 
play a significant role in the crisis.

Purdue's database, which contains the names of more than 1,800 
doctors, could provide leads for investigators at a time when they 
are increasingly looking at how reckless prescribing of painkillers 
contributes to addiction and death.

Purdue has said little about the list since it began identifying 
doctors in 2002. A company scientist offered a glimpse into the 
database at a June drug dependency conference in San Diego, noting it 
was the first time the program had been discussed in public.

In a series of interviews with The Times, Purdue attorney Robin 
Abrams said the company created the database to steer its sales 
representatives away from risky doctors. Policing physicians, she 
said, was not Purdue's responsibility. "We don't have the ability to 
take the prescription pad out of their hand," she said.

Abrams said the company had alerted law enforcement or medical 
regulators to 154 of the prescribers - about 8% of those in its 
database. The company's tally could not be independently verified.

Asked to provide cases reported to law enforcement, she identified 
three Southern California physicians implicated in major schemes to 
funnel OxyContin to addicts and dealers.

One of them, Masoud Bamdad of San Fernando, took in $1.5 million a 
year prescribing OxyContin and other painkillers to young addicts. He 
is serving a 25year prison sentence on a drug dealing conviction. 
Bamdad was linked by prosecutors to six patient deaths.

Another doctor, Eleanor Santiago, is awaiting sentencing on federal 
charges that she helped flood Los Angeles' black market with more 
than 1 million illicit doses of OxyContin. Physician Kevin Gohar was 
linked to a suspected prescription mill in Reseda that authorities 
say sold OxyContin prescriptions to addicts across Southern 
California. Gohar died of a drug overdose in 2011 while a criminal 
investigation was pending.

Mitchell Katz, director of the Los Angeles County Department of 
Health Services, said Purdue has a duty to report all the doctors on 
the list, not just a select few.

"There is an ethical obligation," said Katz, a critic of what he says 
is the overuse of painkillers. "Any drug company that has information 
about physicians potentially engaged in illegal prescribing or 
prescribing that is endangering people's lives has a responsibility 
to report it."

Abrams said that some of the doctors in the database may no longer be 
active prescribers, but she could not provide a specific number.

OxyContin and other prescription painkillers have fueled a surge in 
drug overdoses, which in 2009 claimed 39,147 lives, surpassing for 
the first time traffic accidents as a leading cause of preventable 
deaths. Two years later, the U.S. Centers for Disease Control and 
Prevention declared prescription drug overdoses an epidemic.

Last year, a Times analysis showed that drugs prescribed by doctors 
played a role in nearly half the prescription overdose deaths in 
Southern California from 2006 through 2011. Seventy-one doctors 
prescribed drugs to three or more patients who fatally overdosed. 
Oxycodone, the active ingredient in OxyContin, was one of the most 
often cited drugs in the deaths.

Concerned by the mounting death toll, a congressional oversight 
committee in June called three top federal officials to testify about 
the government's response to the prescription drug crisis. Louisiana 
Republican Rep. Bill Cassidy asked why the government wasn't mining 
prescribing data to target rogue doctors.

"I'm expecting it's going to be a small percent writing a lot of the 
inappropriate prescriptions," said Cassidy, himself a physician. 
"What's the challenge in figuring out which doctors are the bad actors?"

President Obama's drug czar, R. Gil Kerlikowske, testified that the 
federal government didn't have access to such information.

Unbeknownst to Cassidy and Kerlikowske, Purdue Pharma had a database 
similar to what the congressman was looking for.

Targeting abuse

For decades, physicians avoided prescribing narcotic painkillers for 
anything but cancer and end-of-life pain because they feared the risk 
of addiction and overdose. But as Purdue and other drug companies 
pushed for their broad use, doctors began prescribing them for bad 
backs and other common ailments.

OxyContin - twice as potent as morphine - became one of the nation's 
most widely prescribed painkillers by marketing its patented 
time-release formula as safer than other drugs.

But it didn't take long for addicts to discover that "Oxy," as it is 
known on the streets, produced a heroin-like rush when crushed and 
snorted, releasing the pill's full potency at once.

By 2001, OxyContin sales hit $1 billion a year. The privately held 
Stamford, Conn., company was also under fierce attack. Local 
authorities up and down the East Coast, where problems with OxyContin 
first emerged, complained that the drug inflicted addiction and crime 
on their communities. Lawmakers pressed Purdue to do something.

At a hearing on OxyContin abuse that year, Pennsylvania Republican 
Rep. James C. Greenwood, then the chairman of a House oversight 
committee, told Purdue's top executives to use sales data to "weed 
out" bad doctors prescribing their drug.

The next year, Abrams said, Purdue's legal department began training 
sales representatives to report "red flags" at doctors' offices, 
including young patients, long lines, people nodding off in waiting 
rooms and frequent cash transactions.

Abrams said that if she and two other attorneys determine doctors to 
be too risky, Purdue bars sales representatives from marketing to 
them and stops paying commissions on the doctors' OxyContin 
prescriptions. Suspicious doctors are removed from the company's 
numbered sales territories and assigned to the database known as 
"Region Zero," she said.

By Purdue's account, the company has fielded 3,200 reports on 
suspicious doctors and other prescribers. About 75 doctors in the 
database did not prescribe OxyContin, according to Purdue.

Abrams said putting a doctor into the database is "essentially a 
judgment call."

"A lot of these are circumstances that if you were to walk into a 
doctor's office would give you pause and would make you turn around 
and walk out," said Abrams, a former federal prosecutor who 
specialized in criminal healthcare fraud cases.

Abrams declined to say precisely how the company decides which cases 
to refer to authorities. "I don't really want to open up an 
opportunity for folks come in here and start looking and 
second-guessing," she said.

Among the situations that would lead to referrals, she said, are 
cases in which sales representatives witness apparent drug deals in 
physicians' parking lots or observe doctors who appear to be under 
the inf luence of drugs or alcohol.

Law enforcement, she said, "wouldn't be interested" in more vague reports.

Steve Opferman, who heads a healthcare crime task force for the Los 
Angeles County Sheriff 's Department, said Purdue could be sitting on 
valuable leads.

"That's definitely data that law enforcement and prosecutors could 
use," he said.

Bolstering a claim

Purdue used its database this year to bolster an extraordinary 
argument to the U.S. Food and Drug Administration: The OxyContin it 
had sold for 14 years was so prone to abuse that generic drug 
companies should not be allowed to copy it. Purdue said in a letter 
to the FDA that the argument was based in part on an analysis of 
prescriptions written by 364 active prescribers of OxyContin in Region Zero.

According to Purdue, when the company introduced a tamper-resistant 
formulation in August 2010, the doctors' prescriptions for 
maximum-strength OxyContin - the one favored by addicts - plummeted 
by 80%. Prescriptions for Opana, a narcotic painkiller made by a 
rival that could still be crushed and snorted, shot up about 400%, 
the internal study found. When crush-resistant Opana came out two 
years later, the same doctors' prescriptions for that drug also plunged.

Purdue concluded that a small number of doctors might account for a 
"substantial portion" of the nation's black-market supply of 
prescription painkillers, according to a summary of the unpublished 
study. The findings held "important implications," Purdue said, for 
policies aimed at curbing prescription abuse.

The company provided the study to the FDA in a confidential filing; 
it did not include doctors' names.

On April 16, the day Purdue's patent was set to expire, the FDA 
agreed that the original OxyContin - the type easily crushed and 
often abused - was too dangerous to allow generic drugmakers to copy.

At the San Diego conference in June, Purdue epidemiologist Howard 
Chilcoat made a brief presentation about the study. He said there 
were doctors in the database who were prescribing painkillers "for 
what appears to be the wrong reasons."

When he opened the floor to questions, Jane Liebschutz, a medical 
professor from Boston, made her way to a microphone. "Shouldn't those 
364 prescribers be investigated?" she asked.

Chilcoat responded that the company reported doctors to authorities 
when it deemed it appropriate.

In April 2011, eight months after the introduction of the 
tamper-resistant OxyContin, Purdue said it gave the names of 82 
doctors to officials at the U.S. Drug Enforcement Administration, 
which is responsible for granting authority to physicians to 
prescribe narcotic painkillers. The company declined to identify the 
DEA officials.

Joseph Rannazzisi, the DEA official in charge of the office of 
prescription drug control, declined to be interviewed.

Abrams said the company waited to share its suspicions until after 
its analysis "showed some scientific validity" to its theories about 
the doctors.

"We are doing what we think is the right thing for the right 
reasons," she said.

Keith Humphreys, a Stanford University professor and former drug 
policy advisor to Obama, had a different view of Purdue's timing and 
motives. He noted that Purdue became more vigorous about alerting 
government authorities to potential problem doctors after it shifted 
to its tamper resistant formula and when generic-drug makers were 
poised to produce the crushable version.

"Those doctors are a gold mine for Purdue Pharma. And the whole time 
they're taking the money, knowing that something is wrong, and not 
telling anyone until it gives them a market advantage to do so," he 
said. "That is really disgusting."
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MAP posted-by: Jay Bergstrom