I find hard to believe paragraph 8 in that mother after mother begged for their children to be taken off Oxycontin. I am sure being a mother myself that if I spoke to my childs doctor, he would not give them any more. Just doesn't hold water.
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<http://www.nytimes.com/2002/01/19/health/19OXYC.html>
January 19, 2002
OxyContin Prescribers Face Charges in Fatal Overdoses
By BARRY MEIER
Moving against what law enforcement officials say is a boom in "pill mills," prosecutors are charging doctors with murder or manslaughter in the deaths of patients from overdoses of prescription drugs, including the powerful painkiller OxyContin.
In a Florida courtroom this week, Dr. James Graves went on trial on manslaughter charges stemming from the overdose deaths of four people for whom he had prescribed OxyContin and other drugs; next month in a California state court, a similar case is to begin against Dr. Frank B. Fisher. Last year, Florida prosecutors charged Dr. Denis Deonarine with first-degree murder in connection with a fatal overdose.
Legal experts said it was extremely rare for a doctor to be charged with murder or manslaughter because of their prescribing practices. Doctors accused of improperly dispensing drugs have usually been charged with fraud or with illegally prescribing controlled substances.
"I have never seen anything like this before," said Dr. Leonard Hurwitz, a pain management specialist and lawyer in McLean, Va., who helps defend doctors accused of inappropriately or illegally prescribing narcotics.
The three doctors facing manslaughter or murder charges have all pleaded not guilty and the battle lines in the cases are remarkably similar. The doctors maintain that they were serving the needs of low- income patients in chronic pain with aggressive techniques that rely on narcotics like OxyContin, often in high dosages. And they insist that while law enforcement officials find such techniques suspect, they reflect widely accepted medical practice.
But prosecutors say such doctors used changing medical views about narcotics as cover for lucrative practices in which patients pay $100 a visit not for treatment but for a new prescription for pills.
During opening arguments Tuesday in the trial of Dr. Graves, the assistant state attorney, Russ Edgar, told an 11-member jury in Milton, Fla., that the defendant had ignored pleas from pharmacists and patients' families to cut back on his narcotics prescribing. The reason, Mr. Edgar said, was that Dr. Graves was making too much money to stop.
"Mother after mother after mother called the defendant's office and asked him to quit giving their children drugs or they would die," said Mr. Edgar. "The defendant did not quit and they continued to OD and die."
High-profile cases like the one involving Dr. Graves come as federal and state law enforcement officials appear to be intensifying their pursuit of doctors they suspect of illegally or improperly prescribing OxyContin. The federal Drug Enforcement Administration opened 45 such investigations in the year ended last September, up from just two in 1999, according to the drug agency's data.
Many doctors charged or under investigation prescribe other narcotics and tranquilizers in addition to OxyContin. But it is OxyContin, and the intense publicity its use has received, that appears to be propelling the stepped-up pace of prosecutions.
"OxyContin has led to a whole resurgence of pill mills," said Terry Woodworth, the deputy director of the drug agency's division of diversion control, which monitors trafficking in controlled substances.
OxyContin, which when properly used releases timed doses of the synthetic opiate oxycodone, was originally marketed by its maker, Purdue Pharma of Stamford, Conn., as less prone to misuse than other narcotics. But abusers quickly learned they could defeat the pill's safeguard by crushing it and get far higher doses of the narcotic than they could from similar drugs. Over the past two years, OxyContin abuse has been cited as a likely contributing factor in 300 overdose deaths nationwide.
Advocates for doctors facing indictments or trials say that they have been unfairly singled out by overzealous prosecutors and cannot be held responsible for what patients do with the drugs once they leave a doctor's office.
Dr. Hurwitz, the pain specialist and lawyer, said that many doctors like himself believe that large daily doses of narcotics like OxyContin are an acceptable way to treat chronic pain. But he says his own experience has shown him that such practices can quickly bring a doctor to the attention of law enforcement; in the past decade his medical license has been suspended and revoked over narcotics prescriptions; it has since been reinstated.
"When they see anybody prescribing these meds they think the worst and presume the worst, and if there is a bad outcome they act as aggressively as they can," he said.
For his part, Dr. Fisher, the California doctor who is about to stand trial on manslaughter charges, said that he believed that his only crime was aggressively treating pain in poor residents of Redding, a town 150 miles north of Sacramento. He became the biggest prescriber of OxyContin under the state's health insurance program for the poor, Medi-Cal, and it was the $1 million price tag associated with those prescriptions, he says, not any illegal prescribing, that brought law enforcement officials down on him.
"The money drove them over the edge," Dr. Fisher said. "There is also the ideology that these are dangerous, evil drugs."
Whatever the reason, state police officials in early 1999 arrested him along with a local pharmacist and his wife for their roles in what the authorities said was a huge "pill mill" operating out of Dr. Fisher's clinic. He was originally indicted on murder charges in connection with fatal overdoses; those charges have been reduced to involuntary manslaughter.
Sandra Michioku, a spokeswoman for the California state attorney general, said of Dr. Fisher's case only that "the complaint was filed because it was believed that there were deaths related to improper prescriptions."
While the most serious charges against Dr. Fisher were reduced, Dr. Deonarine, of Jupiter, Fla., was charged by state prosecutors last July with murder in connection with a patient overdose death as part of an 80-count indictment. Barbara Burns, an assistant state attorney in the Palm Beach County prosecutor's office, said the murder charge was made under the state's felony murder statute, meaning it resulted from another accusation against Dr. Deonarine ‹ specifically, trafficking in controlled substances.
Dr. Deonarine, who has pleaded not guilty, could face the death penalty or life imprisonment if convicted on the murder charge.
The cases of Dr. Deonarine and Dr. Fisher may both play out along the lines of the trial of Dr. Graves now underway in Florida Circuit Court in Milton, near Pensacola. In his opening statement on Tuesday, the doctor's lawyer, Michael Gibson, said that the deaths of four of his patients had resulted from their abuse of OxyContin, not from his client's prescription of it.
He also said that the 54-year-old doctor, who practiced in Pace, a town near Pensacola Bay, made patients sign "pain contracts" in which they promised to follow his directions. If a patient lied, he said, there was little Dr. Graves could do about it.
"Addicts are not dumb," said Mr. Gibson. "They lie, make up things and exaggerate things."
The lawyer added that Dr. Graves had attracted scrutiny because of a "struggle in the medical community about how to treat pain."
But Mr. Edgar, the prosecutor, charged that the doctor had bragged that treating pain patients was a "gold mine" that he could apparently work with little effort because he rarely examined patients or filled out medical records.
His reputation as running a "prescription mill" was widely known among addicts, Mr. Edgar charged. "The word spread that he was the go- to doctor to get pills," he said.
Dr. Graves's trial is expected to take at least four weeks; he faces up to 30 years in prison if convicted on all charges. It is not clear yet if he will take the stand in his own defense, but during a pretrial hearing in July he is reported to have made one comment about his practice.
"It's what doctors do," said Dr. Graves. "Prescribe drugs."