Friday, 16 November 2012

M.D.'s Are the New Pain-Pill Crime Wave

M.D.'s Are the New Pain-Pill Crime Wave

Dr. Dealer

The doctor, who devoted her life to treating low-income AIDS patients, had pleaded guilty to a staggering violation of her medical oath. Diana Williamson, 56, admitted she had written prescriptions for tens of thousands of powerful painkillers, which were then sold on the black market by a convicted drug dealer.
Photo by Floortje/iStock
Diana Williamson, a doctor who treated AIDS patients, said her alter ego wrote prescriptions for a convicted drug dealer to then sell on the street.
Diana Williamson, a doctor who treated AIDS patients, said her alter ego wrote prescriptions for a convicted drug dealer to then sell on the street.
In preparation for her sentencing, Williamson's lawyers filed court papers last month containing an unusual defense: They said she had suffered from a multiple personality disorder for 25 years as a result of childhood sexual abuse by a priest.

Williamson told her psychiatrists that she had no memory of committing the crimes—that one of her alter egos, a mischievous, immature teenager named Nala, was responsible. Nala "committed these crimes without telling Diana or the other parts of me about them," she wrote in a letter to the presiding judge.

Williamson still awaits sentencing, but the case, unusual as the details are, is hardly an anomaly. It is just one consequence of an epidemic that has spread across the region and continues to thwart government and law-enforcement efforts to stop it.

The prescription-painkiller problem presents itself in myriad ways: fatal drug overdoses, pharmacy robberies, Medicaid fraud, and "doctor shopping" by addicts looking for a friendly physician who will prescribe the painkillers without asking too many questions. And then there are the doctors and medical professionals who dive right into the fray.

Based on a Village Voice review of court records, at least 30 doctors, medical aides, and pharmacists have been indicted since 2010 for illegally prescribing painkillers, OxyContin, and related drugs known as opioids—semisynthetic drugs that act similarly to morphine and heroin. In at least 20 cases, patients of these doctors fatally overdosed on painkillers shortly after receiving prescriptions. Since the source of the pills can be hard to trace, that is probably only a fraction of the total deaths.

Likewise, because it's fairly difficult for law enforcement to make these cases, the actual number of doctors who are illegally prescribing painkillers is probably much higher. The state's medical oversight database shows that this year, dozens of other doctors licensed to practice in New York State have either lost their licenses or were disciplined in some other way for illegally or unethically prescribing painkillers.

The most recent statistics show an increase in such disciplinary cases in each year from 2008 through 2010.
Williamson's arrest was unusual in that it involved a doctor working primarily with minority patients. Overall, the painkiller epidemic is considered a white, suburban, middle-class phenomenon. "I've been doing this for 25 years, and I've never seen anything as bad as it is now," says Jeff Reynolds, executive director of the Long Island Council on Alcoholism and Drug Dependence. "It's the perfect storm."

Attorney General Eric Schneiderman calls it "the perfect crime." "Everyone involved is covered by the paperwork," he said in a report on the painkiller problem.

Opioid painkillers have been around for 100 years. About 20 years ago, the medical community began to view pain not as a symptom but as a disease. Eventually the major medical associations ruled that patients must be treated for pain. Pharmaceutical companies saw a vast new market for their drugs, and the use and abuse of opioids exploded.

In the New York metro area, the tipping point for recognition of the epidemic took place about two or three years ago. Since then, law-enforcement authorities have gone to great lengths to address it and have provoked some changes, including a law signed in August by Governor Andrew Cuomo that will eventually allow authorities to track prescriptions more closely. But as Reynolds notes, it's still getting worse, fueled by a range of factors: naked greed, lapses in oversight, loopholes in regulations designed to regulate the drugs, roadblocks from laws designed to protect patient privacy, and carelessness in securing prescription pads and filling prescriptions.

Solutions are out there: improved methods to allow law enforcement to get information on miscreant doctors, mandatory training of medical staff, better labeling, tighter control of prescriptions, and making insurance coverage for drug-addiction treatment as easy to get as the drugs themselves. But the medical community, the pharmaceutical industry, and insurance companies continue to resist many of these changes. Some law-enforcement officials and drug-treatment experts—including the city's special narcotics prosecutor, Bridget Brennan—believe what's needed is a fundamental change in the way doctors treat pain.

Each week seems to bring new reports that yet another medical professional has been caught illegally prescribing painkillers. "As many physicians as we take down, I see more just coming up," a Drug Enforcement Administration agent testified in a Suffolk County grand jury investigation into pill abuse earlier this year.

It all began with heroin. At one time, heroin was legal and believed safer than morphine. Folks soon figured out the drug's recreational benefits, and the ensuing epidemic ended its sale in the commercial marketplace. In 1970, heroin was declared a Schedule I controlled substance. Related versions of the drug, known as opioids, arrived on the market.

Opioids are known generically as oxycodone or hydrocodone, and by trade names such as OxyContin, Percocet, and Vicodin. The strength of the drugs varies based on the amount of the active ingredient in each pill. Somewhat like antidepressants, each drug can have different effects on a given patient.

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