Pubdate: Sun, 06 Aug 2000 Source: Florida Times-Union (FL) Copyright: The Florida Times-Union 2000 Contact: http://www.times-union.com/ Forum: http://cafe.jacksonville.com/cafesociety.html Author: Mark Reynolds THE ELUSIVE DRUG PROBLEM Addicts Get Prescriptions By Manipulating Doctors, Pharmacies The man responsible for the Jacksonville Jaguars' turf at Alltel Stadium seemed nice enough to pharmacist Mel Fletcher and physician Peter Jansen. He had an ebullient, talkative manner. He visited frequently, stopping by to pick up prescriptions from Fletcher at Atkinson's pharmacy, socializing with his friend -- a recently hired office manager -- in Jansen's Mandarin family practice. Jeffrey Cannon even used his clout as a stadium official to have someone replace the faded and termite-ridden sign marking Jansen's office, the doctor said. So Fletcher and Jansen say they were flabbergasted when police investigators recently gathered enough information to accuse Cannon and his friend of illegally manipulating both health care providers to acquire prescription drugs for personal use. They were aware of people who abuse the prescription drug process to feed their addictions. But the scope of the case against someone who seemed so friendly and prominent demonstrated the yawning depth of the little-known problem and the challenges it poses to police and health care providers. Prescription drug abuse accounts for almost 30 percent of the overall drug problem in the United States, according to the National Association of Drug Diversion Investigators. Verlon Brickey, an official with a Jacksonville clinical drug treatment program, said the center treats at least 1,200 patients a year, and about 20 percent of them list a prescription drug as their primary drug of choice. "Certainly," said Brickey, of River Region Human Services, "there's a lot more of this narcotic abuse going on than most people are aware of." Observers say the problem is requiring the government to employ costly police units with special expertise, taxing the time and energy of doctors and pharmacists and forcing policymakers to choose between making medications readily available to people in need and keeping them from junkies. Fletcher, a pharmacy owner and president of the Duval County Pharmacy Association, points out that all of these issues and cases like Cannon's detract greatly from the satisfaction of helping the sick. "This is probably one of the worst cases that I've ever seen in terms of someone manipulating the system to try to get prescription drugs inappropriately," said Fletcher. "When the investigators came in to ask for the files for one of our customers, my heart just sank." Pharmacies, doctors and the threads of communication between them are easy prey for prescription drug abusers, according to some of the system's critics. How They Do It Duval County's medical community is served by about 140 pharmacies, fielding drug prescriptions in a variety of ways. A great number of cases are handled just like they always were. Doctors give patients handwritten notes on prescription stationary and the patients take those notes to the pharmacy, where they purchase the needed medications. Orders also are called in via telephone by the doctors themselves and by staff in their offices. In recent years, some pharmacies have started using elaborate telephone answering systems to field the calls. Experts say all of these communications are easily undermined by addicts foraging for their next fix. "There's so many ways you can manipulate doctors when you get really skilled at what you are doing," said police detective Lorri Hall, who began investigating drug diversion crimes for the Jacksonville Sheriff's Office about four years ago -- after a long stint fighting street drugs like crack, cocaine, marijuana and heroin. "I never would have dreamed it's such a problem, until I saw it," Hall said. Some addicts start off by visiting a doctor and acquiring a legitimate prescription for a malady. Then, they immediately seek treatment for the same problem from another doctor and another and another. Sometimes they forge the amounts of medication ordered by the doctor. Addicts with less money resort to riskier tactics, like stealing doctors' prescriptions or recruiting help from office staff. "One of the problems we have," said Fletcher, "is that there are so many people who are in a position to call in those prescriptions legally." Some pharmacists will trace a telephone call if they are suspicious about someone's prescription order. Pharmacists often know doctors' handwriting, but they can't recognize every practitioner's handwriting. Doctors and pharmacists sometimes use shorthand to make their communications harder to imitate. Despite all of this, say critics, health care providers know they are easily tricked. All of this subterfuge affects the quality of health care. Compromising Care Doctors and pharmacists concerned with verifying prescription orders have less time to care for the sick. The notion that a patient might be angling for drugs can cloud doctor-patient relations. The threat of being implicated for prescribing medication to an imposter can make some doctors too cautious about prescribing painkillers, according to the state's Board of Medicine. It can distance providers from patients. "It's just a mess," Fletcher said. "It puts a blight on the way you look at other patients when they walk into your store. "I've got to keep a professional distance from them even if it impairs my ability to get to know them so I can give them the best care. If you don't have that trust, it just makes the job impossible." Meanwhile, drug diversion police lack the same resources as investigators assigned to the interdiction of non-medicinal street drugs like crack cocaine. Wilbur Corbitt, the U.S. Drug Enforcement Administration's manager for drug diversion efforts in Florida, said the DEA has 27 agents assigned to drug diversion in comparison to the 415 agents assigned to narcotics interdiction. Unlike the Jacksonville Sheriff's Office, a great number of the state's major metropolitan police departments have no detectives specifically assigned to drug diversion tasks, Corbitt said. Assistant Chief George Lueders said all of the sheriff's drug interdiction teams can use more badges and its two drug diversion investigators are working hard. "They have enough of a caseload that we probably could use two more and they would still be busy," Lueders said. Still, Lueders said police use different tactics for interdicting street-level narcotics. He said the strategies essentially require more manpower -- special intelligence, surveillance, backup. Hall said her division's drug diversion policing efforts have nabbed about 95 people on charges of fraudulently obtaining prescription drugs this year. The detectives arrested about 150 people last year, she said. Hall believes a new law, scheduled to take effect Oct. 1, will make things easier. Legal Remedies The law will change the process by which doctors can prescribe hydrocodone, the same pain-relieving drug that the stadium manager is charged with fraudulently obtaining. Hydrocodone is a narcotic and the country's most abused prescription drug, Hall said. The painkiller is also classified as a Class 3 drug, which means doctors are able to provide patients with pain relief without filling out a written prescription. The doctor can order the medicine from anywhere. But these rules will no longer apply come October when it will be reclassified as a Class 2 drug. Many believe doctors will face far greater difficulty in prescribing the medicine over the telephone. The Florida Board of Medicine voted Friday to ask Attorney General Bob Butterworth to intervene and allow doctors to continue prescribing hydrocodone as they have for years. Michael Jackson, executive vice president of the Florida Pharmacy Association, said doctors will only be able to use the telephone in crisis situations with stiff legal parameters. Cardholders in the 3,200-member association are concerned about the new administrative burdens, Jackson said. The trade-off, say supporters, is that people convicted of fraudulently obtaining the drug will face heftier sentences, especially in cases involving repeat offenders. "What we're going to do to try and stop this problem is to make everything more difficult for everybody else," Fletcher said. "Sometimes that's the price you have to pay." - --- MAP posted-by: Richard Lake