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."
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