Pubdate: Mon, 08 Jul 2002 Source: Charlotte Observer (NC) Copyright: 2002 The Charlotte Observer Contact: http://www.charlotte.com/mld/observer/ Details: http://www.mapinc.org/media/78 Author: Debbie Cenziper Note: Staff Writer Michael Henry Contributed To This Report. CRIME FOLLOWS DRUG'S TRAIL OxyContin abuse struck swiftly in the Carolinas and hasn't let up. The powerful painkiller has become the most heavily abused prescription drug in some Carolina communities, forcing agents with the Drug Enforcement Administration to spend as much as 80 percent of their time investigating OxyContin-related crimes. Their work started in 2000, after distribution of OxyContin in North Carolina had doubled in one year. In South Carolina, it increased even more. Much of the increase can be attributed to OxyContin's growing popularity among pain patients. But as use of the drug spread, so did abuse, addiction and crime. "I've never seen anything like it," says Carroll Baker, police chief of Clinton, S.C, where addicts in the community south of Spartanburg were gaining entry into homes of elderly residents and stealing OxyContin. "They don't want to take money. They don't want to take the gold bracelet. They want the OxyContin." Which is why, in the early months of 2000, law enforcement began to fight back. - -------------------------------------------------------------------------- She could see the man's eyes through his ski mask. But what terrified Julia Lorenz was his hands. They were shaking -- and pressing a pistol against her temple. Lorenz thought about her husband and mother and the friends she would leave behind if she died behind the pharmacy counter in Myrtle Beach this Saturday afternoon in late 1999. "Don't faint," Lorenz, a pharmacy technician, remembers thinking as she watched the pharmacist nearby turn pale. "Just give him what he wants." He wanted the store's supply of OxyContin, a powerful painkiller that by 2000 largely dominated the illicit prescription drug trade in the Myrtle Beach region. Distribution of the painkiller nearly tripled in Myrtle Beach from 1999 to 2000, the largest increase in the Carolinas. Today, distribution of OxyContin in the Grand Strand region is still among the heaviest in the nation, and police fear young people may now be abusing it. Last year, OxyContin was found at a popular nightclub; those arrested ranged in age from 17 to 25. "Kids think that because OxyContin is a prescription, they're OK. They think the government regulates those so they're not going to get hurt," says Detective Amy Stanley with the Myrtle Beach Police. In early 2000, agents with the Drug Enforcement Administration suspected the single-largest source of OxyContin in Myrtle Beach was a nondescript pain clinic tucked into a strip shopping center near the drug store where Lorenz worked. Long after dark, patients would mill around the Comprehensive Care and Pain Management Center parking lot. Employees at nearby businesses compared the clinic to a crack house. At a hot dog restaurant next store, groggy patients would sometimes fall to the floor as they tried to hoist themselves onto stools at the counter. Investigators say that some doctors and staff were inappropriately prescribing OxyContin and other narcotics to patients without legitimate pain, then billing private insurance and Medicaid for office visits and unnecessary medical tests -- or tests that were never conducted. Patients told law enforcement the clinic would at times use a fast-tracking system: Patients in the lobby would raise their hands if they needed a prescription refilled. Then they would pay for an office visit without ever seeing a doctor, and leave with a new prescription. Patients from across the Southeast came to the clinic, and investigators believe the clinic helped fuel the OxyContin black market as far away as Charlotte and Columbia. Lorenz later learned the man who robbed the pharmacy was a clinic patient. No one was hurt, and the man and his accomplice were later caught and arrested. But Lorenz and her colleagues continued to see signs of addiction, abuse and desperation. Groups of out-of-town customers, carpooling from S.C. communities such as Lancaster, Georgetown and Darlington, would regularly come to the pharmacy to fill large OxyContin prescriptions from the pain clinic. "It's the drug," Lorenz says. "Once you start on that stuff, there's no way to get off of it." As law enforcement pushed to clip the OxyContin drug trade, some pharmacists in the Myrtle Beach area criticized OxyContin's manufacturer for promoting the drug despite repeated reports about crime and addiction. "(Purdue Pharma) said this drug is the next best thing since sliced bread," say Ron Mason, a pharmacist in the store where Lorenz works. "They haven't given up. They're still trying to convince people of that." In the past, narcotic painkillers were prescribed mostly for cancer patients or people in severe pain. Purdue promoted OxyContin for a broader range of pain patients, arguing that since the medicine is released slowly, there's a lower risk of addiction. Purdue says it marketed the product conservatively and ethically, and that the company does not have authority to regulate healthcare professionals. When sales representatives learned about problems in Myrtle Beach, the DEA was already investigating, says Purdue spokesman Jim Heins. "What could we do about it?" he says. "All we can do is talk to these doctors about proper pain management and the proper way to do it. If they were bad, they may not listen to us. If they were good and just not doing it right, then we would educate them." In June 2000, the DEA seized the pain clinic's records. In the U.S. Attorney's Office in Florence, 70 miles west of Myrtle Beach, Bill Day began to build his case. Day is soft-spoken and unassuming, but he's a hard-nosed prosecutor when it comes to fraud, easily deciphering off-shore bank accounts and the densest of IRS records. Day started spending half his time working on the Myrtle Beach case. "The people get addicted to OxyContin, so you've got very loyal patients who kept coming back, and they'll wait for hours," Day says. "They'll take whatever tests you want them to take and they're going to do whatever you want them to do, and that generates a lot of money." Day says the doctors made at least $5 million through the clinic. According to indictments, the clinic sought payments for unnecessary medical tests or tests that were never conducted -- the staff threatened to withhold prescriptions to patients if they objected. And to increase the likelihood that insurance plans would pay, patients' symptoms and test results were often faked. The clinic employed 13 doctors, but Day says several left when they suspected problems; others reported their concerns. The clinic closed in June 2001, days after the DEA suspended the physicians' registrations to prescribe narcotics and other controlled substances. Day has so far charged eight doctors. One pleaded guilty earlier this year to unlawful distribution of controlled substances, health-care fraud and money-laundering. Seven were indicted last month and charged with, among other things, conspiracy to distribute controlled substances and money-laundering. Day says distribution of OxyContin resulted in serious injuries and at least one death. If convicted, the doctors face 20 years to life in prison. Besides the doctors, the clinic's psychologist, nerve conduction technician and office manager were also charged. Two have pleaded guilty. Day has also convicted eight patients, charged with, among other things, distributing controlled substances. While drug enforcement agents in South Carolina worked on the problems in Myrtle Beach, law enforcement in North Carolina focused on an obscure medical clinic in rural Cleveland County prescribing unusually high quantities of OxyContin and other narcotics. Patients came by the hundreds, from across the region and out-of-state, to see a small-town doctor named Joseph Talley. His case would pit pain patients against law enforcement, a doctor against government regulators. And it would raise vexing questions. Chief among them: Should doctors be punished when their patients abuse drugs? - --- MAP posted-by: Beth