Pubdate: Sun, 10 Feb 2002
Source: New York Times (NY)
Section: Health
Copyright: 2002 The New York Times Company
Contact:  http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Barry Meier
Bookmark: http://www.mapinc.org/find?186 (Oxycontin)

TINY TOWN LOOMS BIG ON U.S. MAP AS NO. 1 SOURCE OF DISPUTED PAINKILLER

The two doctors in tiny Grover, N.C., are separated by a few streets, a 
world of trouble and a tiny drugstore crammed inside a house trailer that 
is this country's biggest retailer of the painkiller OxyContin.

Sharing a parking lot with that drugstore is a clinic run by one physician, 
Dr. Joseph H. Talley, a self-styled specialist in pain treatment described 
by some of his patients as their best hope for relief.

But the town's other doctor, Dr. Philip M. Day, says he has watched the 
pain clinic's growing practice with concern that some of Dr. Talley's 
clientele may be going to Grover not seeking treatment but for a narcotic high.

Dr. Talley's practice is now in question. Late last month, the federal Drug 
Enforcement Administration suspended Dr. Talley's license to prescribe 
controlled substances, a regulatory classification that includes narcotics 
like OxyContin but not more commonly used drugs like penicillin. The agency 
called Dr. Talley an "imminent threat to public health and safety," 
charging that he had prescribed drugs like OxyContin and methadone, which 
is also used as a pain medication, to patients who were drug dealers or 
drug abusers. The agency said that at least 23 of Dr. Talley's former 
patients had died "in part, due to drug overdoses."

The action follows a complaint by the North Carolina Medical Board in 
October against Dr. Talley charging that he had failed, among other things, 
to examine patients properly before prescribing narcotics or to monitor how 
they used the drugs.

Dr. Talley disputed the drug agency's charges and the complaint by the 
medical board and said he planned to contest them. He said that while he 
was aware that some of his patients had died, he had no way of knowing that 
they had been drug abusers or whether drugs he prescribed had played any 
role in their deaths. "We don't have any way to know that," Dr. Talley 
said. "Some of these people are skilled and they'll get by you."

As misuse of OxyContin has spread nationwide, lawmakers and others have 
looked to possible causes like the aggressive promotion of the drug by its 
producer, Purdue Pharma of Stamford, Conn. But officials say that another 
facet of that problem may be doctors like Dr. Talley, who are so 
enthusiastic about the useful role of narcotics in pain treatment that they 
become targets for drug seekers or fail to detect patients prone to addiction.

Dr. Talley makes no bones about his lack of formal training in pain. An 
outgoing man who in his light blue exam coat and suspenders looks the part 
of the country doctor, he jokes that he would fail any tough test to 
certify him as a pain expert because he only uses drugs to treat pain. 
While many specialists scrutinize patients' drug use with urine tests and 
other means to see whether they are taking narcotics as prescribed or 
possibly selling them on the street, Dr. Talley says he does not use such 
tests because they are unreliable.

He said addiction through prescribed use of narcotics was relatively rare. 
He pointed to studies championed by pain management experts in the 
mid-1990's that found that chronic pain patients could be safely treated 
with narcotics without fear of addiction.

"When I heard about those studies, I was dancing in the street," said Dr. 
Talley, 64, who until recently specialized in treating depression.

But some pain experts cautioned that those studies may have limited value 
because they involved patients in controlled settings like hospitals rather 
than the public.

Dr. Day, the other doctor in Grover, a town of 600 people on the South 
Carolina border, said he still respected Dr. Talley but believed that he 
may have lost the ability in recent years to distinguish real patients from 
others seeking drugs for themselves or to sell. "If a doctor is not 
careful, patients are going to start running the office," Dr. Day said. "I 
think he lost his grip."

Dr. Talley said he became a pain specialist almost by accident about three 
years ago. At that time, the federal authorities shut down a South Carolina 
doctor accused of improperly prescribing narcotics, and he inherited that 
doctor's patients. Then, as more doctors faced regulatory action or 
scrutiny, more patients followed.

His name soon circulated among pain sufferers and on an Internet site run 
by the American Society for Action on Pain, a patient group that argues 
that doctors have long failed to treat pain properly because of unfounded 
addiction fears.

A few days before Dr. Talley lost his right to prescribe narcotics, Desiree 
Malone, who said she found his name through the group's Web site, sat in 
his treatment room, her head and shoulders hunched together.

Ms. Malone said she had suffered incessant pain since a car accident two 
years ago that crushed and broke bones. Many doctors, she said, refused to 
treat her with long-acting narcotics like OxyContin, saying they feared 
scrutiny by the drug agency. Ms. Malone said she found relief from Dr. 
Talley, who prescribed a high dose of OxyContin.

"I can't believe anyone would want to do anything to Dr. Talley," said Ms. 
Malone, 37. "All this man does is take care of patients."

But other patients of Dr. Talley's have come to the attention of law 
enforcement officials. In December, federal officials arrested Debra Lynn 
Morris, charging her with conspiracy to distribute OxyContin and methadone 
illegally.

Dr. Talley said he heard rumors about a year ago of two overdose deaths in 
Ms. Morris's apartment but said he had continued to prescribe her narcotics 
because he was unable to confirm the rumors with the local authorities.

It was not long after the arrest of Ms. Morris, who has pleaded not guilty, 
that federal drug enforcement agents arrived at the Medi-Fair Drug Center, 
the tiny pharmacy here that shares a parking lot with Dr. Talley's clinic.

An owner, Billy Wease, said a federal drug agent told him that agency data 
showed that the pharmacy was the largest retailer of OxyContin in the 
nation. He said that most of those prescriptions came from Dr. Talley's 
clinic, which until recently employed two other doctors.

"I didn't realize we were No. 1," Mr. Wease said. "All I was filing was 
what was coming through."

Dr. Talley said he, too, was struck by the federal data. He said that the 
clinic treated about 1,000 patients and that about 30 percent of the 
prescriptions he wrote were for OxyContin. "That automatically makes me the 
biggest prescriber of OxyContin in the U.S.," he said. That means that 
there are "a lot of guys out there who are not doing their job by 
prescribing this drug," he said.

Federal and state law enforcement officials declined to be interviewed for 
this article other than to say that a criminal investigation was under way 
and that the pharmacy data were accurate.

Dr. Talley said that he trusted his patients and that if a few drug abusers 
slipped by him, there was just so much he could do. "If the addict fools me 
and gets his fix, well at least he got a safe drug to abuse," he said. "But 
if I tell this guy in terrific pain I'm not going to treat his pain and I 
think you are an addict, that just adds insult to injury. It is just 
devastating."

He said that with his permit to prescribe narcotics suspended, he had been 
working nonstop to find other doctors and clinics to see his patients. Ms. 
Malone, the accident victim, said she had lined up a doctor, though the 
change will require her to drive eight hours, to Virginia.

But Dr. Day said he feared his practice would be flooded with patients 
going through drug withdrawal. He said he had already had to wean some of 
Dr. Talley's patients off drugs when they felt they could not get that help 
at the clinic.

"He knew this was going to happen," Dr. Day said. "We had talked about it. 
I have a hard time with his tremendous use of these medications and deaths 
of patients that could have been prevented."

Dr. Talley said any patient who wanted to stop using narcotics could get 
that help at the clinic. As for his ability to tell good patients from bad 
ones, Dr. Talley said he was inclined to wait for someone besides Dr. Day 
to make that call.

"I'll find out what my batting average was when I meet St. Peter," Dr. 
Talley said. "Maybe I got 19 out of 20 right. Maybe I did 50-50. That's 
what I'll be judged on."
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