Pubdate: Wed, 20 Feb 2002 Source: Denver Rocky Mountain News (CO) Copyright: 2002, Denver Publishing Co. Contact: http://www.rockymountainnews.com/ Details: http://www.mapinc.org/media/371 Author: Bill Kaczor Associated Press Writer Bookmark: http://www.mapinc.org/find?186 (Oxycontin) PANHANDLE DOCTOR'S OXYCONTIN CONVICTION TO SEND MESSAGE A doctor's manslaughter convictions for overdose deaths from the painkiller OxyContin should make physicians more cautious about their prescribing practices, a federal drug official said Wednesday. The prosecution of Dr. James Graves, convicted Tuesday in the deaths of four patients, was part of a national crackdown on the abuse of prescription drugs. He was convicted in state court in nearby Milton. "It's going to send a very strong message to the medical community that they treat these very potent drugs _ to include OxyContin but there are others _ with respect," said Laura Nagel, head of diversion control for the Drug Enforcement Administration. Graves, 55, of Pace, was the first doctor in the nation convicted of manslaughter or murder for deaths from OxyContin. He is facing a maximum of 15 years in prison on each of four counts of manslaughter and five counts of unlawful delivery of controlled substance. He also faces 30 years for racketeering. At least two other doctors are facing charges of causing the deaths of patients who took OxyContin. Dr. Frank Fisher is set for trial next week in Redding, Calif., on three manslaughter counts, and Dr. Denis Deonarine of West Palm Beach, Fla., could face a death sentence if convicted of first-degree murder in an overdose death. No trial date has been set for Deonarine. Dr. Theodore Parran, a specialist in internal and addictive medicine who testified against Graves, expects more manslaughter prosecutions. "My impression is that prosecutors have generally felt unwilling to push the manslaughter side of this because of not really having a game plan on how to make a manslaughter charge stick," he said. The Graves case gives them a "roadmap," said Parran, who is on the medical school faculty at Case Western Reserve University in Cleveland. In most cases doctors accused of overprescribing have been charged with crimes such as insurance fraud or illegal distribution. The DEA, working with state law enforcement agencies, in recent years has focused more attention on prescription drugs partly because of OxyContin. The agency blames OxyContin alone for 117 deaths in the past two years and suspects it is the likely cause in 179 others. "It cannot be ignored," Nagel said. "People are dying." Nagel said most physicians have nothing to worry about. "Doctors that are operating and doing everything appropriately, they'll never see us," she said. Parran agreed, saying "This isn't going to have a chilling effect on anybody except for felons." He characterized Graves as a rare "dishonest doc" out to make money from addicted or dependent patients by keeping them coming back for more prescriptions. Dr. William Hurwitz, a pain management physician in McLean, Va., has a different view and is worried that legitimate doctors also have reason to worry because of the verdict. "There's almost a standard of strict liability for any mistakes that are made or deviations in proper behavior by patients," Hurwitz said. "That has a chilling effect and should have a chilling effect on primary care physicians to sort of venture tentatively into managing pain." Graves, a Kentucky native, was a general practitioner but began specializing in pain management a couple years before he was arrested in 2000. Hurwitz said pain management doctors should protect themselves by keeping meticulous records and closely monitoring patients. Some may avoid young and lower-class patients because they are more prone to being drug abusers, he said. Timothy Bannon, a spokesman for Purdue Pharma, which makes OxyContin, declined comment on the Graves case but said the Stamford, Conn.-based company, is vigorously defending itself against lawsuits prompted by overdoses and deaths. "We believe them to be baseless and motivated in many cases by money," Bannon said. "We also feel that these cases can threaten the appropriate care given to patients by their physicians." The company has cited the voluntary withdrawal of three suits in Mississippi, Maine and North Carolina over the past couple months. Bannon said Purdue Pharma also is committed to spending $100 million by the end of the year on developing an abuse-resistant alternative to OxyContin. Addicts defeat OxyContin's 12-hour time release mechanism and get a heroin-like high by chewing the tablets or crushing them and then snorting or injecting the drug. - --- MAP posted-by: Alex