Pubdate: Mon, 05 Dec 2005 Source: Boston Globe (MA) Copyright: 2005 Globe Newspaper Company Contact: http://www.boston.com/globe/ Details: http://www.mapinc.org/media/52 Author: Scott Allen, Globe Staff Bookmark: http://www.mapinc.org/find?232 (Chronic Pain) Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone) DOCTOR'S CASE HIGHLIGHTS GAP IN DRUG SYSTEM Before Arrest, He Led State In OxyContin Prescriptions By the time Dr. Michael Brown was arrested in August in a Jaguar that police say was loaded with cash, prescription drugs, and a jumble of patient records, his reputation for liberally dispensing painkillers had earned him a nickname in law enforcement circles: Dr. Feel Good. Police had identified at least eight suspected drug addicts or dealers among Brown's patients, according to a state investigator's report, and a mothers' group had picketed his Cape Cod office last summer, accusing him of addicting young people to the highly potent drug OxyContin. Yet, the state office that tracks doctors' prescriptions of highly addictive drugs did not notify police or medical regulators while Brown, for more than a year before his arrest, was emerging as the single biggest prescriber of OxyContin in Massachusetts. The Prescription Monitoring Program's records show that Brown, an internist working alone in Sandwich, prescribed about 1.7 percent of the OxyContin prescribed in the state in 2004. The 144,435 tablets of the narcotic he prescribed in the first six months of this year led the state's doctors by a wide margin. Though monitors collect information on more than 2 million prescriptions for addictive drugs each year, they rarely release information about individual doctors unless police or regulators request it -- and then only if a panel of doctors and pharmacists agrees that release of information will not unfairly raise suspicions. Nancy Achin Audesse, director of the Board of Registration in Medicine, said senior staff in the physician-licensing agency can't recall ever receiving a tip about potential overprescribing by a doctor from the Drug Monitoring Program. "The correct way to identify an allegedly misprescribing doctor is not by mothers walking outside the doors," she said, adding that state agencies "need to do a better job of sharing information." Brown has pleaded not guilty to one count of illegal possession with intent to sell the painkiller Norco and 12 counts of illegal drug possession. The drugs in his car -- mostly medicines for asthma, allergies, and erectile dysfunction -- were merely sample packs that drug companies supply to physicians, he has said. His lawyer Russell Redgate denied that Brown improperly prescribed or sold narcotics, saying critics such as the protesters at his office last summer are spreading baseless rumors. Brown's license to practice medicine was suspended within three days of his arrest, but the cochairman of the Legislature's OxyContin Commission, Representative Peter Koutoujian, believes the board could have acted much earlier if it had been notified of Brown's OxyContin prescribing pattern. Koutoujian, a Watertown Democrat, believes the case shows how Massachusetts is falling behind in the battle against one of the fastest-growing kinds of drug abuse: More than 9 million Americans take prescription drugs for nonmedical purposes, sometimes with fatal results. Other states have created readily accessible databases that allow law enforcement officials and licensing agencies to quickly check doctors' prescribing habits and find drug-addicted patients who "doctor shop" by approaching multiple doctors for narcotics. "When the drug monitoring program started in 1992, it was one of the first in the nation and ahead of its time . . . but other states have caught up and surpassed Massachusetts," said Koutoujian. He said his panel is expected to recommend that investigators and regulators get greater access to prescribing records of physicians when it reports early next year on prescription drug abuse. Doctors who support the current monitoring program say the state needs to be cautious about releasing prescribing information to investigators because dispensing large volumes of narcotics, by itself, is a poor indicator that doctors are doing anything wrong. Doctors who run pain management clinics, they point out, would normally prescribe many pain relievers, and over-zealous investigators could discourage them from adequately treating their patients. "If there are 100 doctors in Massachusetts all prescribing over some number of OxyContin dosages, there's no evidence those physicians are any more likely to be" overprescribing drugs than other doctors, said Paul Dreyer, director of the division of health care quality in the Department of Public Health, which runs the monitoring program. Brown's prescribing of pain relievers first came to the attention of law enforcement officials in the mid-1990s, but they had difficulty accumulating enough evidence to charge him with a crime. The Board of Registration, meanwhile, received at least two complaints alleging Brown knowingly prescribed painkillers for drug addicts in the late 1990s, according to board records. One patient wrote in 1999 that "Dr. Brown is known among a whole realm of people and friends for prescribing [narcotics] . . . to satisfy our addiction." But, in each case, the complaint came from a drug addict and Brown denied the accusations. Unable to resolve the contradictory versions, the board entered documents in Brown's file to note the charges had been made. Redgate said the history of fruitless investigations only proves his client is not a drug trafficker. "I've seen in print that the [Drug Enforcement Administration] has been investigating Dr. Brown for 10 years. If true, that's a sterling recommendation" for Brown's innocence, said Redgate. Brown is free with no bail, he said. But members of a family support group called Learn2Cope said that Brown's name came up repeatedly at meetings as the doctor who prescribed narcotics to addicted family members. Marilyn, who asked that her last name not be used to protect her 23-year-old son's identity, said he repeatedly went to Brown when the son became addicted to painkillers following nose surgery. "He along with many of his addict friends would frequent Dr. Brown's office and would pay between $120 and $150 cash for an OxyContin prescription" that her son would then fill at a drugstore, she said. However, she never went to police with her accusation. Earlier this year, a pharmacist on Cape Cod told an investigator from the Board of Registration that she had been suspicious of Brown's practices for eight years, noting that his patients tended to stay on the same dose of OxyContin with no sign Brown was trying to wean them off the medicine, according to a board investigator's report on Brown. Board officials, for reasons that haven't been made public, asked the drug monitors for information on Brown in mid-2003, but, at the time, Brown did not rank among the top 100 prescribers of OxyContin. However, that soon changed as Brown began "ramping up" his prescriptions of narcotics including OxyContin, according to Dreyer. By 2004, Brown was in the top 10 of OxyContin prescribers, and he ranked number one for the first half of 2005, Dreyer said. He confirmed that the drug monitors didn't alert the Board of Registration or police to the trend, but he felt they did not need to because the board had already asked about Brown once in the past. "If they want to know more about him, they can ask us," he said. During the investigation, an informant allowed police to videotape Brown as the doctor repurchased a bag of the narcotic Norco that he had originally prescribed to the informant. The informant told police that Brown regularly prescribed drugs for him and then bought them back. On Aug. 22, police arrested Brown in his car. They found 12 different prescription drugs, more than $60,000 in cash, and X-rays and MRIs in the trunk. Three days later, his medical license was suspended, but by then, board documents show, grave questions about Brown's medical practice were surfacing: In the fall of 2004, he allegedly diagnosed one elderly woman's lung cancer as a rib injury that required pain relievers, rejecting her daughter's suggestion of a second opinion. "Specialist, schmecialist," Brown told the daughter, according to a report by the Board of Registration. Peter Sundelin, another attorney for Brown, said the report contains "substantial inaccuracies," though he declined to elaborate. Koutoujian, of the OxyContin Commission, said the case underscores the need to modernize the drug monitoring program along the lines of other states. In Kentucky, which allows authorized people to directly access its computerized drug-monitoring program, doctors are among its main supporters, say program officials. Robert Benvenuti, inspector general of the Kentucky Cabinet for Health and Family Services, said 85 percent of system users are doctors, mainly checking on their patients' prescription history to keep from falling prey to doctor-shoppers. The system, nicknamed KASPER, also saves investigators time they once spent calling individual drug stores, reducing the average duration of doctor-shopping investigations from 156 days to 16. But Kentucky's system isn't cheap. The state spent $1.4 million to create the computer network, and a dozen employees spend at least part of their time working with KASPER. Massachusetts, by contrast, has only one employee who works primarily on prescription monitoring, and he has other duties as well. Dreyer said the state hopes to add software next year that will allow officials to track "doctor shopping" patients. "When the drug monitoring program started in 1992, it was one of the first in the nation and ahead of its time . . . but other states have caught up and surpassed Massachusetts," said Koutoujian. He said his panel is expected to recommend that investigators and regulators get greater access to prescribing records of physicians when it reports early next year on prescription drug abuse. Doctors who support the current monitoring program say the state needs to be cautious about releasing prescribing information to investigators because dispensing large volumes of narcotics, by itself, is a poor indicator that doctors are doing anything wrong. Doctors who run pain management clinics, they point out, would normally prescribe many pain relievers, and over-zealous investigators could discourage them from adequately treating their patients. "If there are 100 doctors in Massachusetts all prescribing over some number of OxyContin dosages, there's no evidence those physicians are any more likely to be" overprescribing drugs than other doctors, said Paul Dreyer, director of the division of health care quality in the Department of Public Health, which runs the monitoring program. Brown's prescribing of pain relievers first came to the attention of law enforcement officials in the mid-1990s, but they had difficulty accumulating enough evidence to charge him with a crime. The Board of Registration, meanwhile, received at least two complaints alleging Brown knowingly prescribed painkillers for drug addicts in the late 1990s, according to board records. One patient wrote in 1999 that "Dr. Brown is known among a whole realm of people and friends for prescribing [narcotics] . . . to satisfy our addiction." But, in each case, the complaint came from a drug addict and Brown denied the accusations. Unable to resolve the contradictory versions, the board entered documents in Brown's file to note the charges had been made. Redgate said the history of fruitless investigations only proves his client is not a drug trafficker. "I've seen in print that the [Drug Enforcement Administration] has been investigating Dr. Brown for 10 years. If true, that's a sterling recommendation" for Brown's innocence, said Redgate. Brown is free with no bail, he said. But members of a family support group called Learn2Cope said that Brown's name came up repeatedly at meetings as the doctor who prescribed narcotics to addicted family members. Marilyn, who asked that her last name not be used to protect her 23-year-old son's identity, said he repeatedly went to Brown when the son became addicted to painkillers following nose surgery. "He along with many of his addict friends would frequent Dr. Brown's office and would pay between $120 and $150 cash for an OxyContin prescription" that her son would then fill at a drugstore, she said. However, she never went to police with her accusation. Earlier this year, a pharmacist on Cape Cod told an investigator from the Board of Registration that she had been suspicious of Brown's practices for eight years, noting that his patients tended to stay on the same dose of OxyContin with no sign Brown was trying to wean them off the medicine, according to a board investigator's report on Brown. Board officials, for reasons that haven't been made public, asked the drug monitors for information on Brown in mid-2003, but, at the time, Brown did not rank among the top 100 prescribers of OxyContin. However, that soon changed as Brown began "ramping up" his prescriptions of narcotics including OxyContin, according to Dreyer. By 2004, Brown was in the top 10 of OxyContin prescribers, and he ranked number one for the first half of 2005, Dreyer said. He confirmed that the drug monitors didn't alert the Board of Registration or police to the trend, but he felt they did not need to because the board had already asked about Brown once in the past. "If they want to know more about him, they can ask us," he said. During the investigation, an informant allowed police to videotape Brown as the doctor repurchased a bag of the narcotic Norco that he had originally prescribed to the informant. The informant told police that Brown regularly prescribed drugs for him and then bought them back. On Aug. 22, police arrested Brown in his car. They found 12 different prescription drugs, more than $60,000 in cash, and X-rays and MRIs in the trunk. Three days later, his medical license was suspended, but by then, board documents show, grave questions about Brown's medical practice were surfacing: In the fall of 2004, he allegedly diagnosed one elderly woman's lung cancer as a rib injury that required pain relievers, rejecting her daughter's suggestion of a second opinion. "Specialist, schmecialist," Brown told the daughter, according to a report by the Board of Registration. Peter Sundelin, another attorney for Brown, said the report contains "substantial inaccuracies," though he declined to elaborate. Koutoujian, of the OxyContin Commission, said the case underscores the need to modernize the drug monitoring program along the lines of other states. In Kentucky, which allows authorized people to directly access its computerized drug-monitoring program, doctors are among its main supporters, say program officials. Robert Benvenuti, inspector general of the Kentucky Cabinet for Health and Family Services, said 85 percent of system users are doctors, mainly checking on their patients' prescription history to keep from falling prey to doctor-shoppers. The system, nicknamed KASPER, also saves investigators time they once spent calling individual drug stores, reducing the average duration of doctor-shopping investigations from 156 days to 16. But Kentucky's system isn't cheap. The state spent $1.4 million to create the computer network, and a dozen employees spend at least part of their time working with KASPER. Massachusetts, by contrast, has only one employee who works primarily on prescription monitoring, and he has other duties as well. Dreyer said the state hopes to add software next year that will allow officials to track "doctor shopping" patients. - --- MAP posted-by: Beth Wehrman