Drug officials worried about doctors' eagerness to prescribe heroin withdrawal drug for cash
February 15, 2016 12:00 AM
Rosalind Sugarmann, 64, of Allison Park leaves the federal courthouse after her arraignment on Tuesday.
By Rich Lord / Pittsburgh Post-Gazette
Once convicted for dishing out addictive drugs, physician Dominic W. DiLeo is now charged with prescribing medicine meant to ease withdrawal.
DiLeo, 67, of Uniontown, pleaded not guilty in federal court last week to a 237-count indictment focused on his prescription of buprenorphine. That’s the key ingredient in the brand name drugs Suboxone and Subutex, used to stave off withdrawal in heroin addicts.
Drug officials are worried that some doctors are passing out buprenorphine like candy for cash.
Gary Tuggle, a Drug Enforcement Administration special agent, has said he’s seeing “a lot of diversion of Suboxone out the back door” of clinics and doctors offices. In a report released last year, the DEA ranked buprenorphine No. 8 in drugs identified by forensic labs. Marijuana ranked first, methadone 15th.
Even as the case against DiLeo starts, a former Clarion psychiatrist faces an April trial on charges that he allowed massive diversion of buprenorphine from his sprawling practice to the streets of northwestern Pennsylvania.
The crackdown comes even as some addiction experts, and even President Barack Obama, encourage increasing availability of buprenorphine for rehabilitation.
Buprenorphine “is a tool,” said Neil A. Capretto, medical director at Gateway Rehabilitation Center in Aliquippa.
“Like many tools, if used correctly and responsibly, it can be very helpful, and if misused it can create problems,” Dr. Capretto said.
No party drug
In 1994, DiLeo was charged with 13 criminal counts for over-prescribing Percocet and Percodan, versions of oxycodone, an opioid widely blamed for whetting the regional appetite for heroin. He was found guilty at trial and sentenced to 10 years in federal prison.
Released in 2003, DiLeo in 2005 told the state Board of Medicine that he had “taught preventive medicine and health to other inmates” and served as a prison chaplain, according to board documents. His medical license was reinstated.
DiLeo got into the booming buprenorphine business.
Buprenorphine has been permitted in the U.S. since 2003, but physicians need a DEA waiver to prescribe it and are limited to 100 such patients. The number of waivers in Pennsylvania has climbed from 1,535 in 2014 to 1,744 today.
There’s such demand for the drug that doctors can — and some do — demand cash to prescribe it.
Buprenorphine “gives a strong opioid effect,” but with neither the potent rush nor much risk of a deadly overdose, Dr. Capretto said. “It is a wonderful, transforming detox medicine.”
It’s not a panacea, though. Addicted people need “holistic” treatment, Dr. Capretto said. The goal is to stabilize the person’s life and then wean them off of buprenorphine.
People who don’t have tolerances to opioids can get high from buprenorphine, but it’s not a hot party drug.
“When people are selling Suboxone on the street, they’re selling it because the [buyer’s] heroin connection has been picked up [by police] and the guy needs something to avoid withdrawal,” said Alan Axelson, a Bethel Park psychiatrist with both private and public roles who has around 80 patients using buprenorphine in conjunction with group therapy.
Where’s the drug?
Mr. Obama’s administration announced last year that it wanted to double the number of doctors permitted and trained to prescribe buprenorphine, from 30,000 to 60,000, over three years. The flip side: The DEA must vet those doctors and then make sure they are controlling the buprenorphine.
“There are doctors that are abusing it to the point that their patients are coming in and they’re not following through with [treatment],” said Donetta Spears, the DEA’s Diversion Program manager for Pennsylvania. “Should doctors continue to prescribe buprenorphine to a patient [for whom], when they come in with a urinalysis, it’s not in their system? So where is that drug going?”
The DEA’s fear: to the streets.
Prosecutors haven’t yet to detail the case against DiLeo and co-defendant Rosalind Sugarmann, 61, of Allison Park, who is accused of helping to distribute buprenorphine outside of accepted medical practices. Neither would comment after pleading not guilty.
Former psychiatrist Thomas E. Radecki, 69, of Clarion said he “was trying to keep my patients away from illicit drugs” when law enforcement cracked down.
Dr. Radecki said that when he started prescribing buprenorphine, he quickly hit the 100-patient ceiling.
“I’m not good at saying no to people, especially when they have deadly addiction with a high mortality rate,” he said.
So he built a network of a dozen doctors and more than 900 patients receiving buprenorphine. He also sold Subutex legally, he said. He said that any time he learned that a patient was selling their medicine, he discharged them.
In 2013, the state attorney general charged that Dr. Radecki ran an “income-sharing commune,” and doled out excessive prescriptions for buprenorphine, Adderall and Ritalin, which were often sold on the street. Investigators said they seized $465,000 from Dr. Radecki’s offices during a series of searches.
Two months from trial, Dr. Radecki maintains his innocence, saying he tried to understand and follow complex laws. He said law enforcement has taken a “gotcha” approach to fighting the diversion of drugs.
“They ought to have a mindset of helping physicians out,” he said, “and if they think there’s something amiss, they ought to go and talk to them.”
Rich Lord: firstname.lastname@example.org or 412-263-1542. Twitter: @richelord.
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