Pennsylvania lags in discipline for doctors who prescribe too many pain pills
May 23, 2016 10:42 AM
Sue Ogrocki/Associated Press
A pharmacy technician poses for a picture with hydrocodone and acetaminophen tablets, also known as Vicodin.
By Rich Lord / Pittsburgh Post-Gazette
Patients came to Glenn Bryan Davis’ Johnstown, Pa., office from as far away as Sherburne, N.Y., and Vicksburg, Miss.
Why drive all day to see a doctor? Because at least a few patients could walk out with prescriptions for 600 pills of oxycodone, 240 pills of OxyContin, 360 pills of Opana, 960 doses of methadone, 270 of morphine or 90 Fentanyl patches, according to an FBI agent’s affidavit. One patient was prescribed 5,010 powerful pain pills in one month. Some were addicts, while others netted as much as $10,000 a month by selling the medicine, the agent wrote.
Davis, 63, kept prescribing that way for years. Finally, a drug rehabilitation provider’s complaint prompted the FBI to interview his barely-coherent patients and search his office, which spurred the suspension of his medical license in 2013.
While other states along the Appalachian spine have been using data to bust pill-happy doctors, Pennsylvania’s medical overseers depend upon complaints from patients, pharmacists and insurers, and law enforcement actions, to identify doctors who prescribe too much.
From 2011 through 2015, Pennsylvania’s Board of Medicine and Board of Osteopathic Medicine disciplined 53 in-state doctors for overprescribing narcotics. That’s just 1.2 out of every 1,000 doctors, the lowest rate of painkiller-related discipline found in any of the seven states analyzed by the Pittsburgh Post-Gazette in a six-month investigation.
Gov. Tom Wolf’s 17-month-old administration has expanded drug rehabilitation and pushed the overdose antidote naloxone into police departments, schools and pharmacies. But the Pennsylvania panels charged with making sure that doctors serve the health, safety and welfare of the people still don't have the same tools as do similar boards in other states.
● Pennsylvania’s boards can’t tap data to identify doctors who wantonly prescribe — though by the end of the year, the state may become the 49th to have such a resource.
● The boards haven’t yet endorsed narcotic prescribing guidelines.
● Its doctors aren’t required to get ongoing training on the appropriate use of drugs.
● Regulators don’t have access to investigators with expertise in medicine.
“There’s no doubt, there, that we are behind,” said Domenic Marks, of Ross, a member of the family support group Bridge to Hope. His daughter’s addiction started with a prescription. “But the only way you can catch up is to start, and that’s what they’re doing.”
Discipline without data
In Tennessee, a database in place since 2007 allows medical boards to scrutinize the state’s top 50 narcotics prescribers. From 2011 through 2015, Tennessee’s medical licensing boards disciplined four of every 1,000 doctors in the state for prescribing painkillers too freely.
Pennsylvania has a database of narcotic prescriptions — but only law enforcement can see it. The lack of access to a prescribing database “could be a contributing factor, one of the reasons why we have a lower [doctor discipline] rate than others,” said Peter Speaks, deputy secretary for regulatory programs for the Pennsylvania Department of State, which runs the medical boards.
Legislation to create a more complete database, with which doctors could check their patients’ drug histories, passed in 2014. The system may go online by late summer, Mr. Wolf said this month.
Still, doctors won’t be required to use the coming database to pull up a patient’s drug history before prescribing narcotics, as they must in some states, including Kentucky. That state’s efforts will be detailed in the Post-Gazette tomorrow.
Mr. Wolf is sympathetic to calls for a follow-up law to demand that doctors check the database. Told of the Post-Gazette’s findings, he predicted that “the patterns you’ll see in Pennsylvania will be similar to the patterns that you’ve seen in other states that have been more vigorous in addressing this.”
Pushed by prosecutors
Without data, Pennsylvania’s medical boards — which can reprimand, fine, monitor, suspend or revoke the licenses of doctors — largely follow the leads of criminal prosecutors. All four doctors brought before the state’s licensing panels for prescribing irregularities during the first quarter of this year were flagged by law enforcement.
From 2011 through 2015, at least 11 doctors were charged by Pennsylvania’s federal prosecutors with drug dealing. Some got lengthy sentences. Davis, 63, was sentenced in February to six years in federal prison.
Another 31 physicians, eight pharmacists and seven dentists were criminally charged in state court with either the felony of administering drugs outside of normal practice, or the misdemeanor of giving controlled substances to drug-dependent persons.
The boards have the power to discipline doctors who aren’t criminally charged, but the state doesn’t have a single civil investigator focused solely on medicine. The Bureau of Enforcement and Investigation’s 150 employees are mostly former police, but none specialize in doctors or drugs.
Kentucky, which has one quarter the number of doctors, has five specialized medical investigators.
Mr. Speaks said the lack of specialized investigators doesn’t hamstring the boards, because the civil prosecutors are medical specialists.
While medical boards in the most aggressive states have endorsed opioid-prescribing guidelines against which doctors’ decisions can be measured, and have demanded that physicians get continuing education on the dangers of narcotics, Pennsylvania has, as yet, done neither. Pennsylvania Physician General Rachel L. Levine is scheduled to pitch guidelines to her state’s licensing boards in July and August.
Asked whether Pennsylvania might make every doctor take prescribing courses, Mr. Wolf said, “I’m not ruling anything out, I’m just reluctant to pile on mandates.”
Shift to heroin
While the most aggressive of the seven states saw their opioid-prescribing rates drop sharply from 2012 to 2014, Pennsylvania saw the most modest dip — 2.3 percent.
Overdose deaths in Pennsylvania, meanwhile, rose steadily to 2,732 in 2014, from 1,916 in 2010, as pill abusers progressed to heroin.
“We expect that number to continue to grow, given the oversupply of opioids and the availability of cheap heroin,” said Lauren Hughes, Pennsylvania’s deputy secretary for health innovation — a doctor whose to-do list includes the launch of the prescribing database.
“You can see the shift," said James Bracken, administrator of the Cambria County Drug and Alcohol Program, which tries to help people who started on pills prescribed by Glenn Davis and other rogue doctors. Five years ago, 28 percent of Mr. Bracken’s clients primarily used opioids, and 11 percent were on heroin. Now 18 percent prefer opioids, but 38 percent use heroin.
In 2014, Cambria saw 43 fatal overdoses, and ranked third among the state’s 67 counties in per capita drug deaths. Some of the deceased were long-time addicts, but others were just dabbling in the blossoming narcotics culture. “They could be trying it for the first time,” he said, “and it kills them.”
Rich Lord: firstname.lastname@example.org or 412-263-1542. Twitter @richelord.
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