In 2001, Tennessee gave pain physicians green light to prescribe opioids without repercussions
May 26, 2016 12:00 AM
Toby Talbot/Associated Press
In 2001, Tennessee politicians determined that doctors would not be disciplined for prescribing drugs like Purdue Pharma’s OxyContin for patients with “intractable pain.”
State Sen. Janice Bowling achieved the repeal of Tennessee's Intractable Pain Treatment Act, which for 14 years hamstrung local efforts to address excessive prescribing of opioids.
By Rich Lord / Pittsburgh Post-Gazette
In 2001, Tennessee politicians were fighting about the state income tax when the Intractable Pain Treatment Act floated through the Legislature.
“In the hands of knowledgeable, ethical and experienced pain management practitioners,” the legislation declared, “opiates ... can be safe.” Doctors would not be disciplined for prescribing drugs like Purdue Pharma’s hot OxyContin for patients with “intractable pain.”
“With 11 minutes of deliberation, the Tennessee General Assembly passed what Purdue was telling states to do,” said state Sen. Janice Bowling, who was not in the legislature in 2001, but later researched the bill. “The patient became the prescriber, if you will.”
Their act remained law for 14 years, during which Tennessee was inundated with pain clinics — 293, at last count. Neighbors rankled by “pill mills” and the crowds of local addicts and interstate travelers they attracted could complain, but neither prosecutors nor the Board of Physician Examiners could do much about it.
“There are rural counties in Tennessee that had more pill mills than grocery stores,” said Ms. Bowling.
The former legislative leaders who shepherded the act into law, Sen. Roy Herron and Rep. Mark Maddox, could not be reached for comment.
Starting in 2007, Tennessee took measures to track and slow prescribing. From 2011 through 2015, 74 Tennessee physicians were disciplined in relation to their narcotics prescribing by the state’s licensing boards. At least 10 doctors were prosecuted as drug dealers in federal courts in Tennessee in the past five years.
Finally, last year, the legislature repealed the 2001 legislation. But in 2014 alone, 1,269 Tennesseans died of drug overdoses, according to the Centers for Disease Control.
OxyContin for crack
The prescribing free-for-all in Tennessee came at a perfectly awful time for Sanford Kent Myers.
A Knoxville native, Myers studied medicine in the 1980s, when “there was no training on over-prescribing,” he wrote to the Post-Gazette from the Montgomery Federal Prison Camp in Alabama. In the 1990s, hospitals were “really into making sure patients were treated for pain.”
By the time he was in his mid-40s, he was in the middle of a decade-long crack habit that burned “over a half million dollars,” he wrote. “In 2005, I decided to go full blown with writing OxyContin [prescriptions] to obtain crack.”
Myers wrote prescriptions for 90 pills of OxyContin, 80 mg strength, once or twice a month, for each of a roster of “patients” that he never saw, according to the plea agreement he signed. Myers’ drug dealer would shepherd the patients to pharmacies, pay them $250, and sell the pills — around 30,000 a year — on the black market. The dealer paid the doctor in money and cocaine.
Myers is now 61 with the prospect of release next year, and wrote that he’ll work to “demonstrate to the public just how [drug use] will certainly end up twisted, but how it is possible to survive the consequences and become a much better person.”
Charles Michael Howe, an obstetrician and gynecologist who started his residency in 1967, would meet certain patients in the parking lot of his office, in the little Chattanooga suburb of Jasper, to hand them prescriptions for hydrocodone, methadone or oxycodone. Once he told a patient “that she was asking for too much medication and that he just wanted sex,” according to a plea agreement he signed. The next day, though, Dr. Howe “wrote a prescription for [the patient] for 60 oxycodone 15 mg pills."
Now 74, Howe did not respond to a letter sent to Montgomery Federal Prison Camp, in Alabama, where he is serving a three-year sentence.
Jerome A. Sherard, then a doctor, and his nurse practitioner would see 100 patients a day, according to board documents and court filings in the Eastern District of Tennessee. His Chattanooga clinic parking lots became places where “drugs were illegally used, abused, and distributed by patients,” according to the plea agreement he signed. The clinics hired armed guards, but some employees packed their own firearms, while others took the edge off by cadging drugs from their patients.
For all the hassles, the money was good. One of the clinics charged $270 per office visit, grossing $2 million in half a year, according to the documents.
In letters from the Federal Prison Camp Atlanta, Sherard wrote that he “detested and despised what I was doing” but that painkillers just took their place in a state already awash in addiction. “Tennessee, the most prolific producer of alcohol … leads the nation in opioid abuse,” he wrote. “Duh! as my 13-year-old son would say. What does one expect?”
Almost intractable act
At first the pills were “really an East Tennessee problem, you know, Appalachia,” said Logan Grant, a research analyst for the Tennessee Senate Health and Welfare Committee. “It has continued to really get awful there. It is starting to spread across the state.”
In 2012, legislators demanded that doctors check a patient’s drug history using a database before prescribing more than a week’s worth of opioids or benzodiazepines — or face potential discipline against their license. Doctors are now four times more likely to check the database before prescribing than they were in 2010, according to David R. Reagan, chief medical officer for the Department of Health.
The law also now demands that the board scrutinize the state’s top 50 prescribers, plus a handful from rural counties. In 2014, the Board of Medical Examiners endorsed opioid prescribing guidelines. The board also requires that prescribers get two hours of continuing education on opioid prescribing every two years. Pennsylvania has taken none of those steps.
After a shoulder injury, Ms. Bowling, the first-term senator, was prescribed OxyContin and hydrocodone. She took half the recommended dose, for just two weeks, then stopped — and got a taste of withdrawal. “I had clamminess, I had chills, I had nausea, I had insomnia,” she said.
District attorneys told her about the rising number of pill-driven crimes they faced, the overdoses, and the babies born addicted. In 2014, she introduced legislation to repeal the Intractable Pain Treatment Act. She said legislative leaders stalled her for a year, but then passed the repeal under pressure from businesses tired of contending with addicted employees.
The next wave
There have been signs that the pill wave has crested — though perhaps only to be replaced by something worse.
Consumption of opioids has dipped in every county, said Dr. Reagan. IMS Health Inc.’s data indicates an 11.2 percent drop in opioid consumption from 2012 to 2014, though the state still ranked third in the nation.
Heroin use appears to be up, as pill addicts, unable to find prescribers and facing higher street prices, seek an alternative fix. Some doctors blame the state.
“They’ve created this problem with the heroin. … By limiting prescribing,” said Gary S. Hayes, a physician disciplined in 2011 for a handful of questionable pain medicine prescriptions in Tennessee. He now treats weight-loss patients in Alabama.
“We have seen some of that, to be honest,” said Dr. Reagan. “We’ve seen an influx of very cheap, high-quality heroin. … But on the other hand, I don’t think it’s correct … that for every user that has a harder time getting opioids, that user turns to heroin. I don’t think it’s even close to one-to-one.”
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