DEA is cracking down on physicians who overprescribe pills
Feds have taken thousands of prescribing licenses
August 12, 2016 12:38 AM
Toby Talbot/Associated Press
By Rich Lord and Maia Silber / Pittsburgh Post-Gazette
Thousands of medical professionals have quietly signed away their rights to prescribe narcotics — and, in many cases, their careers — in recent years in a little-discussed part of the federal crackdown on prescribing that has some doctors’ advocates crying foul.
From 2011 to 2015, the Drug Enforcement Administration accepted the surrender of 3,679 prescribing licenses nationwide, and revoked another 99, according to the agency’s response this week to a Freedom of Information Act request from the Pittsburgh Post-Gazette. In Pennsylvania during that time, the DEA accepted the surrender of 148 prescribing licenses — typically held by doctors, dentists, veterinarians and nurse practitioners — and revoked one such license.
PG graphic: Revoked or surrendered (Click image for larger version)
When federal agents rush into the office of a physician accused of prescribing too many pain pills, they often offer up a one-page form through which the doctor can surrender his right to prescribe many drugs. If the doctor signs?
“Kiss it goodbye. It’s never coming back,” said Dick Margarita, a former DEA agent who defends California doctors against prescribing-related charges. “One of the prerequisites for being employable is having a DEA [prescribing] license. You’ve basically written yourself out of employment.”
A lot of those license surrenders stem from the effort to combat the diversion to the streets of opioid painkillers, said Barbara Carreno, a DEA spokeswoman.
“DEA is working hard in all aspects of our regulatory authority to try and address the opioid epidemic,” she said. If the DEA sees “the number of schedule II OxyContins that they’ve dispensed in the last two years has gone up 200 times,” that can trigger an investigation and a license action, she said.
The surrender or revocation of a DEA prescribing license can spur state action against a doctor’s privilege to practice medicine — a one-two punch that some view as unfair.
Professor Leo Beletsky, a drug law expert at Northeastern University in Boston, pointed out that dual regulation by federal and state governments can cause frustration and confusion. Although state medical boards issue and regulate medical licenses, doctors must register for a DEA license to prescribe controlled substances.
State and federal authorities may disagree in some cases about how and whether a doctor should be disciplined. “Sometimes the state doesn’t really follow what the federal level is doing, and sometimes the federal level doesn’t fully appreciate the nuance of the situation,” he said.
In Kentucky, where the regulator’s lash has hit rogue prescribers hardest, nearly 20 of every 1,000 prescribing licenses were surrendered or revoked over five years. In Pennsylvania and Ohio, by contrast, roughly five of every 1,000 prescribing licenses were surrendered or revoked.
In states that issue their own controlled substances licenses or have aggressively policed doctors, an action by the DEA almost always triggers a state action. In California, said Mr. Margarita, the DEA and the state medical regulators are “in cahoots,” coordinating their powers to exercise maximum leverage against an accused doctor.
In Pennsylvania, which doesn’t regulate prescribing, “A surrender to the DEA doesn’t automatically trigger revocation or some other discipline on the part of the board,” said Ian J. Harlow, the commissioner of Professional and Occupational Affairs. “These individuals are entitled to due process just like anyone else.”
Doctors are often frustrated that they are investigated by agents who don’t have medical degrees. “A lot of times providers complain that the people who are watching over them have no medical training and they’re not really qualified to make the decision,” Mr. Beletsky said.
DEA agents “indicate they’re there for possibly a routine DEA inspection,” said Detroit defense attorney Ron Chapman II, who works exclusively for accused doctors. “Then come the black SUVs and the DEA agents with jackets, and oftentimes they’ll raid the facility, start taking documents, and separate the physicians in the facility for interviews.”
Mr. Chapman said it would be fairer if the DEA would instead use its power to propose restrictions on a physicians’ prescribing, rather than asking immediately for surrender.
Ms. Carreno said that before trying to take a license, the DEA almost always writes a “letter of admonition” saying something like: “It appears you’re not following the [regulation] here, or you don’t understand the reg.” The agency seeks to suspend a prescribing license — a step toward revocation — only if “their continuing to practice is a public safety issue,” she said.
Doctors, she said, “don’t need to be afraid of the DEA, because only a small number of them are violating the controlled substances act.”
Pennsylvania has, from 2011 through 2015, disciplined relatively few doctors for their prescribing practices, compared with the other states that encompass opioid-plagued Appalachia, the Post-Gazette has reported.
Mr. Harlow noted that effective Aug. 25, Pennsylvania doctors will be able to check patient prescribing histories in an online database, allowing them to detect drug problems. Likewise, the state will be able to access data on any doctor’s prescribing tendencies.
“We now have another tool in the toolbox to look at when we’re opening the case” against a doctor viewed as prescribing unnecessary narcotics, he said.
Rich Lord: firstname.lastname@example.org or 412-263-1542. Maia Silber: email@example.com.
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