OxyContin Invasion

A PERSISTENT PHARMACIST TRIES TO STEM DRUG'S FLOW

As The Prescriptions Pour In, Suspicion Leads To Action

Second Of Three Parts

One day last July, a tall, heavyset man walked into Esterson's Pharmacy in
Fishtown and handed over prescriptions for the painkiller OxyContin and the
sedative Xanax.

Pharmacist Ron Hyman was suspicious: He'd never seen the man before, never
heard of the doctor, and believed the dosages to be unsafe.

"Have you ever taken this before?" Hyman asked. The man said no.

Hyman called the man's prescribing physician, Richard G. Paolino of
Bensalem. A nurse confirmed the order. Reluctantly, Hyman filled it.

A few days later, a petite teenager walked into Hyman's store. She carried
a baby on her hip. The prescription she slid across Hyman's counter was
from Paolino. Again, the doctor ordered 80 milligram OxyContin and 2
milligram Xanax, both to be taken four times daily.

"I have severe back pain," the customer explained, fidgeting. But Hyman
guessed otherwise. She held and lifted her child too easily, he thought.

Alarmed, Hyman called Paolino's office again. OxyContin prescribed at 80
milligrams, four times daily, was unheard of and could kill someone as
small as this customer.

He emphasized his fear to Paolino.

"If you don't want to fill it," Hyman said Paolino told him, "give it back
to her, and I can tell her where to go." Hyman did just that.

Today, Ron Hyman, who has worked in drugstores since he was a teenager, is
hailed by neighbors as a hero for trying to stem the OxyContin tide. For
that persistence, the father of three sons endured two firebombings of his
pharmacy. More than once, he says, he was threatened with death. And the
physician whose prescriptions Hyman refused to fill is scheduled to be
tried next Monday on charges, which he denies, that he prescribed
controlled substances without a valid medical license.

Hundreds of Paolino's prescriptions came into pharmacies in Philadelphia's
Fishtown, Kensington and Port Richmond neighborhoods, beginning last summer.

Within months, six people in the neighborhoods were dead from the OxyContin
scourge, four of them teenagers. Paolino is not charged with causing any
deaths.

Powerful and potentially addictive, OxyContin should first be prescribed in
relatively small amounts - one 10-milligram pill taken twice daily,
according to its manufacturer, Purdue Pharma of Stamford, Conn. If that
dosage is not effective, the prescribing doctor can gradually increase it.

But Paolino's prescriptions were for 80-milligram pills four times daily.
When the teenager came into his store, Hyman called Purdue Pharma and asked
that the recommended dosage schedule be faxed immediately to Paolino's office.

Then he called Paolino back. But the doctor, who is also trained as a
pharmacist, dismissed the recommendations, telling Hyman: "I don't agree
with it."

Hyman returned the prescription form to the teenager, as required by law.
But not until he photocopied it - the first of many Paolino prescriptions
he would quietly copy then refuse to fill.

Pharmacists Put On Alert

Hundreds of others entered Hyman's East Norris Street store last summer,
intent on getting OxyContin, a drug intended for cancer patients and others
suffering severe, chronic pain. "In all my years of pharmacy, I have never
seen anything like this," Hyman said.

Within days, Hyman, 40, called the U.S. Drug Enforcement Administration. As
he turned down the drug-seekers, he told them a lie: He had no OxyContin.

He gave them back their unfilled prescriptions.

In August, two DEA agents visited Hyman at Esterson's, took his photocopies
of OxyContin prescriptions, and said they would investigate.

But the flood of Paolino prescriptions continued, and Hyman called the DEA
again. He also began calling narcotics agents in the Pennsylvania Attorney
General's Office.

And Hyman began alerting other pharmacists, including his business partner,
Robert Wharton, of Foster's Pharmacy in Fishtown, just a few blocks from
Esterson's. Wharton began his own photocopy file of declined prescriptions.

Now Wharton called Paolino. Twice. Each time, he recalled, a female
receptionist blocked him. "He's busy," or, "You can't talk to him," he heard.

Wharton followed Hyman's lead. "We didn't know the person or the doctor and
decided not to fill the prescription," he said. "That's rule number one:
You either know the doctor, or you know the patient."

The pharmacist said he grew tired of being handed prescriptions for the
same dosages of OxyContin and Xanax. When the thwarted customers challenged
him, he replied sarcastically: "You and everyone else get the exact same
medicine. Doesn't that tell you anything?"

Despite their efforts, the prescriptions were getting filled elsewhere.

"They all ended up getting filled because other pharmacies were filling
them," Hyman said. When he questioned one pharmacist, the reaction was
blunt: "Mind your own business."

Hyman and Wharton saw blatant street sales of the drug, and Hyman found in
his store a nearly empty OxyContin bottle from another area pharmacy,
prescribed by Paolino just days earlier. Hyman called the pharmacist who
had filled that bottle.

"Who are you to tell me what to do?" Hyman said that pharmacist asked him.
"If I want to fill these, it's on me."

Other neighborhood pharmacists said they were swamped with Paolino
prescriptions, too.

Brad Tabaac, a pharmacist at Friendly Pharmacy on Front Street, less than a
mile from Hyman's store, said he thought it "bizarre" that his customers
were traveling far from Kensington to see Paolino.

"Why all of the sudden are people from Kensington going up to Bensalem? I
decided I didn't want to participate in whatever was going on."

He said he also called to question Paolino, only to be rebuffed.

At the height of the neighborhoods' OxyContin fever, Hyman said that as
many as 30 or 40 customers a week tried to get prescriptions filled at
Esterson's. When he refused, many argued with him. Some offered to pay him
hundreds of dollars in cash, instead of using their welfare insurance with
its $1 co-pay.

Hyman wondered what, if anything, the authorities were doing. And he
wondered how long it would be before someone died.

Looking Into A Tip

Agents from the DEA and the state Attorney General's Office say they began
to scrutinize Paolino late last summer because of Hyman's calls and tips
from other area pharmacists and citizens. But the case file on Paolino did
not officially open until Nov. 1, the day after Pennsylvania officials
declared his medical license invalid. Authorities say his failure to pay
his medical malpractice insurance ultimately cost him his license.

Narcotics investigators get dozens of tips daily; they say Hyman's was just
one of the thousands they hear about all kinds of drug issues. They say
they must look into every tip before deciding if there is a case.

"Not all tips pan out in every investigation," said Kevin Harley, a
spokesman for the Attorney General's Office. "The fact is . . . you can't
just go and arrest someone based on a tip."

Harley said state and federal drug investigators audit pharmacies to help
ferret out doctors who over-prescribe, pharmacies that heavily dispense,
and patients who "doctor-shop" for prescriptions. Until now, however, the
Attorney General's Office says it has been slowed by a tedious manual
system. That system is being replaced with computerized tracking to more
quickly identify abusers. The DEA uses a computerized system to track
controlled substances such as OxyContin from manufacturer to pharmacist to
patients. The DEA ranks pharmacies by how much of the drugs they dispense
but declined to provide that data for this report.

Insurance companies for welfare patients who bought much of the Fishtown
area's OxyContin were slower than the pharmacists to suspect trouble as
prescriptions poured in. Officials of OakTree Health Plan, one of several
HMOs for Medicaid patients in Southeastern Pennsylvania, said they thought
doctors were merely favoring the new painkiller.

"OxyContin use has increased, but I think the initial perception was not
fraud, but that it was the adoption of a safer alternative [by doctors],"
said OakTree's pharmacy director, Sam Currie. It was not until OakTree was
tipped to OxyContin abuse that the company contacted state and federal agents.

Currie said his and other insurance companies have procedures to detect
prescription-medication abuse.

"All the [medical] plans are cognizant of potential abuses and are very
diligent in tracking them," he said.

Keystone Mercy Health Plan, which also covers some of Paolino's patients,
is rethinking which illnesses should be approved for OxyContin therapy.

"Due to potential abuse of the sustained-release form OxyContin, Keystone
Mercy is closely monitoring the use . . . for other than cancer and
sickle-cell treatment," said Rick Bucks, a company spokesman.

Purdue Pharma, meanwhile, stung by news reports of OxyContin-related deaths
and addiction nationwide, is working to prevent abuses and what it calls
"diversions" of the medication. The company said last week that it would
work with the DEA to urge 800,000 physicians nationwide to prescribe
OxyContin only to patients with serious pain. In May, the company halted
distribution of its 160 milligram OxyContin after just 10 months because of
concerns that such high-strength tablets may be used illegally.

And the company has introduced tamper-proof prescription pads that are
being used by at least 240 Pennsylvania physicians.

A Widening Alarm

Hyman, meanwhile, was sorely frustrated. His neighborhood was in the throes
of what he saw as a drug epidemic, and he had made repeated calls to state
and federal agents. No one called him back.

"It was a nightmare calling them in the first place," Hyman said. "It took
a week until I was able to get someone, and then it took [months] before I
finally got someone in my store."

In October, Hyman decided to take matters into his own hands. He called
local news outlets, including WCAU-TV (Channel 10), which scheduled an
interview. With a crew from the station coming to his store, Hyman called
the DEA again. This time, agents wasted no time. They arrived in less than
an hour - just an hour ahead of the TV crew, he said.

"These types of investigations take time," Hyman recalled the agents
telling him, assuring him that something was being done, even if he didn't
see it. He said agents took all his copies of the suspicious prescriptions,
leaving him with "nothing but my story."

And the agents ordered him not to tell that story to the media.

"They told me if I made an issue of it, they would hit me with hindering an
investigation . . . or something like that," Hyman recalled. "At that
point, I didn't need the aggravation - I kind of took a step back."

Emmett Highland, a DEA spokesman, was not present the day DEA agents talked
to Hyman, but he said he believed investigators would only have gone to the
pharmacist for information and cooperation, not to threaten him.

Steve Schwaid, Channel 10's news director, said his crew could not go on
the air with what it learned from Hyman that day.

"We got some documentation; we spoke to someone who was making the
accusation," Schwaid said. "The problem was, we had nothing on the record.
Everything we had was background." Hyman says he repeated his fear to
investigators.

"The longer you wait, this guy is eventually going to kill someone," Hyman
said.

Next article in series: http://mapinc.org/drugnews/v01.n1382.a05.html