PRESCRIPTION FOR ABUSE

Drug Schemes Target Doctors, Pharmacies

For the better part of a decade, breakfast for Marco Mura consisted of a
bag of heroin and a fistful of prescription painkillers washed down with
coffee. Like many other addicts, he developed a simple yet surprisingly
effective means of feeding his pill habit.

First, he would dupe doctors into giving him prescriptions for the
narcotics by faking back pain or toothaches. Then, using identifying
information on those prescription forms, he would impersonate the doctors
and con pharmacists into giving him any drug he chose. One day, he said, he
scored prescriptions from four doctors, then called in up to 10 additional
prescriptions in each doctor's name at pharmacies from Malden to
Manchester, N.H.

"I was a predator on the medical community," said Mura, who is now serving
time in a New Hampshire prison. Over 10 years, he said, he got caught only
twice.

Police and pharmacists say thousands of individuals in Massachusetts
fraudulently obtain prescription drugs using Mura's techniques or others.
Nationally, 9 million people illicitly used prescription drugs in 1998, far
more than the 1 million who used crack cocaine, according to the National
Institute on Drug Abuse.

Although not all of these people committed crimes to get the drugs, the DEA
estimates prescription drug abuse accounts for 30 percent of reported
deaths and injuries from drugs, fuels a multibillion dollar illicit market,
and contributes significantly to street crime.

In Massachusetts, State Police investigate more than 200 cases of
prescription fraud a year, while hundreds more are pursued by local police
and many go undetected. A year ago, State Police joined with the federal
Drug Enforcement Administration to launch a new assault on the problem. And
last month, the state attorney general met with his counterparts nationally
to discuss ways to fight prescription drug abuse.

"It's an out-of-control problem," said Charles Young, executive director of
the Massachusetts Board of Registration in Pharmacy. The current drug of
choice is Vicodin, a narcotic painkiller that provides a mild high, but
OxyContin, a newer painkiller with a much bigger pop, is gaining fast.

Looking beyond enforcement, state officials are working with pharmacists,
doctors, and hospital administrators to devise ways to stem the trade.
Electronic prescribing, a paperless system in which prescriptions are
transmitted directly from doctor to pharmacist, is one method being
explored. Others are turning to special paper that makes it harder to copy
prescriptions.

Yet they acknowledge that any system can eventually be beaten by cunning
addicts or their medical accomplices. "They focus their whole existence
around drug-seeking behaviors and they get quite good at it," said William
Gouveia, director of pharmacy at New England Medical Center, whose doctors
were among those targeted in a recent scam that hit more than 200
pharmacies with fake computer-generated prescriptions.

Police say a small fraction of medical professionals join the illicit
trade, while more are preyed upon by addicts. "It was creepy," said a
nurse-practitioner at Massachusetts General Hospital, whose name and
federal drug prescribing number were illegally used on dozens of Vicodin
prescriptions. "You feel like you're in an underworld. You feel violated."

To get his drugs, Mura specialized in low-tech methods. He said he became
an expert "doctor shopper," going to one dentist, orthopedist, or internist
after another with fake or real ailments and walking out with a
prescription for Vicodin or Valium. He'd fill those prescriptions, and then
use the doctor's name and identification number to call in another dozen
prescriptions to pharmacies for whatever drug he wanted.

"If I couldn't get heroin, I'd call in Vicodin," he said. "If I wanted to
come down, I'd get Valium."

Impersonating the doctor, he'd make the calls on weekends when the
pharmacists would be unlikely to reach the real doctor for confirmation.
He'd target the larger chains because "there's always a line and they don't
have time to verify."

"I'd psychologically disarm the pharmacist by asking him to pass on some
message to the patient and by using medical lingo," he said. "Then, I'd
show up at the pharmacy with a uniform shirt with the fake patient name I
was using stitched above the pocket. I was only asked for ID twice."

Mura finally got caught committing check fraud to finance his habit. He
also pleaded guilty to doctor shopping for Percodan and is serving 71/2 to
15 years in the Berlin, N.H., state prison.

The recovering addict volunteered his story along with suggestions for
stopping similar scams, saying that for once he wants to do some good. "I'm
taking the addict's cunning, deceitful mind and putting it in reverse," he
said.

Not all aspects of his story could be confirmed, but one of his early
victims, dentist Gary Demetriou of North Andover, remembers giving Mura a
prescription for Tylenol with codeine and later learning Mura had phoned in
a larger quantity.

"The pharmacist was very impressed" with Mura and said Mura "was very
knowledgeable in the way he was presenting himself," Demetriou said. "But
the pharmacist also had a funny feeling."

Mura's methods also match those seen by the State Police drug unit, which
last year arrested several Quincy residents they said had been running a
prescription drug scam since at least 1995.

Police and court documents show this group used computers to create fake
prescriptions, forging the names of doctors from Brigham and Women's
Hospital, New England Medical Center, Beth Israel Deaconess Medical Center,
and several area clinics, some of which they apparently obtained by doctor
shopping. They bought Vicodin at more than 200 pharmacies across the state,
nearly all operated by CVS, usually arriving in evenings or on weekends to
avoid verification and using fake names. In police interviews, they
reportedly admitted selling both the drugs and forged prescriptions, with
one saying he earned up to $6,000 per week. Vicodin, which costs $24 to $44
for 60 pills at the pharmacy, sells on the street for $8 to $10 per pill.

Two of the men, Scott Leuchte and Dennis LaCorte, have long records of
felony prescription fraud convictions. Both are currently serving sentences
in county jails. State law sets much lighter penalties for prescription
drug offenses than for illicit drugs such as cocaine or heroin.

Ironically, laws attempting to curb Medicaid fraud by requiring doctors to
put their DEA numbers on prescriptions have forced doctors to make those
identifiers more public. "Every addict in Boston knows our number and
MGH's," said Gouveia.

Nonetheless, many do not acknowledge a cause for concern. Although CVS was
successfully targeted by the Quincy-based ring, corporate spokesman Mike
DiAngelis said prescription fraud was "not much of a problem." Similarly, a
spokeswoman for the Massachusetts Medical Society said the issue is not a
high priority, although 35 percent of doctors surveyed by the Department of
Public Health said prescription forgery was a significant problem.

In the Quincy case, two victimized doctors said the fake prescriptions were
a different shape from their own and occasionally misspelled the doctor's
name. Yet many were filled by pharmacists who were duped or too busy to
check. "It went on for six to eight months," said Dr. Caroline M. Apovian,
who was working at Brigham and Women's when she got the first call from a
questioning pharmacist at the end of 1999.

Since 1992, the state has employed a computerized system that helps
identify both doctor shopping and abuse of a small group of prescription
drugs after the fact. But opposition from the medical society kept the
state from adopting a tamper-resistant prescription form of the sort New
York state began using last month to foil fraud up front. That form uses
heat and light sensitivity to block copying or altering and includes a
scratch-off authentification. However, both MGH and NEMC have themselves
begun using a lower-tech version of the form.

Now, the state is working with the boards of pharmacy and medicine to
explore computerized prescribing, where doctors use hand-held devices to
send prescriptions directly to the pharmacy. Thousands of doctors
nationwide, including some at Tufts Health Plan, use this system to fax in
prescriptions. But a fully electronic system must await DEA signoff on
electronic signatures.

Mura says simple measures could cut much of the fraud, such as pharmacists
requiring identification from all patients picking up controlled drugs or
implementing a PIN-number system to verify the identity of doctors calling
in prescriptions.

But some fear such measures would end up hurting legitimate patients by
slowing or restricting access to needed drugs.

"Already, some cancer patients in the inner city have a hard time getting
prescriptions filled for certain painkillers," said Harold Demonaco,
director of drug therapy management at MGH. "That's the collateral damage
in the war on drugs."