PAIN-PILL ABUSE HARD TO STIFLE

Officials say drugs freely dispensed in E. Kentucky

The shopping center a Greenup County sheriff once described as an open-air
drug market is quiet now.

The South Shore medical clinic that drew pain-pill addicts from more than
100 miles away is closed, and its owner, Dr. David Procter, is expected to
plead guilty to federal drug charges this morning in Ashland, Ky.

Three other doctors who once practiced in Procter's Plaza Healthcare clinic
and elsewhere in the region have already entered guilty pleas or been
convicted, and a fourth is on trial in Greenup Circuit Court.

Despite the crackdown on doctors accused of being the major suppliers for
the region's prescription drug abusers, the pill-popping problem persists,
although not nearly as much in some areas where the doctors operated, say
law enforcement and drug-treatment officials.

Painkillers are less available in some places, but addicts have found other
physicians willing to write them prescriptions.

Addicts may no longer be able to acquire prescriptions as easily as they did
when Procter operated -- with the assistance of other doctors -- what he
described in court last week as a pill clinic dispensing narcotics to
addicts. But at least one other clinic is operating ''openly and
notoriously'' nearby, said Cliff Duvall, commonwealth's attorney for Greenup
and Lewis counties.

''It seems when you stomp out one fire you get another one,'' said Duvall,
declining to identify the location of the clinic.

Duvall said he never expected controlling illegal traffic in prescription
drugs to be easy because of the nature of addiction. ''Folks are going to do
whatever is necessary to get those drugs. If they have to steal them, they
will do that.''

In Johnson County, addicts are still getting narcotics easily from local
physicians, despite the February conviction of Dr. Frederick Cohn on charges
of prescribing painkillers without a medical purpose, said Terry Scott,
director of Paintsville Professional Associates, a treatment program.

Cohn opened a pain clinic in Paintsville in 2000 after leaving Procter's
clinic and was arrested in August 2001.

''We have a massive problem,'' said Scott. ''All we've done is changed
doctors' names.''

Scott said he gets reports on each of his patients from the state's
prescription-drug monitoring program, called KASPER, which lists the
physicians and pharmacies that prescribed and supplied controlled substances
to the patients.

The reports, which also are available to law enforcement officials, show
that the addicts have been getting their pain pills from four Johnson County
doctors, Scott said. Some claim they have back pain and get prescriptions
for 40 or 50 Lorcet pain pills. Many patients returned every two weeks for
eight or nine months, Scott said.

While Duvall and Scott said there is still a prescription drug problem in
the area, arrests for trafficking in prescription drugs have fallen sharply
since July 1 in a five-county area in northeastern Kentucky, said Detective
David Smith of the FIVCO Area Drug Enforcement Task Force in Ashland.

The federally funded task force, which investigates drug cases in Boyd,
Carter, Elliott, Greenup and Morgan counties, handled 121 cases involving
prescription drugs between July 2001 and June 2002, but it has handled only
25 since last July. Most of the cases involved trafficking.

The number of pills seized has dropped during the two years to 235 from
2,594.

''We're not getting as much information as we were that the pills are out
there,'' said Smith, attributing the drop to the arrests of the doctors.

The arrests have had another benefit, he said: more tips from doctors and
pharmacists about suspected ''doctor shoppers'' -- addicts who visit
multiple doctors and pharmacists to get numerous painkillers.

''We've had doctors calling us giving us information on people bringing them
fake MRI reports to obtain narcotics,'' Smith said, adding that most are
from Greenup County, where Procter's clinic operated. ''Most of the doctors
in Greenup County are scared that we're going to get them involved if they
don't report it.''

Since July 1, the task force has investigated 13 doctor-shopping cases and
charged four people with obtaining controlled substances by deception, Smith
said. The previous year it investigated two cases.

Physicians' concerns about doctorshopping addicts have increased statewide,
as indicated by the number of inquiries made to the state's drug monitoring
system. In 2002, doctors made 83,102 requests for reports on patients, up
from 56,367 the year before, according to Gil Lawson, a spokesman for the
Cabinet for Health Services.

The legislature appropriated $1.47 million for the next fiscal year,
starting July 1, to enhance the monitoring system, by turning around
information requests from physicians more quickly than the current four
hours. A quicker response could help physicians identify doctor-shoppers
before they write them new prescriptions.

The system's information comes from pharmacies and includes information on
the drug prescribed and which doctor prescribed it. The additional money for
the system also is to be used to reduce the one-month lag in reporting of
pharmacy sales to the state, making the database more current.

Like the area federal drug task force, Greenup Sheriff Keith Cooper said he
has made fewer prescriptiondrug arrests since Procter's clinic closed last
year, but he said that's because it was so easy to make arrests outside
Procter's clinic.

In testimony Friday in the Greenup Circuit Court trial of Dr. Rodolfo
Santos, who is accused of twice improperly prescribing controlled substances
to a paid informant, Procter said:

''I explained to him that most of the patients he would see really did not
require medical treatment, but if he wrote prescriptions, he would make
money and I would make money. He had no problem with that.''

Santos has testified that Procter's clinic was in ''disarray'' when he
arrived May 14, 2001. He said he ran the clinic and dismissed about 400 of
2,500 patients for doctor shopping or selling prescriptions.

Cooper said making arrests outside Procter's clinic ''was like fishing in a
pay lake.''

''As far as people selling these pills,'' he added, ''that still goes on,
and it still goes on heavy.'' Abusers in Greenup are largely getting pills
in Ohio now, he said.

Local doctors have become more careful, ''especially with one of them on
trial right now,'' he said, referring to Santos, who was arrested last June.
His trial is expected to go to a jury today.

''They will get careful for a while, but then they will get loose again,''
Cooper said. ''As long as there's a market for it, people will keep doing
it.''

Law enforcement officials also noted several recent cases of stolen
narcotics, including one case last week in which a customer was robbed as he
was leaving a Greenup County drug store.

David Flatt, commonwealth's attorney for Carter, Elliott and Morgan
counties, said there was a break-in at a pharmacy in Olive Hill this spring.

''As long as the prescription drug problem is what it is, we're going to see
abuse both through prescriptions and through break-ins,'' he said.

Along with other officials, Flatt noted that methamphetamine, which has long
been a problem in Western Kentucky, is emerging as a problem in the eastern
part of the state.

''But we still have a much more serious problem with the painkillers,'' he
said.

The Associated Press contributed to this story.