PILL PUSHER OR A LIFESAVER?

DR. CLAUDE Curran sees himself as a thorn in the side of the medical
establishment. If the state Board of Registration in Medicine makes
its case, he may soon be removed.

Curran, who practices out of a ramshackle house in Fall River, is a
relentless pill pusher, according to a 50-page board complaint.

It alleges that the 56-year-old psychiatrist "inappropriately
prescribed" Vicodin or benzodiazepine tranquilizers to at least 25
patients, often without conducting proper tests or medical histories.
To his patients, however, Curran is a lifesaver who has snatched them
from the horrors of heroin and OxyContin addiction.

On a recent weekday, addicts filled Curran's waiting room. Some had
their kids in tow. Some were on lunch breaks from work. Others haven't
worked in years.

A burly man with two skull tattoos on his forehead stood apart from
the other patients.

Crowds, he said, make him nervous after serving 22 years in prison for
"everything but murder." Eventually, they all get ushered into
Curran's cramped office where Elvis memorabilia hangs on prime wall
space normally reserved for medical diplomas.

Massachusetts is in the grip of a drug epidemic.

Heroin is cheap, pure, and abundant.

The addiction rate for OxyContin, a powerful pain killer, has jumped
950 percent in the last decade, according to a recent legislative report.

And public health officials and police can't seem to get a grip on the
diversion of prescription pain medications. Where does the unorthodox
Curran fit into this picture? Is he just a so-called "croaker" who
prescribes drugs irresponsibly to addicts?

Would revocation or suspension of his medical license alleviate the
drug problem in Fall River, or exacerbate it? While state fact finders
prepare to hear the specific allegations against him, state public
health officials should study the wider policy implications of his
case.

Curran is also in hot water over his enthusiasm for Suboxone - a
cutting edge drug containing buprenorphine that offers maintenance
therapy to opiate addicts.

The drug, he says, has fewer side effects and less potential for abuse
than methadone, a synthetic opioid that blocks the effects of heroin.

It's also cheaper.

Despite such advantages, federal drug regulators place tight
restrictions on its use. Physicians are required to take a special
course before offering the drug, and even then each doctor can
prescribe it to no more than 100 patients.

Curran thinks such restrictions are ridiculous. The cap was just 30
patients in 2005 when he lit up the radar of the Drug Enforcement
Administration by prescribing buprenorphine to more than 700 patients.

The feds cracked down. Curran, in turn, organized a protest by addicts
and their families at the JFK Building in Boston. Whatever might be
said about Curran's practice of medicine, it isn't furtive.

Curran acknowledges that he is seen as a "cowboy" in his
field.

But his belief in Suboxone is quite mainstream. Dr. Kevin Hill, a
psychiatrist at McLean Hospital, considers Suboxone, combined with
behavioral therapy, to be the best his field has to offer for opiate
addiction. Hill thinks the 100-patient cap is reasonable. The bigger
problem, he says, is that too few doctors in the state have chosen to
undergo the specialized training needed to prescribe the drug to
addicts. Doctors aren't exactly lining up to treat such challenging
patients, especially at Medicaid rates.

About 900 of the roughly 24,000 active physicians in the state can
prescribe Suboxone, but only 343 of them list their services on an
easily searchable data base.

Curran's door, however, is always open. Amanda, a 28-year-old addict,
tells him that she is desperate to get off methadone.

She and other addicts say methadone is murder on their teeth due to
the side effects of extreme dry mouth.

Yet she lines up at a Fall River methadone clinic for her daily dose
to avoid getting "dope sick." Curran is dismissive of methadone
clinics, which he says can "trigger" illicit drug use by forcing daily
contact with other addicts. But he can't prescribe Suboxone in his
private office for Amanda without exceeding the cap.

The allegations against Curran are disturbing, but so is the
difficulty of finding effective drug treatment.

Most doctors in Massachusetts are allergic to treating
addicts.

Does the Board of Registration in Medicine have a prescription for
that?