DRUG WAR HAS NEW BATTLEFRONT: PRESCRIPTION MEDICINES

JOHNSON CITY - Hard-core illegal drugs are apparently losing their appeal,
as many new addicts turn to prescription drugs to get their highs.

"Lortab, Percocet and OxyContin are the main ones people are trying to
get," said Dr. E.C. Goulding III, director of emergency medicine at North
Side Hospital, Indian Path Medical Center and Sycamore Shoals Hospital.
"They're narcotics that can give someone a euphoria effect. It gives them a
little high all the time, just a feeling like they had a lot of alcohol."

The use of these legal narcotics is making the war on drugs a more
difficult battle to fight, according to local law enforcement.

"If it's an illegal drug, it's obvious that they're not supposed to have
it. If it's there, you know it's illegal," said Capt. Mike Street,
commander of the Johnson City Police Department's Criminal Investigations
Department. "But with these drugs there may be a legitimate reason for a
person having it."

With drug abusers reaching for pills found in little orange bottles behind
the counters of local pharmacies, the battle against drugs has been forced
to recruit soldiers from outside the law enforcement realm to combat the
problem.

"The doctors and the pharmacists, they're the victims of it," Street said.
"I think the majority of them in the area are really good with cooperating
with us. They are trying to do everything they can do."

Pharmacists and doctors are doing their best in trying to eliminate drug
abuse despite facing obstacles in their fields that weren't always so common.

"It's always been a problem since I've been in practice. It's just grown
since then. It's a lot more common," said Pat Rowan, a pharmacist at Boones
Creek Pharmacy who has been in the field for the past 28 years. "Apparently
they have found a way that they feel is relatively easy to get controlled
substances."

Instead of resorting to breaking into or robbing pharmacies,
controlled-substance abusers, often called "pillheads," are using a variety
of fraudulent methods to get their hands on drugs like Lortab and Percocet.

Getting The Goods

According to health professionals like Wayne Copp, a pharmacist at
Blankenship Pharmacy, there are four major methods people are using on a
regular basis to fraudulently obtain narcotics.

"First, you've got valid subscriptions that are being obtained that are not
being used by that person," Copp said. "Part of that market out there is
you've got a person with a legal prescription for a drug that is legal to
dispense, then they're going to go out and sell it - and that's the only
part that is illegal. It's difficult."

It is nearly impossible for a pharmacist to determine who gets a legitimate
prescription filled only to go out and sell the medication, he added.

"Then you've got people who get a legit prescription and then attempt to
alter it in some way," Copp said of the second method used to get
controlled substances.

In late March, a man tested this method at Blankenship Pharmacy when he
passed an altered prescription at the drive-through. The individual
reportedly altered the prescription from its original 50 milligrams of
Indocin, an anti-inflammatory drug, to 5.0 milligrams of Endocet, a pain
medication.

While this individual was arrested and charged with the crime, others do go
unnoticed, Copp said.

"I think it's kind of scary that we don't really know how many get by us,"
he said.

Some addicts take altering prescriptions a step further by stealing blank
prescription pads from a hospital or doctor's office, leaving the drug
abuser with a blank slate for controlled substance desires.

"We try to keep them locked up in the ER or an office, but we have had
prescription pads stolen from the ERs," Goulding said. "We do our best to
prosecute these people."

In early May, police discovered a stolen prescription pad had served up
nearly 500 pills of 40 milligram OxyContin to fraudulent users in the area.

"Somebody had stolen a pad of a doctor from Kingsport, and they floated
those things all over Johnson City," Street said.

The fake prescriptions were used at a variety of local pharmacies.

"It's not isolated," Street said. "They'll start at one pharmacy, and
they'll just keep going. They'll just go in a circuit in a real short
period of time."

While doctors are on the lookout for people trying to steal prescription
pads, it appears that many addicts choose to get their controlled
substances without ever seeing a physician - all with the convenient help
of a telephone.

"The most common way is people will pose as a nurse and call in a
prescription for a patient," Rowan said. "We have seen more fraudulent
phone instances than phony prescriptions."

Pharmacists can, and often do, check up on suspected instances of false
prescriptions, whether written or phoned in, but addicts aren't making it easy.

"What they'll do is forge the prescription and come in at 5:30 when the
doctor's office is closed," Rowan said. "Then you have to make a judgment
call and decide if it's a good prescription. It's hard because if it is
good, you don't want the person to go without."

A similar concern faces doctors, who must determine whether a patient is
experiencing legitimate symptoms of a disease or if he or she is simply
trying to get high.

"We do have them coming in feigning injuries to get drugs," said Goulding,
who estimated they see 10 to 15 instances of someone faking symptoms to get
narcotics each month. In late April, a woman went to the North Side
Hospital emergency room seeking treatment but reportedly gave personnel
false information in order to get a prescription for a controlled
substance. After examining the woman, doctors suspected she was lying.

"We try to find consistency in what they report happened and what the
physical exam shows," Goulding said.

Last Thursday, another woman was arrested for the same crime after she gave
medical North Side personnel false information and even tried to taint a
medical test in order to get a prescription for pain medication.

In early May, a similar type of incident occurred involving two local
hospitals. A Mountain City man arrived first at Johnson City Medical Center
to receive treatment for his injured hand. After receiving a prescription
for pain medicine and having it filled, the man then reported to North
Side, where he was treated for the same injury and received another
prescription for the same pain medication.

Health institutes are now working together to decrease the number of such
instances that might go unnoticed.

"We are able now to look at a computer to see how many times a person has
been to any of the five hospitals (of Mountain States Health Alliance),"
Goulding said.

Goulding often asks patients when they last went to a hospital, and if
their claim doesn't match up to what the computer shows, it's a good
indication that something isn't right, he said.

Cracking Down

Another issue making it difficult to eliminate or decrease illegal use of
controlled substances stems from the people doing the abusing of these drugs.

"With this type of crime, it's so widespread among different classes that
it affects people everywhere," said JCPD Lt. Matt Howell. "There have been
many professional people that we've arrested."

Despite the difficulties facing the fight against controlled substance
abuse, health professionals and law enforcement agencies are working hard
to crack down on the number of people who get away with narcotics fraud.

"We are doing better at fighting this," Goulding said. "I think the more
aggressive the pharmacists, physicians and law enforcement get with this,
the less it's going to happen."

And while controlled substance abuse has been an existing issue for
decades, the perspective of health professionals has changed over the
years, leaving this type of drug addict with less room for error.

"It used to be that if I suspected it, I'd tear up the prescription and
tell them not to come into the store again. Usually that would take care of
it," Copp said. "Now, I just sense that we've got to let people know that
it's really risky to try that here."

Doctors are also emphasizing the legal ramifications for prescription fraud
and controlled substance abuse.

"There's more than just a slap on the hand involved in this," Goulding
said. "You can go to jail."