PRESCRIPTION FOR A PROBLEM

Addicts Finding Ways To Obtain Potent Pharmaceuticals

It's as simple as changing the numbers on a prescription.

Or stealing prescription drug pads from a doctor's office.

The abuse of prescription medications is becoming more prevalent in
Pike County and southwest Mississippi, according to local narcotics
officials.

To help fight prescription drug fraud, Purdue Pharma Technologies on
Connecticut gave the city a $10,000 grant earlier this year. That
money went to the McComb Police Department before finally winding up
in the budget of the Southwest Mississippi Narcotics Enforcement Unit.

McComb Police Chief Billie Hughes said the grant money was "something
the city can't pass up. We don't have to have matching funds to go
with it and it's an unlimited-use grant. And the company encourages us
to use it that way ... to track prescription drug fraud."

Prescription drugs come in many forms, from pills to liquids, and are
grouped according to schedules by the Drug Enforcement Agency
depending on its medicinal value, potential for abuse and dependency
liability.

For example, marijuana and heroin are considered Schedule I drugs with
a high potential for abuse. Schedule II drugs include opiates such as
hydrocodone, oxycodone and morphine. These drugs have a high potential
for abuse, said local pharmacist Keith Guy.

"OxyContin has gotten most of the publicity," Guy said at his office
at Guy' s Innovative Medical Services.

"It's gotten bad publicity, too, because people crush it and then
snort it. It's a wonderful drug and one that works if it's used
properly for pain management."

Prescription drug fraud and abuse is a multibillion-dollar business,
with oxycodone one of the most frequently abused drugs, according the
Drug Enforcement Agency.

Oxycodone, a controlled substance, is an active ingredient in over 20
prescription drugs, including OxyContin, according to the DEA Web
site. OxyContin is the No. 1 prescribed narcotic medication for
treating moderate-to-severe pain in the United States.

A single 20-milligram OxyContin tablet legally selling for about $2
can be sold for as much as $25 on the illegal drug market.

"It's no secret to how they get the pills either," said Mississippi
Bureau of Narcotics Commander Mike Aldridge.

"They have a legitimate prescription for drug X for 10 pills. They
make the 1 a 4. Or they add a zero to 10 and try to get 100. We have
pads that are stolen from doctors' offices and people write their own
prescriptions.

"When someone walks in with a prescription for 100 Loritab, that
should be a red flag right there," he said.

Aldridge and Guy recalled a past case where an individual in McComb
was either "doctor shopping" or "pharmacy hopping."

"We pulled the records from the pharmacy they'd been to," Aldridge
said. "They were receiving 4,000-plus pills a month. They were abusing
the drug and people build up a tolerance to them. They go to a doctor
with a complaint of pain and (find ways) to get multiple prescriptions
filled."

Guy, whose career in pharmacy spans over 29 years, said earlier in his
career he was the victim of a forged prescription.

"I remember this lady came in with a prescription for diet pills," he
said. "It looked kind of strange for some reason but I filled it.
Later, I showed it to someone and they made a copy of the
prescription."

The county district attorney later showed up, Guy said, "and raked me
over the coals. And I'm the one who showed it to them. But she was
smart. Came in when I was extremely busy with customers."

Aldridge said people often go to multiple doctors with the same
complaint of pain and receive multiple prescriptions.

"They know how to manifest pain," he said. "We've seen an increase in
people reordering (prescription medications) from overseas over the
Internet. We have people go to Mexico and they walk into a pharmacy
and buy what they want and buy by the thousands. It's that easy."

Locally, pharmacies and physicians' offices have also been burglarized
to obtain the medications.

"Doctors seem to be doing a better job of not leaving the examination
room when they are treating a patient," Aldridge said. "Doctors are
able to recognize people who are trying to doctor shop."

Robert Byrd, an attorney in the Pike County District Attorney's
office, handles many prescription drug fraud cases and estimates four
to five cases a month go to a grand jury in the three-county area of
Pike, Walthall and Lincoln.

"It's hard to say," he said. "I'm sure other cases aren't even
reported and we have others who are returning to court on multiple
indictments.

"But this problem is like everything else, where doctors may be more
willing to prescribe medications at the request of the patient. Once a
person becomes addicted to the drug, the doctor won't prescribe it any
more and that person has to find a way to get it."

Punishment for fraud has been handled like many other crimes though it
varies. Less than a decade ago, Pike Circuit Court Judge Keith
Starrett instituted a drug court to help those with addictions. There
are currently 11 drug courts in Mississippi and five more are planned.

Those found guilty don't usually serve jail time, but are placed on
strict probation, said Byrd. A person's background, however,
determines the severity of their punishment, he said.

How should officials try to prevent drug fraud?

Aldridge said creating a prescription data base could be a
beginning.

"I think that would prevent some of the doctor shopping that goes on,"
he said. "The information in the database would keep track on
transactions. It would track if someone got a prescription filled in
McComb then a day or two later gets one filled in Brookhaven or
somewhere else."

But Guy said privacy issues should be considered. Though he said
prescription drug fraud is illegal - and dangerous - privacy issues
should be a factor. Guy proposes a contract between a doctor, patient
and pharmacist. Although he said he doubts it would be it could be
made legally binding.

"It is just a signature," he said. "But a contract like that could be
used to manage the pain of a patient.

"There needs to be some kind of documentation. Right now, we don't
have adequate pain relief management in Pike County."

What would be the terms of such a document?

"Simple. I'm your doctor and I'm in charge of managing your pain. It
could state that you can't go to another doctor or take any other
prescribed medication. If you do, you're fired as my patient."

Guy said he sees a national data bank as an infringement.

"To me, that's a loss of freedom," he said. "Do you want people,
anyone, to know (your medical history)?"

"If every doctor had a computer and has access to your records, is
that good or is that bad?"

Drug Fraud

Almost half the law enforcement agencies that responded to a 2000
National Drug Threat Survey listed prescription drug fraud as a
problem in their jurisdiction.

Successful offenders got caught less often, as with any other crime,
and prescription drug fraud goes undetected in many cases because it's
not a high priority for police.

Prescription drug fraud also leads to other crimes, including
Medicaid fraud, obtaining drugs illegally over the Internet and theft
by pharmacy workers and health-care providers.

Many experts attribute the growth in prescription drug abuse in part
to the recent availability of OxyContin, an oral, form of oxycodone
that acts for 12 hours.

Prescribed by a doctor, OxyContin is an effective pain reliever. But
crushed and snorted or mixed with water and injected, the drug
delivers its power in one punch, producing a high similar to heroin.

Sources: DEA and National Survey of Primary Care Physicians and Patients on
Substance Abuse