S.C. CONSIDERS PAINKILLER SAFEGUARDS

A question hangs over the wreckage of Myrtle Beach's former Comprehensive
Care and Pain Management Center: How could this have happened?

The answer is rooted in a health care system that, since 1996, has
encouraged a spectrum of medical professionals to treat pain by prescribing
OxyContin and other powerful drugs, according to pain management specialists.

Government oversight has lagged behind changing medical philosophy. South
Carolina and other states, scrambling to catch wayward prescribers and
addicts before lives are ruined, hope the answer lies in a computer-based
prescription monitoring system.

The challenge is a tricky one, experts say.

"I don't think any legal system is going to second-guess someone who's
trying to be a good physician," said Dr. Gene Reeder, a professor of
pharmacy at the University of South Carolina. "There's the rub: How do you
know when there is not a valid [doctor-patient] relationship?"

Doctors On Trial

The case of three Myrtle Beach doctors charged with illegally prescribing
narcotics shows the fine line pain management specialists walk between
operating legitimately and breaking the law, health officials say.

Witnesses in federal court in Florence described a path to corruption
dozens of other doctors have followed, according to Dr. Eliot Cole,
education director for the California-based American Academy of Pain
Management.

"You've got some bad practitioners who have decided the money's too good,
or they're too easily swayed and willing to write a prescription at the
drop of a hat," Cole said.

Michael Woodward, former owner of the Myrtle Beach clinic, attended
training sessions presented by the academy in 1999, Cole said. While the
Comprehensive Care and Pain Management Center was in operation, South
Carolina led the country in distribution of OxyContin, said John Ozaluk,
assistant special agent in charge of the Drug Enforcement Administration in
South Carolina.

Since the indictment of eight clinic doctors and three employees, the state
has fallen to a more normal ranking, Ozaluk said.

In 2000, S.C. pharmacists dispensed 217 grams of OxyContin per 100,000
people, 18 percent more than the national average of 183 grams that year,
according to Bill Mahon, chief executive officer of the S.C. Medical
Association. Horry, Georgetown and Lancaster counties led the state in
those OxyContin prescriptions.

That number dropped to 91 grams per 100,000 in the first three months of
2001, as agents began to arrest suspects in the case and pharmacists began
to decline prescriptions.

Woodward and others have testified that, between 1997 and 2001, the clinic
became an easy target for drug addicts because doctors prescribed
medications after little or no examination.

That's not surprising, Cole said.

"The most common denominator of people who I see get in trouble is failure
to do proper medical review," Cole said. "They've allowed themselves to be
too quick at prescribing. Whatever the patient wants is OK with them."

Catching A Scam

The DEA enforces federal drug laws regarding OxyContin and similar
narcotics. To do so, the DEA depends on states to report violators.

In South Carolina, undercover agents test clinics and pharmacists for
fraud. But the Department of Health and Environmental Control also depends
on pharmacists and doctors to report wrongdoings.

That's where the system can come unglued, Reeder said.

"The responsibility's on the pharmacist as to whether there's an apparent
aberration going on," Reeder said. "But, in reality, there are a lot more
pharmacies than there are physicians."

Abusers who spread their prescriptions among many pharmacies can make it
hard to catch a scam, Reeder said.

But even when pharmacists do catch on, some may be reluctant to report
doctors who may be overprescribing, said Dr. Lynn Johnson, director of the
Center for Pain Medicine at East Carolina University in Greenville, N.C.

"The checks and balances here, that remains a problem," Johnson said. "The
doctors essentially support the pharmacists. That's a difficult
relationship to assail."

The S.C. Medical Association adopted a set of guidelines in 1992 to help
doctors who want to practice pain medicine.

Mahon said his group created the policy because stronger pain medicines,
such as OxyContin, were hitting the market.

"We didn't wait for the national association," he said. "We felt a need for
it, and we developed a policy."

Mahon says most members who are pain management certified operate within
the law. "They know the rules, and if they break them, they know the
seriousness of the issue," he said. "Ninety-nine point nine percent of [the
doctors] follow the rules."

Safety Net For Abuse

Several states have taken steps to stop overprescription before it destroys
careers as happened at Woodward's clinic.

Texas and California, for example, download pharmacists' records to sniff
out developing abuse patterns.

South Carolina is considering a similar system, DHEC spokesman Thom Berry said.

"It could give us the potential to determine whether patients are seeing
multiple physicians for the same complaint or whether doctors are
overprescribing," Berry said.

But the task can be daunting. In 2001, the Texas system reported 1.5
million prescriptions for controlled substances, said Tela Mange,
spokeswoman for the Texas Department of Public Safety.

Analysts review those records and report oddities, such as doctors
prescribing large amounts of OxyContin, to the state medical board. That
board questions doctors about their practices, Mange said.

"We feel it's really allowed us to stay away from the problems some states
in the Northeast have had, especially with OxyContin," Mange said. She
couldn't say how many cases of abuse the system has caught since it began
in 1999.

South Carolina had a chance more than a decade ago to build a safety net
for doctors and patients, but legislators failed to act.

A bill proposed by then-state Sen. Michael T. Rose of Dorchester County
would have mandated a triplicate prescription system for doctors.

Under that system, in use in Texas and California at the time, copies of
doctors' prescriptions went to pharmacists and state drug controllers where
regulators looked signs of abuse, Reeder said.

Rose's bill was introduced in the Senate's medical affairs committee Jan.
8, 1991, but went no farther.

Rose, who no longer sits in the Senate, couldn't remember why the bill died
in committee.

Future Of Painkillers

Doctors support more oversight, but remain leery of police telling them how
to run their practices.

"It's very important that, at the state level, whatever monitoring system
that's set up, they just don't tap somebody on the shoulder and say,
'You're writing a lot of prescriptions, you must be a bad person,'" said
Dr. Marc Hahn, president of the American Academy of Pain Medicine.

Hahn and others say OxyContin is only the latest prescription drug to be
abused by patients and doctors. Vicodin, Dilaudid and other painkillers
also have similar histories, Hahn said.

In light of the Myrtle Beach bust and similar crackdowns, doctors worry
their colleagues will be reluctant to prescribe OxyContin and other drugs
to people who truly need them.

"The bigger problem now," Hahn said, "is that there are patients out there
who are suffering chronic pain that aren't getting appropriate treatment."

Staff writer Kenneth A. Gailliard contributed to this report. Contact Kevin
Wiatrowski at 626-0305.