BIG DOSES LEAD TO BIG TROUBLE

Just after 7 a.m. in a medical clinic already packed with patients, Dr.
Joseph Talley steps outside an exam room and into a semi-circle of flashing
badges.

For years, he figured this day might come. Now, standing before drug
enforcement agents with the power not just to disable his medical practice
but to help put him in jail, Talley says he's furious.

His Grover clinic, in southeastern Cleveland County, is teeming with some
20 law enforcement agents. They seal off the driveway and send patients
away. They confiscate the clinic's prescription narcotics. They haul off
box after box of medical files, 4,000 folders documenting almost 40 years
of work as a family practitioner.

It's Dec. 19, 2001, and the Carolinas are two years into a fierce battle
against the abuse of a painkiller sweeping the illicit prescription drug
market.

OxyContin, a government-approved narcotic, has eased the chronic and
sometimes debilitating pain of thousands of people nationwide. But abusers,
from addicts to teens to some pain patients, discovered that using a
crushed pill produces a heroin-like high. Abuse struck regions of
Appalachia, Alaska and Maine before moving into the Carolinas in 1999.

Law enforcement dismantled OxyContin rings from Durham to Statesville to
Lancaster, S.C., and targeted a Myrtle Beach pain clinic that investigators
say needlessly prescribed OxyContin and other narcotics while charging
private insurance and Medicaid hundreds of thousands of dollars.

Talley's case brings the struggle to a controversial new level.

About 65 doctors and 35 pharmacies have been investigated by the Drug
Enforcement Administration for diverting OxyContin, many for financial
gain. But Talley's case is different.

He's one of a handful of doctors accused of inappropriately prescribing
massive, unconventional doses of OxyContin and other narcotics, not for
personal gain, but essentially because he believes drugs work best to ease
pain.

He's become a central figure in a growing national debate about how far
doctors should go, and what standards should be followed, when treating
pain with narcotics.

In a clinic where chairs are held together with duct tape, Talley spends
hours counseling patients who are often uneducated, disabled, poor or
without access to medical care. He considers himself a victim of his own
beliefs, another in a growing list of physicians the DEA has investigated,
mainly, Talley believes, to prove the agency is winning the war on drugs.

Law enforcement and the N.C. Medical Board disagree.

They say Talley is not a pioneer of pain management -- he is, quite simply,
a reckless physician.

After months of investigation, they say Talley almost exclusively relies on
drugs when pain specialists combine drugs with treatment such as physical
therapy. They charge he fails to perform physicals and diagnostic tests or
run drug screens to make sure patients are taking the pills he prescribes
- -- not selling them for profit.

Worst of all, investigators say, 23 of Talley's patients died in recent
years at least in part by overdosing on the drugs he prescribed. If he's
charged criminally in connection with those deaths, Talley's case would
likely be the largest of its kind in the nation.

"It's like they've said that every single thing that I've done, all the
papers I've written, all the patients I've seen, everything that I've done
has been wrong," says Talley, 65, shortly after drug enforcement agents
came to his office.

In Washington, D.C., meanwhile, the DEA prepares to suspend Talley's
registration to prescribe narcotics. And in Raleigh, the Medical Board is
considering revoking Talley's license to practice medicine -- which would
end his medical career in North Carolina.

Talley Accused Of Recklessness

In 2000, distribution of OxyContin in the region including Talley's medical
clinic is heavier than in any other N.C. area, and 2 1/2 times higher than
the national average.Law enforcement discover some of Talley's patients are
selling their pills, at times, police say, right in the clinic's parking
lot. Other patients overdose and die. In a drug store 50 feet behind the
clinic, pharmacist Billy Wease learned to collect only a day's supply of
narcotics like OxyContin from the distributor for fear that addicts would
steal the drugs.

In Union, S.C., Debra Morris says she began sharing and sometimes selling
pills among a group of Talley's patients.

Morris, 48, was a patient at the clinic for five years, taking OxyContin
and later methadone for chronic pain, she says. Morris and other patients
became friends. It was easy, she says, to convince Talley to prescribe
narcotics.

"If you had some excuse, some reason, some disability or health problem,
yeah, he would try it," she says.

Morris says the group became addicted to pills, trading or loaning each
other OxyContin or methadone until Talley renewed their prescriptions.

In March 2001, investigators learned that five of Talley's patients in
Union County, S.C. had died -- four from overdoses. At least two had
obtained OxyContin from Morris, investigators say.

Morris was arrested and held on $5 million bond. She was later indicted on
charges of conspiring to distribute OxyContin and methadone. Her son, Ivan,
was also indicted on drug charges. Both pleaded guilty and will be
sentenced later this year.

Talley says he would never prescribe narcotics to someone he knew was an
abuser, and said he called authorities when he heard rumors about Morris
trading pills. Talley said Morris told him the rumors were untrue and he
continued to prescribe methadone to her.

"You cannot take someone's medicine away based on a rumor from a
non-official person," Talley says.

He also argues that in pain management, abusers will sometimes dupe
doctors. But if doctors are too fearful of the possibility of deception, he
says, some patients who hurt won't get treatment.

DEA officials would not comment publicly on the Talley investigation.

But in a January order, obtained by The Observer, to suspend Talley's
narcotics' registration, the agency accuses Talley of excessively
prescribing narcotics to patients without a legitimate medical need. Also,
the agency says Talley prescribes narcotics to drug addicts or out-of-state
patients treated after telephone consultations.

Talley says he requires his patients to visit at least once.

The N.C. Medical Board says Talley fails to give minimal exams before
prescribing painkillers and fails to monitor patients with such things as
drug screens to make sure they aren't abusing narcotics.

Some doctors who have known Talley for years say over time he lost
perspective and stopped monitoring patients or taking such basic steps as
running drug screens. Talley himself says his course of treatment almost
exclusively features narcotic painkillers, as opposed to options like
physical therapy.

Says Bill Breeze, former lawyer for the N.C. Medical Board: "He used only
one weapon from the arsenal that he could use."

Pain Patients Turn To Talley

In a one-room apartment in Kings Mountain, David McCurry tries to fight the
pain.

It courses from his neck to his back to his legs, like a throbbing
toothache that never goes away. An amputee with medical conditions that
include a bulging disc in his back, McCurry was a patient of Talley's for
12 years. OxyContin helped McCurry walk, clean, even go fishing.

But in January, one month after drug enforcement agents came to Talley's
clinic, the DEA pulled the doctor's registration to prescribe narcotics.
The suspension order called Talley "an imminent danger to the public health
and safety."

Now, McCurry can't find another doctor willing to prescribe such liberal
doses of OxyContin.

He's confined to his wheelchair again. He can't sleep. A former truck
driver who inscribed his dead wife's name, Verleen, on the knuckles of his
hand, McCury cries several times a day.

"If it wasn't for Dr. Talley, I would not be living," he says.

Seizing Talley's narcotics' registration is in many ways like taking away
another doctor's stethoscope.

When other physicians run tests, perform surgeries, order physical therapy
and still can't ease chronic pain, patients come to Talley for narcotic
painkillers. New research has shown that narcotics like OxyContin can be
used successfully to treat pain.

Talley admits he pushes that theory to the limit. While some doctors might
prescribe 30 to 60 milligrams of morphine, Talley might prescribe 300.

Piles of sample drugs, treating everything from allergies to anxiety, spill
out of the closet in his office, where the clock comes from the makers of
Claritin, the magnet from Effexor, the coffee mug from Xanax, the notepad
from Prozac.

Some visits, Talley never touches his patient. He sits across the room in
his trademark suspenders and baby blue lab coat, prescription pad in hand,
and asks questions.

With his narcotics' registration suspended, Talley works the phone, trying
to find doctors for patients like McCurry.

But some doctors say they fear Talley's patients are addicts. Talley
suspects that others are hesitant to prescribe high doses of narcotics
because of the possibility of government scrutiny.

Meanwhile, Talley knows his patients will lose access to medical care and
medication if they can't find another doctor. In a similar Virginia case,
at least one chronic pain patient committed suicide after his doctor lost
his registration to prescribe narcotics.

"Are opioids a viable option for your clinic?" Talley asks a few weeks
after his registration is suspended. He's in his office, empty Diet Coke
cans strewn about, trying to find a new doctor for a female patient.

Another call: "The DEA has just clipped my wings. I've got a patient who's
pretty desperate."

A third try, this time about an S.C. doctor he knows: "Is he still willing
to stick his neck out? Have you seen anything from the DEA?"

"I feel useless," Talley says when he's done and is unable to find help.
"The practice and my career is in shambles, but these patients are more
than customers to me. And now I have to tell them goodbye."

Family Doctor Learns To Treat Pain

Talley never set out to champion pain management.He opened his family
practice in 1969. In the 1970s, before many other doctors, Talley endorsed
treating anxiety and depression with now-common psychiatric drugs like
Xanax and Prozac. He spoke at seminars, published papers and a textbook.

In 1990, he met an anesthesiologist who touted the benefits of narcotics
long-term for chronic pain. Through word of mouth or the Internet, patients
learned of the small-town doctor willing to prescribe large doses of
painkillers.

Talley says he knew he was risking his livelihood. But he was propelled by
a strong belief in the benefits of narcotics, as well as a fairly healthy
ego, colleagues and friends say.

Law enforcement officials, speaking on the condition of anonymity, say
Talley has been irreverent toward them for years, acting in a
"catch-me-if-you-can" fashion. Talley likes to show visitors letters he
wrote in response to a pharmaceutical company that had repeatedly warned he
may be over-prescribing to some patients.

Talley sent replies like this one:

"Please accept my profound apologies for my rather intemperate reply to
your January 10th (letter) regarding this patient. As my wife and my
attorney have very forcefully pointed out, it is inappropriate and
discourteous (of me) to refer to a senior executive of a large corporation
as a 'butthead,' no matter how much of an imbecile he may be. Please allow
me to retract that ill-conceived characterization of you."

Part brow-beater, part prankster, Talley once suspended bras from the
chapel ceiling in college. At medical school at the University of Virginia,
Talley says he placed in the bottom 10 percent of his graduating class,
though he earned top scores on his medical boards. He brashly calls the DEA
"goons" and state medical boards "the KGB," but he's fatherly and
protective of hundreds of patients who have sought his help.

And he adamantly believes he's done nothing to hurt them.

He says he doesn't understand why law enforcement has targeted his clinic.
Unlike many doctors who have lost their narcotics' registrations or faced
charges, Talley has not been accused of personal drug abuse or sexual
misconduct. He's not accused of fraud or prescribing narcotics for
financial gain. In 2000, he says he earned $140,000, the most he ever made
from his practice.

"I guess I always suspected there might be a day of reckoning with the DEA,
but I didn't realize it would be a high-profile campaign against doctors,"
Talley says.

Blaming Doctors For Addiction?

DEA officials say doctors who prescribe narcotics responsibly have nothing
to fear.

But some doctors, they say, defend reckless behavior by arguing they are
aggressively treating pain.

"The DEA isn't unreasonable," says Bob Williamson, former drug diversion
chief for the DEA-Atlanta division, which oversees the Carolinas. "...This
is a very dangerous substance with a well-known abuse potential. If you're
going to be involved in this business, you really have a lot of homework to
do to make sure you've done the work-up , to make sure that patients are
not trafficking drugs, and that you're not becoming just a source of drugs."

Doctors from California to Virginia have had their prescribing privileges
suspended after being accused of dispensing OxyContin and other narcotics
inappropriately, and at least a half-dozen have been charged criminally. In
a high-profile case in Florida, a jury in February found Dr. James Graves
guilty of four counts of manslaughter for prescribing OxyContin to patients
who died of overdoses. He was sentenced to 63 years in prison.

So far, Talley has not been charged in the deaths of any patients. But he's
worried criminal charges are coming.

Charlotte attorney Lyle Yurko, who is representing Talley, argues what's
happening to the doctor sets a frightening precedent.

"The primary responsibility for someone who is abusing drugs needs to be
put on the person abusing the drugs," he says.

Others, however, say doctors must share in that responsibility by taking
steps, such as random drug testing, to ensure patients are taking pills as
prescribed. Talley argues the tests aren't always accurate because people
who sell their pills know to take them in the days before a doctor visit.

"It's not 100 percent but it's better than nothing," says Dr. Sharon
Sweede, staff physician at the Julian F. Keith Alcohol and Drug Abuse
Treatment Center in Black Mountain, near Asheville. "It would help any
doctor from being overrun by a bunch of people who are just coming in to
get drugs to sell."

Dr. George Raad, a Charlotte family practitioner, has for years been
medical director of a drug treatment center at Carolinas Medical
Center-Mercy. Basic standards dictate that doctors conduct physical exams
before prescribing narcotics, he says.

Raad says that according to the N.C. Medical Board, the issue in Talley's
case is irresponsible prescribing without proper follow-up.

"Pain management is not on trial," he says.

A Struggle In Raleigh

In March, three months after Talley faced the DEA in his clinic, he strides
into a Raleigh board room without speaking and finds his seat up front.The
N.C. Medical Board has called a hearing to determine whether Talley will
lose his medical license.

Talley glances at his wife, Sara, sitting in the back of the room with
three of their four grown children. Several of Talley's patients left home
before dawn to attend. State Bureau of Investigation investigators sit
nearby, notepads in hand.

The board chairman calls the meeting to order: "The State of North Carolina
Medical Board vs. Dr. Joseph Talley."

Talley is the first witness.

The board's attorney asks why Talley doesn't perform exams. Talley says:
Exams aren't always necessary because he requires that patients bring
medical documents from other doctors. More importantly, physical exams
cannot prove whether a person is truly in pain.

Why doesn't Talley look to see if patients are abusing drugs? Talley says:
His nurses sometimes check for needle marks during blood pressure tests,
but he does not make patients roll up their sleeves to prove they have no
tracks.

That afternoon, Fayleen Huffstetler tells her story.

She woke up in April 2001 to find her husband on the living room floor,
dead from an oxycodone overdose. He had been prescribed OxyContin and two
other oxycodone-based painkillers.

Both were patients of Talley's. The couple completed drug rehab in December
2000, according to the DEA. Fayleen says she called Talley's office after
they finished to tell the staff that Talley must not prescribe more pain pills.

In March, however, the Charlotte couple visited Talley. When Roger, 49,
complained of pain from kidney stones, Talley prescribed OxyContin. Fayleen
says she didn't protest because she figured Talley knew what he was doing.

Talley counters neither of the Huffstetlers said anything to him about
rehab. In any case, he says, it's wrong to withhold pain medication from
patients because of previous addictions.

At the hearing in Raleigh, Fayleen Huffstetler blames Talley for
prescribing drugs that "shattered" her family.

Talley's lawyer say the blame is misplaced.

"Weren't you the one who used him and lied to him to get narcotics?"
Talley's lawyer Robert Clay asks.

"If your child was a diabetic would you feed them sugar? Would you?" she
responds.

The hearing lasts three days.

Several weeks later, the board chairman ends the matter with one statement:
"The board has decided that Dr. Talley's license be suspended indefinitely."

Talley goes home. The next day is his 65th birthday.

Grover Clinic Shut Down

His medical career all but over, Talley builds wooden trains or plays his
tuba. He's also copying patients' charts at his now-closed clinic to help
his lawyers prepare for possible criminal trial or malpractice lawsuit.

Nervous about what will happen to his wife if he's put in jail or left
penniless by civil litigation, Talley has started paying his utility bills
months ahead of time.

Although he can no longer see patients, his diplomas and medical license
still hang on his office wall.

"I'm a doctor," Talley says. "They can't take that away."

Law enforcement officials in the region around Talley's practice,
meanwhile, say they're relieved the clinic has closed.

But advocates for pain patients worry about those who couldn't quickly find
another doctor.

In late March, in a Spartanburg apartment decorated with pictures of
angels, Butch Cox talks about killing himself.

He had been seeing Talley for five years for degenerative disc disease and
painful back injuries. He also suffers from severe depression and anxiety.
Talley first prescribed OxyContin but later switched Cox, 43, to methadone
because it's cheaper.

With Talley out of business, Cox can't find a doctor willing to prescribe
heavy doses of painkillers and anti-depressant medication. His older
brother left his construction job to move in with Cox.

The brothers have called mental health centers, hospitals, crisis hotlines,
psychologists and doctors, but no one is willing to take Cox on long-term.

Crying in his dark apartment, head in his hands, Cox asks, "Where do I turn
now?"

Ten weeks later, on June 10, Cox was found dead in his bed. Officials have
not yet determined how he died.