Part 5 Of 6

DRUG WARS

Prescription Drugs Snare New Generation Of Abusers: Millions Addicted To
Pain Killers And Anxiety Drugs; Cost To Health Care System Is Billions

The dealers rounded up carloads of addicts and drove them to doctors'
offices, emergency rooms and health care clinics across Florida. At each
stop, physicians prescribed pharmaceuticals for them that were in demand on
the street.

The addicts were then shuttled to pharmacies where they exchanged their
prescriptions for pills. But instead of taking the medicines, police said,
the addicts gave them to the dealers in return for illegal drugs or cash.

The dealers shipped about 5,000 OxyContin pills a week north to Norwood and
Winthrop, where they had local connections, and from there they sold them
to users throughout Massachusetts.

State Police Lt. Arthur McLaughlin said the drug ring peddled $200,000
worth of pills a week until a special squad of federal, state and local
investigators busted them several months ago.

McLaughlin, a member of the squad, said 95 percent of the prescription
drugs purchased by the Florida-Massachusetts ring were paid for by
Medicaid, the taxpayer-funded program that provides health care to the
nation's most economically depressed people.

Across the United States, billions of health care dollars are eaten up by
drug abusers who defraud private and public health insurers to obtain
pharmaceuticals. When public health insurers like Medicaid lose money, so
do taxpayers, and it isn't chump change.

MassHealth, the Medicaid program in Massachusetts, pays out millions every
year for fraudulent prescriptions and junkies' prescription-culling doctor
visits. Taxpayers also spend additional hundreds of millions of dollars
prosecuting and jailing offenders and on programs to rehabilitate users and
identify their enablers in the health care system.

The use and abuse of powerful prescription drugs have expanded rapidly in
recent years. Domestic sales of prescription medications totaled $145
billion in 2000, up 14.9 percent from the prior year, according to IMS
Health, which tracks trends in the pharmaceutical industry.

Health industry experts say Americans have become more comfortable with
taking medication. Additionally, public awareness of the benefits of
prescription drugs has risen, in large part because of direct marketing.
And diversion and abuse have grown with the number of prescriptions being
filled.

Millions of Americans are addicted to pain killers, anxiety drugs and
amphetamines. While some of these addicts are street junkies, most have
jobs and families. Police say prescription drug abusers often are people
who would never consider using a drug that didn't come from a pharmacy.

"Research shows more people are addicted to licit drugs than illicit
drugs," McLaughlin said. "The medical community calls pharmaceutical
addiction the hidden epidemic."

In 1999, 1.5 million people reported abusing pain relievers for the first
time, according to the U.S. Department of Health and Human Services. That
is four times as many as in 1980, the department said, and roughly half of
the first-time abusers in 1999 were between 12 and 17 years old. The 1999
figures are the most recent available.

Taxpayers underwrite these addictions. Addicts often perpetrate fraud to
get the prescription drugs they seek. Although MassHealth officials say
they can't estimate how much fraud is committed annually, the National
Health Care Anti-Fraud Association, a health-care fraud watchdog, estimates
fraud makes up between 3 percent and 10 percent of all insurance payments.
Conservative estimates indicate prescription fraud makes up roughly 6
percent of all medical fraud.

In 2000, MassHealth spent roughly $4.4 billion, including about $800
million on its pharmacy program. If a minimum of 3 percent of the total is
being swallowed up by fraud, MassHealth could be losing $132 million a year
for all types of fraud. Additionally, MassHealth could have paid out nearly
$8 million for fraudulent prescriptions.

Americans have been abusing prescription drugs for decades. In the '70s,
the drug of choice was Valium, called the housewife's heroin. In the '80s,
Percoset and Dilaudid, highly addictive painkillers, were popular. In the
'90s, people again turned to painkillers, in particular Percoset and
Vicodin. They also used Xanax, a tranquilizer. Today, the most sought after
drug is OxyContin, a painkiller that when abused produces a heroin-like rush.

Doctors who turn their offices into prescription factories cost taxpayers
millions of dollars a year for fraudulent office visits and prescriptions.

MassHealth pays $60 for an office visit, and State Police said addicts can
visit six doctors in one day. That's a $360 daily drain on health care
dollars - for one abuser.

MassHealth tries to minimize loss. The agency uses a computerized database
to keep patients from filling multiple prescriptions for the same drug. But
addicts will steal or borrow IDs, and if doctors and pharmacists don't
check them, there isn't much MassHealth can do about it.

"If a person walks in (to a pharmacy) with six prescriptions for OxyContin,
they won't be filled," said Richard McGreal, spokesman for the state
Division of Medical Assistance, which administers MassHealth. "The system
will also prohibit you from getting OxyContin today at CVS and tomorrow at
Brooks. We won't pay that claim. Are there other ways to get it filled? Sure."

On the street, the Medicaid card is called the "Gold Card" because those
who have one seldom have their identities verified, police said.

MassHealth knows this and so has additional controls in place. Among other
things, the public health insurer uses primary care physicians to control
the flow of office visits and prescriptions. But if a doctor is bad,
McGreal said, there isn't much MassHealth can do.

Sgt. Francis M. O'Brien is a member of the State Police Narcotics Diversion
Investigative unit. He said doctors who write fraudulent prescriptions can
be the biggest problem of all, even though there aren't many of them. Last
year, the state cited 10 of the 30,000 doctors in Massachusetts for abusing
their prescribing powers, and almost all of them were writing prescriptions
for themselves. But even one doctor writing phony scrips can be devastating.

One doctor "can create havoc," O'Brien said. "You can get 30,000 or 40,000
prescriptions over a pretty short time."

The last two doctors prosecuted by the Medicaid fraud control unit in the
Attorney General's office made $400,000 each from fraudulent office visits
and prescriptions, according to Nicholas Messuri, the chief of that unit.

"They're just a drug dealer with a prescription pad," Messuri said.

If the first line of defense is the doctor, the pharmacy is the second
defense against misuse of legal drugs.

The state Board of Registration in Pharmacy currently licenses 9,778
pharmacists, 1,014 pharmacies and 71 wholesale distributors. During the
state fiscal year that ended last June 30, two licensees were suspended,
seven were placed on probation and one license was surrendered voluntarily
for diversion.

Bad pharmacists, like bad doctors, are rare, but they can pump thousands of
pills onto the streets. The real problem, however, is usually one of
logistics. Pharmacists are busy and don't have the time to check that every
customer is who he says he is. The law states pharmacists must only make a
"good faith effort" to confirm a customer's identity.

"The diverters know which pharmacies are really busy and when they're the
busiest," McLaughlin, the State Police lieutenant, said. "They'll call in
prescriptions when the pharmacists are too busy to check their validity,
when people are coming home from work, or near closing time. They'll
actually monitor those pharmacies to determine when they're the busiest."

Another way pharmaceuticals get into the wrong hands is through call-ins,
which McLaughlin said are one of the most common methods used to obtain
prescription drugs illegally. Pill seekers pose as someone authorized to
request a prescription, phone it in to a pharmacy and never send in the
prescription. McLaughlin said the odds are pretty good that the pill seeker
will score at least once a day.

This is why the scam works. The federal government regulates prescription
drugs by grouping them in categories, called schedules, which identify
their medical usefulness and potential addictiveness. Schedule I drugs,
like heroin, cannot be prescribed in the United States, have high potential
for abuse and have no accepted medical value in this country.

Schedule II drugs, like morphine, are the most tightly controlled legal
drugs because they have a high potential for abuse. But unlike Schedule I
drugs, they are accepted for medical use. Lesser restrictions apply to
drugs on the remaining schedules because they are believed to be less
addictive.

Full prescriptions for legal drugs other than those on Schedule II can be
called in to pharmacies by doctors, nurses or medical-office receptionists,
something that is convenient for legitimate patients, but often abused by
pill seekers. A hard copy of the prescription isn't necessary, although one
is supposed to be supplied within seven days of the phone order.

There are some system-wide controls in place that help minimize
prescription fraud, but they are not foolproof.

One method is drug tracking. The most dangerous and addictive legal drugs,
classified as Schedule II and Schedule III drugs, are tracked by the U.S.
Drug Enforcement Administration. The DEA assigns a registration number to
all Schedule II and III narcotics and uses it to follow the pills from the
time they're manufactured until they reach the dispenser.

Once the drug reaches the dispenser, the paper trail is picked up by the
state Department of Public Health, but the state follows only Schedule II
drugs.

Under the state program, Schedule II drugs are tracked from the pharmacy to
the end user and pharmacists must report how much of each drug was
prescribed, the prescriber's DEA number, a pharmacy identification number
and other information. That information goes to the state Department of
Public Health, where it is entered into a database known as the Electronic
Data Transfer System, or EDT.

Massachusetts is one of only 15 states with a prescription-monitoring
program. But the state database is not linked to the federal tracking
system, something that can slow down law enforcement efforts.

The state looks at the information it collects for prescribing trends, and
can analyze the data in response to requests from law enforcement or
regulatory agencies, but it seldom provides police or regulatory agencies
with unsolicited information based on its findings.

"It could be used to identify questionable data, but it's a matter of
resources and priorities," said Grant Carrow, the director of the state
drug control program that runs the EDT. "We have to use the resources to
meet the highest priorities, and the highest priorities in this program are
to assist law enforcement and regulating agencies to pursue ongoing
investigations."

So the data that could tell law enforcement and regulatory agencies which
doctors prescribe the most OxyContin or which pharmacies supply the most
Ritalin is collected but not used unless it's asked for. Carrow said if the
program had more resources, it would be an easy leap from collecting the
data to disseminating it.

"We certainly could provide more information to law enforcement, provided
they would want it," he said.

McLaughlin said he'd take all the information the EDT could provide. "The
more intelligence we have, the quicker we can solve these cases and the
more cases can be solved," he said.

There are other ways the EDT tracking system could become more effective.
Popular painkillers, such as Vicodin, codeine-based drugs and anti-anxiety
drugs, such as Valium, Xanax and Klonopin, are not monitored in
Massachusetts because they are not Schedule II drugs. Police say 70 percent
of the investigations conducted by diversion investigators involve these
and other non-Schedule II drugs. These lower-schedule prescriptions are
refillable (Schedule IIs are not), making their abuse even more difficult
to stem.

Expanded monitoring of prescription drugs would help derail the
distribution networks for both pharmaceuticals and illegal drugs, according
to police who combat diversion. "It would not only help find illicit use of
pharmaceuticals, but it would help us find illegal drug users," said
O'Brien of the State Police narcotics unit. "They're the same people and
the paper trail makes it easier."

Police also hope the regulation of the way prescriptions are written will
increase, and one sought-after step is serialization.

With such a regulation, doctors would receive a state-supplied prescription
pad with numbered pages. If somebody stole it, the doctor would know what
pages were missing. Pharmacists would also know that if they received a
prescription with a number assigned to one doctor, but signed by another,
the prescription was fraudulent.

Eventually, police hope paper prescriptions will become a thing of the
past. Electronic prescriptions are the wave of the future. These would be
written on the doctor's computer, protected by code words and E-mailed to
pharmacies. Pharmacies would have some way to confirm that the E-script
came from a particular doctor's office.

It is expected that sometime this year, the DEA will propose new
regulations to allow electronic transmissions for prescriptions.

"That would eliminate forged scripts," McLaughlin said. But, he noted,
"Some computer hackers would find a way, but then you'd have a trail to
follow."

In this series:

DRUG WARS

Today: Our Pill-Popping Nation

Far more people abuse prescription drugs than ever touch cocaine or heroin.
It the silent epidemic

Friday: Is There A Better Way?

To anti-drug warriors, it's simple: do everything we've been doing and
more. But drug-policy reformers say that's doing more harm than good