A DUBIOUS DISTINCTION FOR THE TOWN OF GROVER

The two doctors in Grover, N.C., are separated by a few streets, a
world of trouble and a tiny drugstore crammed inside a house trailer
that is this country's biggest retailer of the painkiller OxyContin.

Sharing a parking lot with that drugstore is a clinic run by one
physician, Dr. Joseph H. Talley, a self-styled specialist in pain
treatment described by some of his patients as their best hope for
relief.

But the town's other doctor, Dr. Philip M. Day, says he has watched
the pain clinic's growing practice with concern that some of Talley's
clientele came to the town on the Cherokee County border not seeking
treatment, but for a narcotic high or to get drugs like OxyContin to
sell on the street.

But Talley's clinic may be closing soon. Late last month, the federal
Drug Enforcement Administration suspended Talley's license to
prescribe controlled substances, calling him an ''imminent threat to
public health and safety.'' The agency charged that Talley had
prescribed drugs like OxyContin and methadone, which is also used as
a pain medication, to patients who were drug dealers or drug abusers
and that at least 23 of Talley's former patients had died ''in part,
due to drug overdoses.''

The action follows a complaint by the North Carolina Medical Board in
October against Talley charging that he had failed, among other
things, to examine patients properly before prescribing narcotics or
to monitor how they used the drugs.

Talley disputed the drug agency's charges and the complaint by the
medical board and said he planned to contest them. He said that while
he was aware that some of his patients had died, he had no way of
knowing that they had been drug abusers or whether drugs he
prescribed had played any role in their deaths. ''We don't have any
way to know that,'' Talley said. ''Some of these people are skilled
and they'll get by you.''

As misuse of OxyContin has spread nationwide, lawmakers and others
have looked to causes like the aggressive promotion of the drug by
its producer, Purdue Pharma of Stamford, Conn. But officials say that
another facet of that problem may be doctors like Talley, who are so
enthusiastic about the useful role of narcotics in pain treatment
that they become targets for drug seekers or fail to detect patients
prone to addiction.

Talley makes no bones about his lack of formal training in pain. An
outgoing man who in his light blue exam coat and suspenders looks the
part of the country doctor, Talley jokes that he would fail any tough
test to certify him as a pain expert, because he only uses drugs to
treat pain. While many pain specialists now scrutinize patient drug
use with urine tests and other means to see whether they are taking
narcotics as prescribed or possibly selling them on the street,
Talley says he does not use such tests because they are unreliable.

He said addiction through prescribed use of narcotics was relatively
rare. He pointed to studies championed by pain management experts in
the mid-1990s that found that chronic pain patients could be safely
treated with narcotics without fear of addiction.

''When I heard about those studies, I was dancing in the street,''
said Talley, 64, who until recently specialized in treating
depression.

But some pain experts cautioned that those studies may have limited
value because they involved patients in controlled settings like
hospitals rather than the public.

Day, the other doctor in Grover, a town of 600 people, said he still
respected Talley but believed that he had lost the ability in recent
years to distinguish real patients from others seeking drugs for
themselves or to sell. ''If a doctor is not careful, patients are
going to start running the office,'' Day said. ''I think he lost his
grip.''

Talley said he accidentally became a pain specialist almost by
accident about three years ago. At that time, the federal authorities
shut down a South Carolina doctor accused of improperly prescribing
narcotics, and he inherited that doctor's patients. Then, as more
doctors faced regulatory action or scrutiny, more patients followed.

His name soon circulated among pain sufferers and on an Internet site
run by the American Society for Action on Pain, a patient group that
argues that doctors have long failed to treat pain properly because
of unfounded addiction fears.

A few days before Talley lost his right to prescribe drugs, Desiree
Malone, who said she found his name through the group's Web site, sat
in his treatment room, her head and shoulders hunched together.

Malone said she had suffered incessant pain since a car accident two
years ago that crushed and broke bones. Many doctors, she said,
refused to treat her with long-acting narcotics like OxyContin,
saying they feared scrutiny by the drug agency. Malone said she found
relief from Talley, who prescribed a high dose of OxyContin.

''I can't believe anyone would want to do anything to Dr. Talley,''
said Malone, 37. ''All this man does is take care of patients.''

But other patients of Talley have come to the attention of law
enforcement officials. In December, federal officials arrested Debra
Lynn Morris, charging her with conspiracy to distribute OxyContin and
methadone illegally.

Talley said he heard rumors about a year ago of two overdose deaths
in Morris' apartment but said he had continued to prescribe her
narcotics because he was unable to confirm the rumors with the local
authorities.

It was not long after the arrest of Morris, who has pleaded not
guilty, that federal drug enforcement agents arrived at the Medi-Fair
Drug Center, the tiny pharmacy here that shares a parking lot with
Talley's clinic.

An owner, Billy Wease, said a federal drug agent told him that agency
data showed that the pharmacy was the largest retailer of OxyContin
in the nation. He said the vast majority of those prescriptions came
from Talley's clinic which, until recently, employed two other
doctors.

''I didn't realize we were No. 1,'' Wease said. ''All I was filing
was what was coming through.''

Talley said he, too, was struck by the federal data. He said that the
clinic treated about 1,000 patients and that about 30 percent of the
prescriptions he wrote were for OxyContin. ''That automatically makes
me the biggest prescriber of OxyContin in the U.S.,'' he said. That
means that there are ''a lot of guys out there who are not doing
their job by prescribing this drug,'' he said.

Federal and state law enforcement officials declined to be
interviewed for this article other than to say that a criminal
investigation was under way and that the pharmacy data were accurate.

Talley said that he trusted his patients and that if a few drug
abusers slipped by him, so be it. ''If the addict fools me and gets
his fix, well at least he got a safe drug to abuse,'' he said. ''But
if I tell this guy in terrific pain I'm not going to treat his pain
and I think you are an addict, that just adds insult to injury. It is
just devastating.''

He said that with his license suspended, he had been working nonstop
to find other doctors and clinics to see his patients. Malone, the
accident victim, said she had lined up another doctor, though the
change will require her to drive eight hours to Virginia.

But Day said he feared his practice would be flooded with patients
going through drug withdrawal. He said he had already had to wean
some of Talley's patients off drugs when they felt they could not get
that help at the clinic.

''He knew this was going to happen,'' Day said. ''We had talked about
it. I have a hard time with his tremendous use of these medications
and deaths of patients that could have been prevented.''

Talley said any patient who wanted to stop using narcotics could get
that help at the clinic. As for this ability to tell good patients
from bad ones, Talley said he was inclined to wait for someone
besides Day to make that call.

''I'll find out what my batting average was when I meet St. Peter,''
Talley said. ''Maybe I got 19 out of 20 right. Maybe I did 50-50.
That's what I'll be judged on.''