TINY TOWN LOOMS BIG ON U.S. MAP AS NO. 1 SOURCE OF DISPUTED PAINKILLER

The two doctors in tiny 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 Dr. Talley's
clientele may be going to Grover not seeking treatment but for a narcotic high.

Dr. Talley's practice is now in question. Late last month, the federal Drug
Enforcement Administration suspended Dr. Talley's license to prescribe
controlled substances, a regulatory classification that includes narcotics
like OxyContin but not more commonly used drugs like penicillin. The agency
called Dr. Talley an "imminent threat to public health and safety,"
charging that he had prescribed drugs like OxyContin and methadone, which
is also used as a pain medication, to patients who were drug dealers or
drug abusers. The agency said that at least 23 of Dr. 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 Dr. Talley charging that he had failed, among other things,
to examine patients properly before prescribing narcotics or to monitor how
they used the drugs.

Dr. 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," Dr. 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 possible 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 Dr. 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.

Dr. 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, he 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 specialists scrutinize patients' drug use with urine tests and
other means to see whether they are taking narcotics as prescribed or
possibly selling them on the street, Dr. 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-1990's 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 Dr.
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.

Dr. Day, the other doctor in Grover, a town of 600 people on the South
Carolina border, said he still respected Dr. Talley but believed that he
may have 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," Dr. Day said. "I
think he lost his grip."

Dr. Talley said he 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 Dr. Talley lost his right to prescribe narcotics, 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.

Ms. 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. Ms. Malone said she found relief from Dr.
Talley, who prescribed a high dose of OxyContin.

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

But other patients of Dr. Talley's 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.

Dr. Talley said he heard rumors about a year ago of two overdose deaths in
Ms. Morris's 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 Ms. 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 Dr. 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 that most of those prescriptions came from Dr. Talley's
clinic, which until recently employed two other doctors.

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

Dr. 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.

Dr. Talley said that he trusted his patients and that if a few drug abusers
slipped by him, there was just so much he could do. "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 permit to prescribe narcotics suspended, he had been
working nonstop to find other doctors and clinics to see his patients. Ms.
Malone, the accident victim, said she had lined up a doctor, though the
change will require her to drive eight hours, to Virginia.

But Dr. 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
Dr. Talley's patients off drugs when they felt they could not get that help
at the clinic.

"He knew this was going to happen," Dr. 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."

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

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