DOCTOR DEFENDS PRESCRIBING POWERFUL PAINKILLERS

GROVER - One day after federal drug agents suspended his license to
prescribe narcotics, a Cleveland County family practitioner says he
did the right thing in prescribing powerful painkillers for almost all
of his patients.

Dr. Joseph Talley said four plain-clothes Drug Enforcement
Administration agents entered his clinic Wednesday, taking the
plastic-encased federal drug license off his desk and confiscating all
narcotics from the office.

Meanwhile, state medical examiners allege he failed to take
appropriate steps to weed out drug abusers, or properly examine,
diagnose and follow up with more than 20 patients to whom he
prescribed painkillers over the past decade.

The N.C. Medical Board has scheduled a hearing next month at which his
license to practice medicine can be suspended or revoked. And state
and local police say they are investigating whether he improperly
dispensed narcotics to patients, at least one of whom died.

The action followed a Dec. 19 raid in which DEA agents seized patient
records, filling more than 30 boxes with files and documents. Talley
said one of his two partners at the Grover Medical Clinic resigned
immediately after the raid. He said two nurses also have quit since
then.

DEA officials won't comment on Talley's case, saying it's part of an
ongoing investigation.

But Talley said Thursday he's been told to expect criminal charges,
and he's hired a criminal lawyer in Charlotte to defend him.

Talley, 64, acknowledges he prescribes large dosages of opioids --
powerful opium-based drugs including morphine and OxyContin -- to
patients for chronic pain. For example, Talley says that while some
doctors might prescribe 30 or 60 milligrams of morphine, he might
prescribe 300 milligrams. He's gotten popular as a result, with
patients hailing from as far away as California and Oklahoma and
praising his practice on Web sites for pain sufferers.

Talley says he's willing to risk being duped by the occasional abuser
or drug dealer if it means every person who's truly in pain gets
relief from the drugs he prescribes.

"The basic decision you've got to make is if society is better off --
if a patient is better off -- if you let a drug addict dupe you and
you play into his hands, or let a patient down who really has pain?"
Talley says. "It seems to me to be a no-brainer."

He said he prescribes narcotics for about 97 percent of his 3,000
patients, including about 1,300 who come in quarterly.

Talley said about half his patients fill their prescriptions at a
nearby pharmacy. A sign at his clinic, about 40 miles west of
Charlotte on the S.C. border, notes that two major chain stores will
no longer fill his prescriptions.

Today, Talley is wondering how many of his patients will bother coming
to see him since he can no longer prescribe the drugs they seek. He
says he's known as "the doctor of last resort" for patients whose own
doctors won't prescribe narcotics long-term.

The case against Talley comes as state medical boards, including North
Carolina's, publicly state physicians will not face scrutiny merely
for regularly prescribing opioids, which because they can be
habit-forming were not generally prescribed for long-term use.

But prescribing the drugs for relief of chronic pain, rather than to
terminal patients, requires higher vigilance on the part of doctors to
reduce the chance of being taken advantage of by a drug-seeker,
officials say.

"Any doctor can be duped. Even the best doctor can be duped. The
question is whether the overall pattern of conduct is such that they
can be duped on a regular basis," said David Joranson, senior
scientist and director of the Pain and Policy Studies Group at the
University of Wisconsin.

Talley acknowledges his willingness to prescribe powerful painkillers,
at times without ordering standard diagnostic tests. Even
sophisticated tests can't always pinpoint the cause of chronic pain or
help in treating it, he said.

Talley says he has corresponded with members of the medical board for
more than a decade to advise them on how he's treating patients.

The lawyer who is defending him before the medical board, Robert Clay
of Raleigh, said that's a sticking point in the case.

"They've had the opportunity to look at what he's done for 11 years.
They've never given him any warning, expressed anything" wrong, he
said. "He's written to them on many occasions."

"The medical board has said in position statements that they want to
encourage doctors to do exactly what he's doing," he said. "The
medical board has said that doctors who practice within acceptable
standards of care need not fear the medical board."

On Thursday, Talley blinked away tears as he talked about patients who
will be in pain or suffer withdrawal without his prescriptions. He
said he expects some of his patients will "be vomiting and sweating
and seeing a little green monster or two."