OXYCONTIN PRESCRIBERS FACE CHARGES IN FATAL OVERDOSES

Moving against what law enforcement officials say is a boom in "pill
mills," prosecutors are charging doctors with murder or manslaughter in the
deaths of patients from overdoses of prescription drugs, including the
powerful painkiller OxyContin.

In a Florida courtroom this week, Dr. James Graves went on trial on
manslaughter charges stemming from the overdose deaths of four people for
whom he had prescribed OxyContin and other drugs; next month in a
California state court, a similar case is to begin against Dr. Frank B.
Fisher. Last year, Florida prosecutors charged Dr. Denis Deonarine with
first-degree murder in connection with a fatal overdose.

Legal experts said it was extremely rare for a doctor to be charged with
murder or manslaughter because of their prescribing practices. Doctors
accused of improperly dispensing drugs have usually been charged with fraud
or with illegally prescribing controlled substances.

"I have never seen anything like this before," said Dr. Leonard Hurwitz, a
pain management specialist and lawyer in McLean, Va., who helps defend
doctors accused of inappropriately or illegally prescribing narcotics.

The three doctors facing manslaughter or murder charges have all pleaded
not guilty and the battle lines in the cases are remarkably similar. The
doctors maintain that they were serving the needs of low- income patients
in chronic pain with aggressive techniques that rely on narcotics like
OxyContin, often in high dosages. And they insist that while law
enforcement officials find such techniques suspect, they reflect widely
accepted medical practice.

But prosecutors say such doctors used changing medical views about
narcotics as cover for lucrative practices in which patients pay $100 a
visit not for treatment but for a new prescription for pills.

During opening arguments Tuesday in the trial of Dr. Graves, the assistant
state attorney, Russ Edgar, told an 11-member jury in Milton, Fla., that
the defendant had ignored pleas from pharmacists and patients' families to
cut back on his narcotics prescribing. The reason, Mr. Edgar said, was that
Dr. Graves was making too much money to stop.

"Mother after mother after mother called the defendant's office and asked
him to quit giving their children drugs or they would die," said Mr. Edgar.
"The defendant did not quit and they continued to OD and die."

High-profile cases like the one involving Dr. Graves come as federal and
state law enforcement officials appear to be intensifying their pursuit of
doctors they suspect of illegally or improperly prescribing OxyContin. The
federal Drug Enforcement Administration opened 45 such investigations in
the year ended last September, up from just two in 1999, according to the
drug agency's data.

Many doctors charged or under investigation prescribe other narcotics and
tranquilizers in addition to OxyContin. But it is OxyContin, and the
intense publicity its use has received, that appears to be propelling the
stepped-up pace of prosecutions.

"OxyContin has led to a whole resurgence of pill mills," said Terry
Woodworth, the deputy director of the drug agency's division of diversion
control, which monitors trafficking in controlled substances.

OxyContin, which when properly used releases timed doses of the synthetic
opiate oxycodone, was originally marketed by its maker, Purdue Pharma of
Stamford, Conn., as less prone to misuse than other narcotics. But abusers
quickly learned they could defeat the pill's safeguard by crushing it and
get far higher doses of the narcotic than they could from similar drugs.
Over the past two years, OxyContin abuse has been cited as a likely
contributing factor in 300 overdose deaths nationwide.

Advocates for doctors facing indictments or trials say that they have been
unfairly singled out by overzealous prosecutors and cannot be held
responsible for what patients do with the drugs once they leave a doctor's
office.

Dr. Hurwitz, the pain specialist and lawyer, said that many doctors like
himself believe that large daily doses of narcotics like OxyContin are an
acceptable way to treat chronic pain. But he says his own experience has
shown him that such practices can quickly bring a doctor to the attention
of law enforcement; in the past decade his medical license has been
suspended and revoked over narcotics prescriptions; it has since been
reinstated.

"When they see anybody prescribing these meds they think the worst and
presume the worst, and if there is a bad outcome they act as aggressively
as they can," he said.

For his part, Dr. Fisher, the California doctor who is about to stand trial
on manslaughter charges, said that he believed that his only crime was
aggressively treating pain in poor residents of Redding, a town 150 miles
north of Sacramento. He became the biggest prescriber of OxyContin under
the state's health insurance program for the poor, Medi-Cal, and it was the
$1 million price tag associated with those prescriptions, he says, not any
illegal prescribing, that brought law enforcement officials down on him.

"The money drove them over the edge," Dr. Fisher said. "There is also the
ideology that these are dangerous, evil drugs."

Whatever the reason, state police officials in early 1999 arrested him
along with a local pharmacist and his wife for their roles in what the
authorities said was a huge "pill mill" operating out of Dr. Fisher's
clinic. He was originally indicted on murder charges in connection with
fatal overdoses; those charges have been reduced to involuntary manslaughter.

Sandra Michioku, a spokeswoman for the California state attorney general,
said of Dr. Fisher's case only that "the complaint was filed because it was
believed that there were deaths related to improper prescriptions."

While the most serious charges against Dr. Fisher were reduced, Dr.
Deonarine, of Jupiter, Fla., was charged by state prosecutors last July
with murder in connection with a patient overdose death as part of an
80-count indictment. Barbara Burns, an assistant state attorney in the Palm
Beach County prosecutor's office, said the murder charge was made under the
state's felony murder statute, meaning it resulted from another accusation
against Dr. Deonarine — specifically, trafficking in controlled substances.

Dr. Deonarine, who has pleaded not guilty, could face the death penalty or
life imprisonment if convicted on the murder charge.

The cases of Dr. Deonarine and Dr. Fisher may both play out along the lines
of the trial of Dr. Graves now underway in Florida Circuit Court in Milton,
near Pensacola. In his opening statement on Tuesday, the doctor's lawyer,
Michael Gibson, said that the deaths of four of his patients had resulted
from their abuse of OxyContin, not from his client's prescription of it.

He also said that the 54-year-old doctor, who practiced in Pace, a town
near Pensacola Bay, made patients sign "pain contracts" in which they
promised to follow his directions. If a patient lied, he said, there was
little Dr. Graves could do about it.

"Addicts are not dumb," said Mr. Gibson. "They lie, make up things and
exaggerate things."

The lawyer added that Dr. Graves had attracted scrutiny because of a
"struggle in the medical community about how to treat pain."

But Mr. Edgar, the prosecutor, charged that the doctor had bragged that
treating pain patients was a "gold mine" that he could apparently work with
little effort because he rarely examined patients or filled out medical
records.

His reputation as running a "prescription mill" was widely known among
addicts, Mr. Edgar charged. "The word spread that he was the go-to doctor
to get pills," he said.

Dr. Graves's trial is expected to take at least four weeks; he faces up to
30 years in prison if convicted on all charges. It is not clear yet if he
will take the stand in his own defense, but during a pretrial hearing in
July he is reported to have made one comment about his practice.

"It's what doctors do," said Dr. Graves. "Prescribe drugs."