Prescription drug abuse: Investigating 'pill doctors'

It takes a tremendous amount of evidence and proof before medical review boards will even think of suspending a doctor’s license, let alone revoke it

The drug landscape has shifted dramatically in recent years and law enforcement agencies now find themselves battling the legal system. Prescription drug abuse — the intentional use of medication without a prescription or taken in a way other than as prescribed — has skyrocketed in recent years. 

In 2010, approximately 7 million people were current users of psychotherapeutic drugs taken nonmedically, according to the National Institute on Drug Abuse (NIDA). The most popular drugs for abuse are opioids, and include drugs like Vicodin and OxyContin. 

According to NIDA, 2.5 million people abuse prescription opioids for the first time every year. Since 1994, use of opioids for non-medical purposes has grown 450 percent. 

And, this epidemic is especially inviting to younger generations. Nearly one in 12 high school seniors reported nonmedical use of Vicodin and one in 20 reported abuse of OxyContin, according to NIDA. 

On April 2-4, the National Rx Drug Abuse Summit in Orlando, Fla. brought together law enforcement officials, local, state, and federal agencies, businesses, academia, clinicians, educators, and state and national leaders. Keynote speakers included several members of Congress as well as New York City Governor Michael Bloomberg. 

The conference was an effort to coordinate action and focus on ways to work together to fight against prescription drug abuse. American Military University’s James Deater was one of the presenters at the conference. 

His session, Undercover Investigations, focused on helping law enforcement refine their investigation efforts. 

The Rise of Pill Doctors
One of the primary issues for law enforcement is that many people are obtaining prescription drugs through legal channels. “Unfortunately, there are more of these pill doctors out there than most people realize,” he said. During his presentation to a crowd nearing 250 attendees, Deater focused on how police can investigate and build cases against legally licensed pill doctors. 

During a case in Maryland, one pill doctor — a licensed practitioner authorized by the DEA to prescribe narcotics — was charging $300 for a written prescription. 

The investigation by the Maryland State Police included extensive undercover police work. As a result, officers regularly observed between 15 and 20 individuals lined up outside the house where the doctor ran his practice.

“The biggest issue is that these people are doctors,” Deater said. “As unfair as it sounds, it takes a tremendous amount of evidence and proof before medical review boards will even think of suspending a doctor’s license, let alone revoke it.”

During his 24 years in law enforcement, Deater spent 15 years in the Homeland Security and Intelligence Bureau. He investigated large-scale national and international drug trafficking organizations, homicides and gangs. He found that the average case involving doctor prescriptions and illegal drug prescriptions took about 18 months. 

“That's about the time it takes for law enforcement and review boards to garner enough evidence to prosecute these doctors,” he said. The Maryland case was investigated for more than 10 months and resulted in $1.4 million in cash deposits from illegal prescriptions.

The Role of Pharmacies
In addition to fraudulent doctors, pharmacies also have had a large role in the distribution of illegally prescribed doctors. There have been several instances of collusion between pharmacies and doctors where pharmacies willingly fill prescriptions they suspect to be fradulent. 

However, Deater said many pharmacies do contact law enforcement when they receive what appears to be either an illegal prescription (possibly the result of a stolen prescription pad) or a fradulent prescription issued by a pill doctor. 

During his presentation, Deater urged law enforcement officers to take prescription drug cases seriously. 

“If law enforcement gets a tip about a kid using pills, they should really give it a look, no matter how small it appears to be,” Deater said. “Investigating further may find the doctor involved and the bigger supplier who has access to a doctor.”

Prescription Drug Abuse
There have been some recent wins in the fight against prescription drug abuse. On April 16, the Food and Drug Administration said it would not approve generic versions of the OxyContin, the painkiller that symbolized a decade-long epidemic of prescription drug abuse, according to the New York Times

The original version of the drug, approved in 1995, could easily be crushed to remove the time release element of the drug. However, a new version of OxyContin turns to a jellylike mass when crushed.  

There has also been discussion about the importance of doctor’s changing to digital means of prescribing drugs to patients. “With the technology available there’s no reason we can’t digitize prescription pads,” Deater said. Surprisingly, there is a lot of kickback from doctors and others opposed to digitizing prescription pads. 

Even with some of these changes, or potential changes in place, Deater had a dire warning for conference attendees. “This has escalated to a level worse than the 1980s epidemic of crack with so many people overdosing and getting hooked,” he said. 

“The pill world is so inviting to younger crowds, you no longer have to go to downtown LA or Miami where you’re worried about getting robbed or shot. You can just seek out a pill doctor or a dealer in nice area and pay some money and get pills.”

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