|
Day
1
|
Day
2
|
Day
3
|
Day
4
|
Day
5
|
Day
6
|
|
|
Story:
|
Prescription
DRUGS
snare new generation of ABUSERS
Millions addicted to pain killers and anxiety drugs; cost to health care system is billions
The dealers rounded up carloads of addicts and drove them to doctors’ offices, emergency rooms and health care clinics across Florida. At each stop, physicians prescribed pharmaceuticals for them that were in demand on the street.
 |
|
GARY HIGGINS photo illustration
/The Patriot Ledger |
The addicts were then shuttled to pharmacies where they exchanged their prescriptions for pills. But instead of taking the medicines, police said, the addicts gave them to the dealers in return for illegal drugs or cash.
The dealers shipped about 5,000 OxyContin pills a week north to Norwood and Winthrop, where they had local connections, and from there they sold them to users throughout Massachusetts.
State Police Lt. Arthur McLaughlin said the drug ring peddled $200,000 worth of pills a week until a special squad of federal, state and local investigators busted them several months ago.
McLaughlin, a member of the squad, said 95 percent of the prescription drugs purchased by the Florida-Massachusetts ring were paid for by Medicaid, the taxpayer-funded program that provides health care to the nation’s most economically depressed people.
Across the United States, billions of health care dollars are eaten up by drug abusers who defraud private and public health insurers to obtain pharmaceuticals. When public health insurers like Medicaid lose money, so do taxpayers, and it isn’t chump change.
MassHealth, the Medicaid program in Massachusetts, pays out millions every year for fraudulent prescriptions and junkies’ prescription-culling doctor visits. Taxpayers also spend additional hundreds of millions of dollars prosecuting and jailing offenders and on programs to rehabilitate users and identify their enablers in the health care system.
| Millions of Americans are addicted to pain killers, anxiety drugs and amphetamines. While some of these addicts are street junkies, most have jobs and families. |
The use and abuse of powerful prescription drugs have expanded rapidly in recent years. Domestic sales of prescription medications totaled $145 billion in 2000, up 14.9 percent from the prior year, according to IMS Health, which tracks trends in the pharmaceutical industry.
Health industry experts say Americans have become more comfortable with taking medication. Additionally, public awareness of the benefits of prescription drugs has risen, in large part because of direct marketing. And diversion and abuse have grown with the number of prescriptions being filled.
Millions of Americans are addicted to pain killers, anxiety drugs and amphetamines. While some of these addicts are street junkies, most have jobs and families. Police say prescription drug abusers often are people who would never consider using a drug that didn’t come from a pharmacy.
“Research shows more people are addicted to licit drugs than illicit drugs,’’ McLaughlin said. “The medical community calls pharmaceutical addiction the hidden epidemic.”
In 1999, 1.5 million people reported abusing pain relievers for the first time, according to the U.S. Department of Health and Human Services. That is four times as many as in 1980, the department said, and roughly half of the first-time abusers in 1999 were between 12 and 17 years old. The 1999 figures are the most recent available.
Taxpayers underwrite these addictions. Addicts often perpetrate fraud to get the prescription drugs they seek. Although MassHealth officials say they can’t estimate how much fraud is committed annually, the National Health Care Anti-Fraud Association, a health-care fraud watchdog, estimates fraud makes up between 3 percent and 10 percent of all insurance payments. Conservative estimates indicate prescription fraud makes up roughly 6 percent of all medical fraud.
In 2000, MassHealth spent roughly $4.4 billion, including about $800 million on its pharmacy program. If a minimum of 3 percent of the total is being swallowed up by fraud, MassHealth could be losing $132 million a year for all types of fraud. Additionally, MassHealth could have paid out nearly $8 million for fraudulent prescriptions.
Americans have been abusing prescription drugs for decades. In the ’70s, the drug of choice was Valium, called the housewife’s heroin. In the ’80s, Percoset and Dilaudid, highly addictive painkillers, were popular. In the ’90s, people again turned to painkillers, in particular Percoset and Vicodin. They also used Xanax, a tranquilizer. Today, the most sought after drug is OxyContin, a painkiller that when abused produces a heroin-like rush.
Doctors who turn their offices into prescription factories cost taxpayers millions of dollars a year for fraudulent office visits and prescriptions.
MassHealth pays $60 for an office visit, and State Police said addicts can visit six doctors in one day. That’s a $360 daily drain on health care dollars - for one abuser.
| Doctors who turn their offices into prescription factories cost taxpayers millions of dollars a year for fraudulent office visits and prescriptions. |
MassHealth tries to minimize loss. The agency uses a computerized database to keep patients from filling multiple prescriptions for the same drug. But addicts will steal or borrow IDs, and if doctors and pharmacists don’t check them, there isn’t much MassHealth can do about it.
“If a person walks in (to a pharmacy) with six prescriptions for OxyContin, they won’t be filled,” said Richard McGreal, spokesman for the state Division of Medical Assistance, which administers MassHealth. “The system will also prohibit you from getting OxyContin today at CVS and tomorrow at Brooks. We won’t pay that claim. Are there other ways to get it filled? Sure.”
On the street, the Medicaid card is called the “Gold Card” because those who have one seldom have their identities verified, police said.
MassHealth knows this and so has additional controls in place. Among other things, the public health insurer uses primary care physicians to control the flow of office visits and prescriptions. But if a doctor is bad, McGreal said, there isn’t much MassHealth can do.
Sgt. Francis M. O’Brien is a member of the State Police Narcotics Diversion Investigative unit. He said doctors who write fraudulent prescriptions can be the biggest problem of all, even though there aren’t many of them. Last year, the state cited 10 of the 30,000 doctors in Massachusetts for abusing their prescribing powers, and almost all of them were writing prescriptions for themselves. But even one doctor writing phony scrips can be devastating.
One doctor “can create havoc,” O’Brien said. “You can get 30,000 or 40,000 prescriptions over a pretty short time.”
The last two doctors prosecuted by the Medicaid fraud control unit in the Attorney General’s office made $400,000 each from fraudulent office visits and prescriptions, according to Nicholas Messuri, the chief of that unit.
“They’re just a drug dealer with a prescription pad,” Messuri said.
If the first line of defense is the doctor, the pharmacy is the second defense against misuse of legal drugs.
The state Board of Registration in Pharmacy currently licenses 9,778 pharmacists, 1,014 pharmacies and 71 wholesale distributors. During the state fiscal year that ended last June 30, two licensees were suspended, seven were placed on probation and one license was surrendered voluntarily for diversion.
Bad pharmacists, like bad doctors, are rare, but they can pump thousands of pills onto the streets. The real problem, however, is usually one of logistics. Pharmacists are busy and don’t have the time to check that every customer is who he says he is. The law states pharmacists must only make a “good faith effort” to confirm a customer’s identity.
“The diverters know which pharmacies are really busy and when they’re the busiest,” McLaughlin, the State Police lieutenant, said. “They’ll call in prescriptions when the pharmacists are too busy to check their validity, when people are coming home from work, or near closing time. They’ll actually monitor those pharmacies to determine when they’re the busiest.”
Another way pharmaceuticals get into the wrong hands is through call-ins, which McLaughlin said are one of
| Massachusetts is one of only 15 states with a prescription-monitoring program. But the state database is not linked to the federal tracking system, something that can slow down law enforcement efforts. |
the most common methods used to obtain prescription drugs illegally. Pill seekers pose as someone authorized to request a prescription, phone it in to a pharmacy and never send in the prescription. McLaughlin said the odds are pretty good that the pill seeker will score at least once a day.
This is why the scam works. The federal government regulates prescription drugs by grouping them in categories, called schedules, which identify their medical usefulness and potential addictiveness. Schedule I drugs, like heroin, cannot be prescribed in the United States, have high potential for abuse and have no accepted medical value in this country.
Schedule II drugs, like morphine, are the most tightly controlled legal drugs because they have a high potential for abuse. But unlike Schedule I drugs, they are accepted for medical use. Lesser restrictions apply to drugs on the remaining schedules because they are believed to be less addictive.
Full prescriptions for legal drugs other than those on Schedule II can be called in to pharmacies by doctors, nurses or medical-office receptionists, something that is convenient for legitimate patients, but often abused by pill seekers. A hard copy of the prescription isn’t necessary, although one is supposed to be supplied within seven days of the phone order.
There are some system-wide controls in place that help minimize prescription fraud, but they are not foolproof.
One method is drug tracking. The most dangerous and addictive legal drugs, classified as Schedule II and Schedule III drugs, are tracked by the U.S. Drug Enforcement Administration. The DEA assigns a registration number to all Schedule II and III narcotics and uses it to follow the pills from the time they’re manufactured until they reach the dispenser.
Once the drug reaches the dispenser, the paper trail is picked up by the state Department of Public Health, but the state follows only Schedule II drugs.
Under the state program, Schedule II drugs are tracked from the pharmacy to the end user and pharmacists must report how much of each drug was prescribed, the prescriber’s DEA number, a pharmacy identification number and other information. That information goes to the state Department of Public Health, where it is entered into a database known as the Electronic Data Transfer System, or EDT.
Massachusetts is one of only 15 states with a prescription-monitoring program. But the state database is not linked to the federal tracking system, something that can slow down law enforcement efforts.
The state looks at the information it collects for prescribing trends, and can analyze the data in response to requests from law enforcement or regulatory agencies, but it seldom provides police or regulatory agencies with unsolicited information based on its findings.
“It could be used to identify questionable data, but it’s a matter of resources and priorities,” said Grant Carrow, the director of the state drug control program that runs the EDT. “We have to use the resources to meet the highest priorities, and the highest priorities in this program are to assist law enforcement and regulating agencies to pursue ongoing investigations.”
So the data that could tell law enforcement and regulatory agencies which doctors prescribe the most OxyContin or which pharmacies supply the most Ritalin is collected but not used unless it’s asked for. Carrow said if the program had more resources, it would be an easy leap from collecting the data to disseminating it.
“We certainly could provide more information to law enforcement, provided they would want it,’’ he said.
McLaughlin said he’d take all the information the EDT could provide. “The more intelligence we have, the quicker we can solve these cases and the more cases can be solved,” he said.
There are other ways the EDT tracking system could become more effective. Popular painkillers, such as Vicodin, codeine-based drugs and anti-anxiety drugs, such as Valium, Xanax and Klonopin, are not monitored in Massachusetts because they are not Schedule II drugs. Police say 70 percent of the investigations conducted by diversion investigators involve these and other non-Schedule II drugs. These lower-schedule prescriptions are refillable (Schedule IIs are not), making their abuse even more difficult to stem.
Expanded monitoring of prescription drugs would help derail the distribution networks for both pharmaceuticals and illegal drugs, according to police who combat diversion. “It would not only help find illicit use of pharmaceuticals, but it would help us find illegal drug users,” said O’Brien of the State Police narcotics unit. “They’re the same people and the paper trail makes it easier.”
Police also hope the regulation of the way prescriptions are written will increase, and one sought-after step is serialization.
With such a regulation, doctors would receive a state-supplied prescription pad with numbered pages. If somebody stole it, the doctor would know what pages were missing. Pharmacists would also know that if they received a prescription with a number assigned to one doctor, but signed by another, the prescription was fraudulent.
Eventually, police hope paper prescriptions will become a thing of the past. Electronic prescriptions are the wave of the future. These would be written on the doctor’s computer, protected by code words and E-mailed to pharmacies. Pharmacies would have some way to confirm that the E-script came from a particular doctor’s office.
It is expected that sometime this year, the DEA will propose new regulations to allow electronic transmissions for prescriptions.
“That would eliminate forged scripts,” McLaughlin said. But, he noted, “Some computer hackers would find a way, but then you’d have a trail to follow.”
NUMBERS
1.5M
Americans who start abusing prescription drugs each year
50%
First-time abusers of prescription drugs who are 12 to 17 years old