Wally Herger fails to address 4,140 people dieing in 36 months

 Congressman Wally Herger and his staff have failed to address this very deadly epidemic after being shown explicit evidence  for months concerning the prescription / OTC drug epidemic.  Even though in Butte county where he resides prescription drugs are the leading cause of death, seeing the national scale of the epidemic his response is silence.  Congressman Herger you disappoint me greatly, but more important you have failed the families that have lost or are going to lose loved ones from prescription / OTC drugs


Since March of 2008 when the CDC  told the senate about the prescription drug epidemic, prescription / OTC drug overdoses have killed 4,140 people in 36 months, 115 deaths a month.  Additional drug screening by all doctors could reduce these numbers dramatically, but this would take for each patient an extra 20 minutes from doctors and a minimal cost to patients.  

Twenty minutes and a minimal expense or a persons life. 

I thought the medical profession was committed to saving lives, not time or a minimal expense.

Prescription / OTC drugs in 36 months killed 4,140 people

Since March of 2008 when the CDC  told the senate about the prescription drug epidemic, prescription / OTC drug overdoses have killed 4,140 people in 36 months, 115 deaths a month.  Additional drug screening by all doctors could reduce these numbers dramatically, but this would take for each patient an extra 20 minutes from doctors and a minimal cost to patients.  

Twenty minutes and a minimal expense or a persons life. 

I thought the medical profession was committed to saving lives, not time or a minimal expense.

Death from Prescription Drugs in America

Every day in America 35 people die from prescription drugs.  Since I began researching the prescription drug epidemic in America 3,035 people have died from prescription drugs.  I am keeping the death toll from prescription drugs in America and will be posting these deaths on this blog.  I am not sure how many deaths it will take for politicians to mandate all doctors to screen their patients more effectively to reduce these deaths, but now at least politicians will see the number of deaths their delay is having.

5 Most Serious Addictions in the US, According to Sober Author of Addict Nation, Jane Velez-Mitchell - EIN News - News Media Monitoring

5 Most Serious Addictions in the US, According to Sober Author of Addict Nation, Jane Velez-Mitchell - EIN News - News Media Monitoring

Prescription drug deaths skyrocket 68 percent over five years as Americans swallow more pills

Prescription drug deaths skyrocket 68 percent over five years as Americans swallow more pills

Commentary: After crying, we opened our eyes to drug abuse reality

Commentary: After crying, we opened our eyes to drug abuse reality

Controlling pain without creating addicts

Updated: March 23, 2011, 4:28 PM

Washington State will put in place later this year one of the most comprehensive efforts yet in the nation to prevent excessive prescribing of narcotic painkillers.
It will require doctors to consult a pain specialist if a patient's opioid dose increases above a certain level without improvement and to use a prescription monitoring program to thwart doctor-shopping.
Prescribers will have to maintain screening and treatment records and, for the first time in any state, enter a patient's progress in a statewide database.
"The only way to change the practice of medicine is to mandate a culture of measuring care, of knowing whether what you do is harmful or helpful," said Dr. Alex Cahana, a pain specialist who helped drive the initiative.
Washington State's tougher measures will not apply to cancer pain, end-of-life care or acute pain after an injury or surgery. Instead, they reflect the growing array of state, federal and medical industry actions to grapple with an epidemic of addictions, overdoses and deaths arising from more liberal use of prescription narcotics for chronic ailments other than cancer, such as back pain.
It won't be easy.
The scope of the problem is enormous, and medical practice is slow to change.
Americans comprise 4.6 percent of the world's population, yet consume 80 percent of the supply of narcotic painkillers. The initiatives also have triggered criticism over their potential chilling effect on pain care to suffering patients, micromanaging of doctors and cost to taxpayers.
"Everyone is trying to proceed rationally in an irrational situation. It's a little like trying to stop water from flowing to the oceans," said Dr. Paul Updike, director of chemical dependency at Sisters Hospital in Buffalo.
To work well, the response must thread a needle by reducing abuses while ensuring adequate access to painkillers for patients who need them. And the need is great.
An estimated 76.5 million Americans age 20 and older reported a problem with pain that persisted for more than 24 hours in a National Center for Health Statistics survey. Studies indicate that prolonged pain can cause depression, anxiety and substance abuse, as well as anguish at home and work.
Narcotic painkillers offer relief, and patients like Joanne Kushka, a Buffalo resident who suffers from fibromyalgia, don't want to see the medical community return to the era not so long ago when physicians were reluctant to use the drugs.
"Seven years ago, I went to a doctor who wouldn't take my pain seriously, so I know what it's like to deal with an unwillingness to prescribe," she said. "Now I take a painkiller as needed, and when I need it, I really need it."
On the federal level, attention has focused on law enforcement, such as the arrest in January of a Niagara Falls doctor accused of operating his medical office as if he were a drug dealer. But the response goes beyond criminal investigations.
Western New Yorkers turned over 652 pounds of controlled substances as part of the Drug Enforcement Administration "Prescription Drug Take-Back" program between October 2008 and November 2010. The program represents a key component of a national drug strategy released in 2010 by the White House Office of National Drug Control Policy.
The strategy also calls for expanding state prescription drug monitoring programs, informing the public of the risks of prescription drug abuse and educating doctors on appropriate opioid prescribing.
R. Gil Kerlikowske, director of the White House office, calls prescription abuse the "nation's fastest-growing drug problem" and sees raising awareness as a key part of the solution.
"Once you have more attention to it, people recognize the potential problem," said Kerlikowske, the former Buffalo police commissioner.

FDA eyes policy change
Meanwhile, the Food and Drug Administration is immersed in a potentially major policy change for opioids that follows from legislation giving the agency authority to require that drugmakers do more to reduce safety risks.
Last year, advisory panels rejected an FDA proposal, saying it didn't go far enough.
The plan would have required drug companies to develop educational programs for doctors to use on a voluntary basis on patient selection, dosing and monitoring for long-acting painkillers, such as OxyContin. It also would have required manufacturers to provide FDA-approved education sheets that doctors could use to help guide patients on the safe use, storage and disposal of opioids.
Panelists wanted the training mandatory for doctors, perhaps as a requirement to obtain a DEA registration to prescribe narcotic painkillers. They also called for inclusion of the more-frequently prescribed immediate-release opioids, such as hydrocodone, one of the most abused prescription drugs in the U.S.
The FDA is expected to release a final plan this year. But agency officials, as well as others, voice skepticism over the government's ability to manage a mandatory training program of the enormity that would be needed. There are 750,000 medical professionals registered with the DEA to prescribe narcotic painkillers, and the immediate-release versions account for 91 percent of the 257 million opioid prescriptions dispensed by retail pharmacies.
"You can't fault the FDA for trying to make a dent. But there were 400,000 to 500,000 unique users of OxyContin alone last year. Good luck trying to mandate an education program," said Steven Passik, a pain care expert and clinical psychologist at Memorial Sloan-Kettering Cancer Center in Manhattan.
Link to transcripts of the FDA advisory committee hearings.
Monitoring scripts
In states, one of the major efforts to prevent doctor-shopping focuses on prescription monitoring.
The electronic databases operational in 43 states track patients taking controlled substances to identify those who might be selling or abusing the drugs.
Some of the programs are reactive, generating reports to doctors in response to inquiries about a patient. Others are proactive, identifying patients who visit multiple doctors or prescribers who write an unusual number of prescriptions.
Despite hopeful signs, the programs have yet to significantly affect abuse, said Aaron M. Gilson, a senior researcher at the University of Wisconsin's Pain & Policy Studies Group.
The programs are only as good as the timeliness of the information and number of practitioners who use them, and only about 20 percent of physicians nationwide know about the databases, he said.
"It's not clear the extent that prescription monitoring programs work or if they have a negative effect on prescribing," he said. "And for clinicians who use them, it's not clear in many instances what they should do with the information."
New York operates one of the oldest programs, but physicians say it is cumbersome and the alerts of suspicious activity often arrive too late.
"It could be improved. Usually, you get reports weeks after a prescription was written," said Dr. David Bagnall, a pain specialist who directs the Spine Center of Niagara and the fellowship at RehabNY.
Health Department spokesman Jeffrey Hammond responded that feedback about the system has been mostly positive.
Linking state databases
Proposed legislation in New York would require doctors and pharmacists to access the data before prescribing a controlled substance. It also would require doctors, not just pharmacists, to report prescriptions for the drugs to the state database.
Ultimately, the goal is to link the state systems and make the information more timely.
Congress in 2005 passed the National All Schedules Prescription Reporting law to expand and coordinate the monitoring programs, but money was not appropriated to fund it until the Obama administration set aside $2 million in 2009.
That's considered a fraction of what will be needed, and funding is likely to remain an obstacle. In Florida, for instance, Gov. Rick Scott recently called for canceling plans for a drug-monitoring program because of the state's budget deficit. Florida is considered a haven for pill mills.
More than anything, experts say, deterring abuse will depend on better education of physicians and patients, as well as better professional guidance on prescribing painkillers and treating addiction.
A survey by the National Center on Addiction and Substance Abuse at Columbia University reflects the gaps in knowledge. It showed that only 40 percent of doctors were trained to identify prescription drug abuse and addiction, and less than half received instruction in pain management.
To make matters worse, a lack of research has created professional disagreement over such basic issues as the effectiveness of opioid therapy for chronic pain and the risk of addiction. For example, a 2009 study of 1,843 Washington State workers with back injuries from 2002 to 2005 found that only 26 percent of the patients on opioid painkillers saw their pain improve, and only 16 percent experienced improvement in physical function.
"All of this is not rocket science," said Dr. Richard D. Blondell, director of addiction medicine at Sheehan Health Network.
"The solution is research, education and training," he said. "You need a core of physicians who know what they are doing and who can disseminate the information to others."
A balancing act
Bolstering medical school curriculums will take decades. Meanwhile, education often falls to local programs similar to one presented in December by insurer Independent Health and sponsored by drug manufacturers Purdue Pharma, Covidien and Reckitt Benckiser.
About 150 nonpain specialists listened as Buffalo-area experts in pain and addiction talked about such topics as appropriate prescribing, drug-seeking patients and identification of addiction. Unlike the 1990s, when the medical community urged aggressive pain treatment for chronic pain, the advice today is to use caution.
"Anyone who treats pain confronts a balancing act. They have an ethical, moral and professional obligation to treat it. They also must be ethically, morally and professionally concerned about drug addiction and diversion," said Ellen Battista, director of Pain Treatment Consultants of Western New York.
She and others stressed the need to think differently about the goal of treatment.
"Saying you want to be pain-free is a little like saying you want to be richer. When is enough enough?" Bagnall said.
The problem of prescription drug abuse is complex and resists easy solutions, experts say. Voluntary steps by the medical community and better public education help but may fall far short in stemming what has become a public health crisis.
"The burden of these drugs is not just addicts who overdose. So many people are touched by this tragedy -- elderly women, teenagers, infants born to addicted mothers, an explosion of admissions to detox centers and emergency rooms," said Cahana.
He defends Washington State's more extensive approach.
"We need to do more than take a few courses sponsored by drug companies," Cahana said. "We need to codify best practices and change pain management so that we don't assume from the start that giving narcotics is the best treatment."
hdavis@buffnews.com

A Plague of Pills

• 2011
• The Talk of Maine
• Down East & Acadia

• By: Virginia Wright

Image ©IStockPhoto.com/prosadoprosado
For most of Paula Frost’s life, crime was practically unheard of in her hometown of Perry, a community of 850 people way Down East in Washington County. Then about five years ago, she started locking her doors. “I have deadbolts on both of them,” says Frost, who directs outpatient drug counseling at the Regional Medical Center in Lubec and heads Perry’s volunteer fire department. “And I always take my keys out of my vehicle. If addicts are not supporting their habit by selling pills, then they’re stealing. They will take anything that isn’t nailed down, quite literally, and they might even pull the nails out and take them and the hammer, too. Because of what I do, I have a pretty good idea of who is doing what out there, but the average person doesn’t. There is a huge amount of distrust in the community.”
The news over the past several months cannot have done much to raise anyone’s sense of security. Last fall a Lubec man was beaten and held at gunpoint in his own home by two men demanding money and prescription drugs. Three months later, two men assaulted a pregnant woman at her home in Steuben; they, too, took money and pills. Yet while Washington County’s problem has been especially stark, it is hardly the only area of Maine feeling the effects of the prescription drug abuse epidemic. Early this winter, federal law enforcement agencies headed by the U.S. Attorney’s Office stepped in to help investigate and prosecute a rash of pharmacy robberies, which jumped from seven in 2009 to twenty-one last year. Those robberies, along with ten burglaries, occurred in cities and small towns scattered across the state, from Biddeford to Stonington to Bethel to Jay.
Along with these very real crimes has come some unintended myth-making regarding Maine’s niche in what is truly a national scourge. In January, for example, several news outlets reported that Maine had the highest percentage of residents in the nation seeking treatment for addiction to prescription narcotics, drawing that conclusion from a federal Substance Abuse and Mental Health Services Administration (SAMHSA) report. But that interpretation is faulty, cautions Marcella Sorg, a forensic anthropologist at the University of Maine’s Margaret Chase Smith Policy Center. “States contribute data to SAMHSA only for programs that receive public funding,” Sorg explains. “So, for example, a state like Connecticut, which has many more private facilities providing this care, will have a lower rate in the SAMHSA report, but it has nothing whatsoever to do with the actual rate at which people are being admitted for substance abuse treatment. In addition, states have different ways of reporting data. Maine happens to have one of the best data systems in the country. It also happens to have the highest percentage of publicly funded treatment in the country.”
Sorg tracks epidemiological data on prescription and illicit drug abuse in Maine, and she serves on the Community Epidemiology Work Group, which monitors trends for the National Institute on Drug Abuse. She says the best way to measure the extent of the problem in Maine is “to compare it against itself over time.” By that measure, the state does indeed have a serious, and worsening, problem. The number of drug-related deaths has climbed more than 500 percent, from 34 in 1997 to 179 in 2009; more than 90 percent of the deaths involved at least one prescription drug. Treatment admissions related to opiate abuse (excluding heroin and morphine) have grown 60 percent since 2005, a trend driven by the synthetic opiate oxycodone, according to a report by the Maine Substance Abuse Commission. Crime has followed a similar track, says Roy McKinney, director of the Maine Drug Enforcement Agency (MDEA). Prescription drugs were implicated in 43 percent of MDEA’s arrests last year, compared to just 12 percent in 1997.
Although southern Maine was the first area to experience a rise in drug-related deaths, Washington County acquired early notoriety for the large number of people being treated for overdoses. The problem emerged soon after the painkiller OxyContin, Purdue Pharma’s time-release form of oxycodone, hit the market fifteen years ago. “You would hear stories about people who were using, and you would see people who appeared to be under the influence, but they were not coming in for treatment,” Paula Frost recalls. “For three to four years, individuals and families struggled to deal with it on their own. Then they started coming out of the woodwork.”

Those early cases of addiction, Frost says, were largely accidental — that is, people initially took medication for pain and “they didn’t know how to deal with it, so they started using more and more and more and more.” Now, Frost’s clients are just as likely to be people who sought pills for recreation right from the start. “They’ve found a wide variety of drugs they can abuse — opiates like oxycodone and methadone, or anti-anxiety medications like Xanax, Valium, and Klonopin, and even things like Ritalin [a stimulant used to treat attention deficit disorder in children].”
Heroin, cocaine, methamphetamine, and other illicit drugs have a grip in Maine, but our geography favors the prescription variety. Smuggled into the country, illicit drugs must travel the nation’s transportation infrastructure, McKinney says, and as a result, their use tends to be concentrated in metropolitan areas. “It may be more difficult for someone in a rural setting to make that connection with dealers of illicit drugs,” he says, “but the pharmacy is just down the street.” Prescription drugs are fast outstripping marijuana as the drugs most abused by teenagers, McKinney says, and most of them are getting the pills from their home medicine cabinets.
Frost observes a cultural facet to the phenomenon in Maine, combined with a misperception of the risks. “In Massachusetts, the opiate addiction is mostly heroin,” she notes. “Up here, the folks I work with will tell you they only use heroin if nothing else is available. They prefer OxyContin 80 because they know exactly what they are getting. They know they need three of them over the course of the day to not get sick, whereas with heroin they don’t know what they’re getting.”
There are other reasons that rural Maine is susceptible, according to Sorg. Its older population is likely to have more health problems, which in turn means more medicines being prescribed. Likewise, the blue-collar jobs that dominate in rural areas are associated with the kinds of injuries that may be treated with prescription narcotics.

The temptation to sell pills can be hard to resist for some people who live in economically depressed communities, says Washington County Sheriff Donnie Smith. “You’re sitting in your home and it’s freezing cold and someone calls you up and says, ‘You know those pills you’ve got are worth sixty dollars on the street today.’ Well, that’s sixty dollars worth of oil in your tank. That’s an easy source of money,” Smith says.
“We’ve seen people abusing and selling that you wouldn’t ever believe would be doing it. It’s not just one age group. It’s people in their teens to people in their sixties and seventies.”
Some of the drugs sold in Washington County have been smuggled across the Canadian border, but Smith calls overprescribing “the biggest problem we have.” He tells of one home invasion victim whose legally prescribed monthly supply of the narcotic painkiller Dilaudid would fetch $24,000 on the street. “That to me is unacceptable,” Smith says. “It’s unbelievable that one person would need that much medication and not need to be hospitalized. That’s what we’re up against. When someone starts out with a legal prescription and they’re selling a pill here and a pill there, that’s a very difficult thing to overcome. In cases like that, we usually go and talk to the physician. Sometimes it helps. Sometimes it doesn’t.”
Smith says the impact on his community has been profound. As a young officer, he patrolled the county’s roads during the early eighties, when “if you got someone for a usable amount of marijuana, you had a drug bust.” After a dozen years away from law enforcement, he returned in 1998 to find a rapidly changing social landscape.
“It’s a horrible, horrible addiction,” he says. “The drive to satisfy that need is putting people in some pretty desperate situations. It affects society at every level. I don’t think there’s a home in Washington County that hasn’t been affected one way or another. It affects job growth because if you don’t have a clean community, businesses aren’t going to come. It affects the economy because the workforce is not here. We’ve got one business in this county that was firing people ten to twelve at a time because they couldn’t get to work or they’d come in high. The company asked for surveillance because people were dealing drugs in the parking lot.”
The prescription drug epidemic in Maine and elsewhere is in part an unintended consequence of a shift in health-care providers’ approach to pain relief. “Doctors ask if you have pain, and they give you something for it,” says Sorg, a former nurse who remembers being unable to relieve the pain of post-surgery patients. “They expect to give you some treatment, and that’s a good thing.”
The prescription system, however, has weaknesses, Sorg says. Medicines intended for short-term use are dispensed thirty-, sixty-, and ninety-pills at a time. Pills build up in home medicine cabinets as new medications are substituted and leftovers are forgotten. “It’s a system that produces redundancy,” Sorg says, and that can lead to those pills being diverted to illegal uses.
Sorg believes one of Maine’s best preventive tools is a seven-year-old prescription drug monitoring program overseen by the Office of Substance Abuse in the Maine Department of Health and Human Services. The database tracks all prescriptions for controlled substances dispensed in the state. It is designed to identify patients who “doctor shop” — that is, seek painkillers from multiple prescribers — and to identify prescribers who write a lot of orders for opiates. Only about 35 percent of Maine’s 6,500 licensed prescribers participate in the voluntary program, but Maine Medical Association Director Gordon Smith says the MMA is making a push to get more doctors to enroll.
“For the past six to eight years, we’ve been aggressively involved in education and advocacy,” Smith says. The MMA has held roughly thirty programs to teach doctors about pain treatment and assessing patients for risk of addiction.
Meanwhile, Maine is doing a good job of addressing the issue of unused medicine disposal, according to Roy McKinney. MDEA receives an average of one hundred pounds of prescriptions weekly through the mail-back program it implemented three years ago, and some local police departments have placed collection boxes in their headquarters.
Last September, the state ranked first on a per capita basis in a national drug take-back program, with Mainers discarding 7,820 pounds of prescriptions at drop-off sites around the state. Another program is scheduled for April 30.
“It is a very, very complicated issue,” Sorg says. “Society has to recognize the problem. I don’t think we do. We have a culture that dictates that if you’ve got a little something wrong with you there’s a pill for that. We have a folk pharmacology where people feel they can figure stuff out and take what they need. We need public education. We need education in the therapeutic encounter. And we need to be vigilant.”

• By: Virginia Wright

Rx for Danger

http://www.buffalonews.com/city/special-reports/article368420.ece

Updated: March 20, 2011, 7:31 PM

First of four parts
A Niagara Falls doctor stands accused of recklessly prescribing powerful narcotic painkillers to just about any patient who walked in his office.
His staff is accused of dealing the drugs on the streets.
And a Cheektowaga doctor sucked into a separate illegal prescription drug ring, while not arrested, turned in his license to prescribe narcotics and then retired.
That's only the beginning.
A physician's assistant at a Wyoming County hospital. A receptionist at a plastic surgeon's office in West Seneca. A pharmacy cashier in Buffalo. A medical secretary in Amherst. All arrested on prescription drug charges.
"In the old days, you needed the French Connection ... These days all you need is a prescription pad," said Erie County District Attorney Frank A. Sedita III.
Forget Colombian drug cartels and Afghanistan poppy fields. The latest explosion of powerful and addictive drugs to hit the streets is manufactured by American pharmaceuticals and sometimes dispensed by those we trust the most -- our doctors and other health care workers.
And Western New York sits at the center of this explosion.
A months-long Buffalo News investigation found that, in total, three of the most abused narcotic painkillers -- oxycodone, hydrocodone and fentanyl -- are prescribed by doctors in Western New York at a significantly higher rate than in the rest of the state.
In Western New York, use of hydrocodone, the most-prescribed drug in the nation, increased by more than twice the state average between 2007 and 2009, The News found.
The wider availability of opioids coincides with greater misuse of the drugs.
Among 15 regions in the state, parts of the Southern Tier have the highest rate of illegal use of prescription painkillers, and the Erie-Niagara region has the third-highest rate, according to federal data.
Western New York also is home to two doctors who prescribe the largest number of prescriptions for controlled substances in New York State.
One was arrested in January and charged with running his Niagara Falls office as if he were a drug dealer, according to federal prosecutors, prescribing powerful opiates to just about any patient who asked for them. "We think the large majority of doctors [in Western New York] are doing things properly," said U.S. Attorney William J. Hochul Jr. "But a few are not, and we will prosecute those cases."
The News investigation included reviews of New York State Health Department data on prescription opioids, federal and local arrest and court documents, and interviews with dozens of law enforcement and medical professionals. It found:

• Prescription opioids appear to have become more popular among drug abusers than cocaine, leading to an increasing number of crimes related to prescription medications.

Most of the crimes involve drug users and street dealers who break into homes and pharmacies to get drugs or illegally buy or sell the drugs on the streets. But, as has been the case in Western New York and elsewhere around the nation, the problem is exacerbated when even a small fraction of the medical community itself -- whether receptionists and secretaries or doctors and physician assistants -- gets involved in the illegal drug marketplace.

• All addicts don't start out as street drug users.

A recent University at Buffalo study of 75 addicts in a treatment program found 41 percent reported their addiction began with medicine legitimately prescribed by their doctor, but that most evenutally ended up buying drugs on the streets.

• Over 400 doctors have been arrested nationally since 2004 for mishandling prescription painkillers.

It's a small percent of the almost 1 million doctors in the United States, but the number of arrests in recent years is significantly higher than a decade ago, prior to the explosion in opioid availability and abuse. The most recent case here included Pravinchandra V. Mehta, the Niagara Falls doctor arrested in January on felony drug distribution charges.

No national figures are available on the number of medical support personnel arrested on prescription drug charges, but in Western New York, at least eight have been arrested in the past year alone.

• Taxpayers are picking up much of the tab on this illegal trade in narcotic painkillers.

Many of the prescriptions used to buy street drugs are obtained through the publicly funded Medicaid program, some costing as much as $1,000 for a 30-day supply. A recent GAO report pegged the cost to Medicaid of opioid abuse in four states, including New York, at $63 million over a recent two-year period.

• The abuse of these powerful painkillers is deadly.

Nationally, accidental drug deaths involving prescription opioids more than tripled from 4,000 in 1999 to 13,800 in 2006. There were 113 drug deaths in the Buffalo Niagara region in 2008, with 84 involving opioids. The previous year, there were 88 deaths, 70 involving opioids, according to the most recent data available from the National Drug Abuse Warning Network.

"There are a lot of deaths as a result of prescription drug overdoses," said William Burgin, executive director at Alcohol and Drug Dependency Services in Buffalo.

Among them in recent years: Matt Rybinski, 17, of Lancaster; Zachary Crotty, 19, of Colden; Eric Fischer, 19, of Amherst; and Brandon Kopacz, 23, of Elma.

Also, Jeffrey Schmidt, 19, and William B. Jakobi, 27, both of Niagara Falls; Victoria A. Eikenburg, 25, of City of Tonawanda; Adam J. Tafelski, 22, of North Tonawanda; and Alane Butler, 48, of Amherst.

A case study
The arrest of Mehta in Niagara Falls and the accusations lodged against him and his office workers offer a case study in what can happen when someone in the medical profession and illegal prescription drug trade mix.
A patient -- who t-nurned out to be working with the U.S. Drug Enforcement Administration -- went to Mehta complaining of back pain and asked for pain pills. Mehta spent about a minute examining the man. Without taking a patient history, Mehta prescribed hydrocodone, also known by such brand names as Vicodin or Lortab, according to court records. In a follow-up visit, Mehta spent about 30 seconds in the examining room with the patient before prescribing more drugs, records state.
In another instance, Mehta gave a patient an extra 30 pain pills for a friend with a back problem, even though Mehta had not examined the friend, according to court papers.
Some of the drugs Mehta prescribed ended up going to drug addicted or patients who sold the drugs to drug dealers or addicts, federal officials said.
Mehta's office workers also sold the doctor's prescriptions directly to street users and addicts, the DEA charged.
In one case, former employee Shannon Figurelli obtained a blank prescription slip from Mehta's office, the DEA charges. Figurelli wrote the prescription out in a Medicaid recipients' name and went with the Medicaid recipient to the drugstore, where the Medicaid recipient got the prescription for 90 oxycodone painkillers filled, according to court records.
Figurelli paid the Medicaid recipient $600 for her help, authorities claimed. Figurelli then sold many of the pills for $30 each on the Tuscarora Indian Reservation, court records state.
Medicaid, the government health program, paid $1,037 for the pills that Figurelli could sell for as much as $2,700, according to court documents.
In another instance, authorities said, Chantel Stypick, another former Mehta employee, who also had a prescription slip from Mehta's office, made out a prescription for 60 pain killers in an addict's name. The prescription cost $800. The addict put in $600 and Stypick $200, the authorities said. The addict got 20 pills; Stypick took the other 40.
Mehta and his staff poured some 40,000 prescriptions for controlled substances -- representing about 3 million pills -- into Erie and Niagara counties over a 2 1/2-year period, according to the DEA. That was the second-largest number dispensed by any of the 65,000 doctors in New York State, according to state Health Department data.
The physician who distributed the most controlled substances in New York State is Dr. Eugene J. Gosy, a board-certified neurologist who runs a pain management center off Youngs Road in Amherst. With some 2,700 doctors referring patients to him, Gosy & Associates is believed to be the largest pain management center in the state.
DEA bust
The depth of the illegal prescription opioids problem, including the role doctors play in it, first became evident in the Buffalo area last summer, when the DEA busted a 33-member prescription drug ring allegedly headed by Michael McCall, of Cheektowaga.
McCall, 50, coached gang members on how to get doctors to prescribe painkillers to them, according to federal investigators. The drugs, they said, were then purchased with Medicaid and sold on the streets of Buffalo and suburban Erie County for a profit.
Gosy's pain center was among those the gang visited. But the favorite was the office of Dr. Marita Gopalakrishnan, a Cheektowaga internist who was viewed by many in the gang as the easiest mark of the physicians they targeted, according to federal sources.
When the investigation into McCall and his gang was completed, and the DEA approached Gopalakrishnan, the doctor voluntarily turned in his government registration to prescribe narcotics and then retired.
Gopalakrishnan contends he provided good care but was conned by some patients into giving them drugs.
"It was a working class neighborhood. There were a lot of people out of work and complaining of pain. I took pity on them," he said. "But some of the patients were fooling me."
Another doctor, Richard C. Dobson, of Rochester, also recently gave up his registration to write narcotic prescriptions. Prescriptions taken from his office were being used to illegally obtain fentanyl in Amherst, federal investigators said.
These issues go beyond the doctors and involve others in medical offices.
In the past year, a West Seneca woman working as a receptionist in a plastic surgeon's office was charged with forging prescriptions to obtain 8,000 hydrocodone pills over the course of a year.
A Rite Aid pharmacy cashier in Buffalo was charged with stealing 4,800 Lortabs, worth about $5,000, from the store by changing vials and computer items.
A North Tonawanda woman working as a medical secretary at the All Care For Women medical practice in Amherst, was charged with forging a doctor's signature to obtain as many as 1,900 Lortabs over three months.
And Charles M. Livingston, a former physician's assistant at Wyoming County Community Hospital in Warsaw, faces charges of selling blank stolen prescription slips for $800 each. The Orleans County district attorney said Livingston also worked at a sports medicine office and was medical director for the Rochester Raiders indoor football team. Police said prescription slips allegedly stolen from doctors by Livingston were illegally sold in numerous locations in Western New York.
Also arrested was one current and three former workers in Mehta's Niagara Falls office.
What went wrong?
None of this has been lost on the larger medical community, which is trying to figure out what went wrong.
Opioids for cancer patients and others in pain at the end of life have long been an accepted medical practice. In recent decades, the trend has been toward aggressive treatment of noncancer pain with narcotics as well. It's been a blessing to many people genuinely in pain.
But it has also led to increased access to the drugs on the streets, an epidemic of deaths and overdoses -- and doctors who are what some in the medical community characterize as the "Four Ds": dated in their medical knowledge, duped by patients, dishonest or disabled by the drugs themselves.
The problem, some medical experts say, is complex. Any solution, they say, must balance the need to maintain access to painkillers for the many patients that truly need them.
"It's unrealistic to say you won't prescribe the drugs," said Dr. Paul Updike, director of chemical dependency at Sisters Hospital. "About 80 percent of visits to primary care doctors involve pain as the primary or secondary reason for the visit. For many of these people, these medications are appropriate."
Tomorrow: Prescription drug explosion brings addiction, overdoses and deaths
hdavis@buffnews.com, dherbeck@buffnews.com, lmichel@buffnews.com and sschulman@buffnews.com

Absentee Political Leaders

26,000 drug overdoses each year and over half of the victims die from prescription drugs.  You would think that our political leaders would intervene to a greater extent.  The pharmaceutical companies making billions of dollars of profits with their huge lobbying groups heavily influence our political leaders to do the bare minimum to intervene.  Donations out weigh human tragedy and loss of life when it comes to doing the right things morally and ethically.  So sad, so very sad!

Gov. John Kasich calls the problem "epidemic."

Kevin Wolford's obituary on Nov. 30 did not necessarily stand out from the others on Page A5 of The Courier.

He died at Blanchard Valley Hospital three days earlier. He lived in McComb. He graduated from Findlay High School. He worked at Consolidated Biscuit Co. He loved the Detroit Red Wings. He was survived by parents, sister, grandparents and a nephew.

But a closer look shows Wolford was only 26. And memorials in his name were directed to Century Health Inc.

Indeed, something was very different: Wolford was the third Hancock County resident to die of a heroin overdose in the past two years.

His death followed a wave of unintentional drug overdose deaths in Hancock County. The number tripled from three deaths in 2005 to nine deaths in 2009, according to new statistics from the Ohio Department of Health.

(Despite the increase, Hancock County still has fewer drug overdose deaths than similar-sized Erie, Ross and Scioto counties.)

Statewide, the Department of Health reported fatal overdoses have increased from about 300 in 1999, to 1,000 in 2005, to about 1,400 in 2009. That is more than a 300 percent increase over the 10 years.

This increase in deaths, the state said, can be largely attributed to prescription drug overdoses.

Of the deaths in 2009, about 40 percent, or 550, were because of prescription pain medications, the state said.

Half of the prescriptions taken each year are used improperly, according to the Institute for Safe Medication Practices, a nonprofit organization devoted to medication error prevention and safe medication use, according to its website.

According to the group, improper use is caused by:

• Changes in prescribing practices for pain medication;

• Changes in marketing of medications directly to consumers;

• Over-medication and mixing medications;

• Substance abuse;

• Medications being used by people they are not prescribed for;

• Doctor shopping;

• Prescription fraud;

• Illegal online "pharmacies;"

• "Pill mills," places that distribute pain pills to people without a legitimate medical need, according to the U.S. Drug Enforcement Administration;

• Improper storage and disposal of medications.

Gov. John Kasich calls the problem "epidemic."

Last month, Kasich traveled to Scioto County, an area that has been particularly hard hit by these drugs, to announce additional resources to combat the problem.

In Scioto County last year, 9.7 million doses of prescription painkillers were dispensed, "123 doses for every man, woman and child in the county," Kasich said.

"It's just a monumental problem in this state," state Attorney General Mike DeWine said Thursday.

As a new state priority, other agencies, such as the Bureau of Criminal Investigation and the Organized Crime Investigations Commission, will be called in to help, DeWine said.

He charged the state medical board has not done its part to investigate physicians who illegally prescribe painkillers.

The board "has not been aggressive enough in this area. The medical board needs to lead ... to have some guts," he said.

"The key is to remove doctors who abuse the public trust they have. ...What we're looking at is the abuse," DeWine said.

In many counties, said House Speaker Bill Batchelder, R-Medina, prescription painkillers are "coins of the realm."

While prescription drug overdoses can be deadly, heroin is a proven killer, too.

Heroin overdoses accounted for about 20 percent, or 280, of Ohio's unintentional drug overdose deaths in 2009, the state said.

And it has claimed three young lives in Hancock County.

In addition to Wolford, who died of an accidental heroin and morphine overdose, Aaron Grotrian, 20, lost his life to heroin on Aug. 28, 2009, as did Taylor Akerman, 19, on Jan. 31, 2010.

"It's a tragedy that there is another death," said John Stanovich, who chairs the Hancock County Prescription and Opiate Abuse Task Force.

"This is still a significant problem in our community and we need to continue our efforts and maybe even step up our efforts a little bit," Stanovich said.

The task force is a collection of community leaders, elected officials and citizens who have charged themselves with reducing and preventing the spread of heroin and pain pill addiction.

The task force has asked for a $20,500 grant from Handbags That Help, a women's giving circle, to help combat the drug problem.

The money would go toward an "Ask the Expert" column in The Courier, DVDs to educate people, a consultant to develop lesson plans to educate teachers and students, and drug identification guides to be used in conjunction with "Street Smart" training.

During the training, law enforcement officers bring in samples of drugs to schools and explain to teachers how they are used and what they look like.

The Hancock County Alcohol, Drug Addiction and Mental Health Services board plans to provide $9,500 in matching funds to implement the task force's ideas. This money will be used to bring in speakers, host public forums and assist with public awareness of the drug problem, and to train professionals on the abuse issue.

Grant recipients will be announced in April, according to the task force.

Kure Beach And Carolina Beach Police Arrest Prescription Drug Dealer

Kure Beach And Carolina Beach Police Arrest Prescription Drug Dealer

Wednesday, 23 February 2011 00:00

By WILLARD KILLOUGH III
Managing Editor

KURE BEACH - Narcotics Detectives from the Kure Beach and Carolina Beach Police Departments are working together to battle drug dealers on Pleasure Island.
According to the Kure Beach Police Department, on February 11, 2011, Narcotics Detectives from both departments arrested 52-year-old Parnell Crittenden of Wilmington, NC on five counts of trafficking in opium.
According to detectives, after a yearlong investigation, they served a search warrant on Crittenden's home at 2305 Waverly Drive in Wilmington and found over 800 units of opiate derivatives.
According to a press release issued by the Kure Beach Police Department, "Detectives believe Mr. Crittenden was responsible for 40 to 50 percent of the illegal prescription narcotics being provided to Pleasure Island."
Crittenden was scheduled for a grand jury hearing in Wilmington on February 21.
According to police, prescription narcotics have climbed to the top of their radar. The illegal sale of prescription medication has become one of the top problems facing law enforcement nationwide. The problem is there is an endless supply of prescription medications and street level drug dealers have taken advantage of it.
Prescription medications are virtually odorless and much easier to conceal than traditional narcotics, making law enforcement's job much more difficult.
According to a release issued Monday, "Depending on the type of medication, some are being sold for as much as $40.00 per pill. With a standard thirty-day supply of ninety pills, a drug dealer is looking at $3,600.00 per prescription. However, it is not uncommon for detectives to find prescriptions written for much higher quantities. Most recently, detectives found a prescription that had been filled for 970 Oxycodone HCL 40mg as a three month supply to a single patient."
Detectives say the illegal sale of prescription medications is affecting all walks of life and they've had cases involving teenagers all the way up to senior citizens.
According to the release, "We have seen that younger adults and teens involved in the prescription drug trade are doing it as a means to make fast easy money. Whereas some older adults who have no medical insurance or have recently lost their
insurance do it as a means to make enough money to have their necessary prescriptions filled."
Police say whatever the reason, the public needs to be aware that the penalties for illegal selling of prescription medications are high and lawmakers are taking notice of this new trend.
According to the U.S. Department of Justice, the threat posed by the diversion and abuse of Controlled Prescription Drugs (CPDs) is increasing, largely aided by rapidly increasing distribution of the most addictive CPDs, prescription opioids. According to the Drug Enforcement Administration (DEA), the amount of prescription opioids distributed to retail registrants increased 52 percent from 2003 through 2007.
Opioid pain relievers are popular among drug abusers because of the euphoria they induce. Opioid pain relievers include codeine, fentanyl (Duragesic, Actiq), hydromorphone (Dilaudid), meperidine (Demerol, which is prescribed less often because of its side effects), morphine
(MS Contin), oxycodone (OxyContin), pentazocine (Talwin), dextropropoxyphene (Darvon), methadone (Dolophine), and hydrocodone combinations (Vicodin, Lortab, and Lorcet).
The Centers for Disease Control and Prevention (CDC) reports that a high percentage of people who die from a prescription opioid poisoning have a history of substance abuse and that many have more than one CPD in their system at the time of death. For example, a 2008 CDC study found that 82.3 percent of diversion-related unintentional overdose decedents in West Virginia in 2006 had a history of substance abuse and that 79.3 percent had used multiple substances that contributed to their deaths.
In many instances, these individuals were simply using prescription opioids (either singularly or in combination with other CPDs, alcohol, or illicit drugs) to achieve a heroin-like euphoria, and many did not have a legitimate prescription for the drugs.
For example, the CDC study found that 63.1 percent of all unintentional CPD overdose deaths in West Virginia in 2006 involved individuals who did not have prescriptions for the drugs that contributed to their deaths. Sources of prescription medications diverted to street level dealers are unscrupulous physicians writing bogus prescriptions as well as ordering from online pharmacies.
More specifically, methods of diversion include:
• Pharmaceuticals manufactured lawfully, but stolen during distribution
• Medications obtained inappropriately from legitimate end-users, (e.g., friends share prescription drugs, family members leave medicine in easily accessible places, etc.)
• Fraudulent prescriptions written on prescribing pads that have been stolen from medical offices
• “Doctor shopping” is a method where individuals see several doctors in an attempt to obtain multiple prescriptions without revealing what they are doing. Often these individuals will have their prescriptions filled at several different pharmacies to avoid detection.

Fatal overdoses were fueled by prescription drugs

Sadness swallowed Jarrod Barber.

His friend had just died of cancer. He was smoking more and more marijuana and experimenting with pills.

Jodi Barber, Jarrod's mother, posts a flyer at the Fatburger in Aliso Viejo recently. She is going from store to store hoping to put up as many placards as possible around her community of Laguna Niguel. She wants to remind young people and their parents to be wary of prescription drug overdosing.

H. LORREN AU JR., THE ORANGE COUNTY REGISTER

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On the eve of his friend's funeral, Barber, 19, passed out on the family couch in Laguna Niguel while watching a late-night movie.

Slumped in a corner, he looked to friends as if he was sleeping. He was actually dying.

Barber fatally overdosed Jan. 8, 2010, on a cocktail of Opana, a narcotic painkiller, Seroquel, an anti-psychotic and Clonazepam, an anti-convulsant often used to treat anxiety, coroner's records show.

Abuse of prescription drugs has risen nationally among teens and young adults, experts say, because these drugs are easy to get and seen as a "safe" high. The names of doctors who are an easy touch for prescription narcotics spread quickly among teens. Some users get huge prescriptions and then sell pills on the street to finance their own habit.

Here in Orange County, coroner records show that accidental fatal overdoses rose steadily from 130 in 2003 to 266 in 2009. Preliminary figures for 2010 show at least 240 overdoses although final toxicological findings are still pending in some of the cases.

Barber didn't have a prescription for the Opana. Jarrod's mother, Jodi Barber, believes he purchased it from a now-deceased friend who was a patient of Dr. Lisa Tseng of Rowland Heights – an osteopath under state and federal investigation. There's no mystery about the other drugs: Dr. Paul D. Corona of Laguna Niguel prescribed the Clonazepam, and a few months later, the Seroquel.

Coroner's records show that drugs prescribed by Tseng – including Xanax, methadone and morphine – were found in the bodies of at least three fatal overdose victims in Orange County since 2000. Additionally, the parents of two other dead youths, Jarrod Barber and Ryan Winter, blame Tseng for the drugs that led to their overdoses. Jodi Barber says she has taken her suspicions to the federal Drug Enforcement Administration.

In August, after discovering that Tseng had written more than 27,000 prescriptions over a three-year period, federal agents revoked Tseng's license to prescribe narcotics. DEA investigators alleged in court papers that Tseng was operating "outside of the ordinary course of a professional practice." Meanwhile, the state Board of Osteopathic Medicine is working to revoke her medical license, officials confirm.

Unlike Tseng, Corona, who specializes in the treatment of mood disorders, has not been named as a target by state medical investigators or federal drug authorities. But records show that Corona is on five years probation with the state medical board for using drug samples to treat his own manic disorder. Additionally, a lawsuit filed in Orange County Superior Court in 2007 accuses him of negligence and wrongful death for his treatment of a woman who crashed her car while driving under the influence of prescription drugs, killing a young mother. Corona calls the suit "nonsense."

In an interview, Corona described himself as the "guru" of prescribing mood-stabilizers to treat substance abusers; a regimen he says is effective at relieving the underlying depression or anxiety often at the root of addiction. He says he rarely prescribes pain killers. An author and former radio personality, Corona's message is that psychotropic medicines are invaluable in healing the mind and, consequently, the body.

"I am the top prescriber of psychotropic medications around," Corona said. "Ninety-five percent of my patients are very happy. The fact anyone would put me in that category (as Tseng) is laughable."

Corona is praised by some local doctors, but a psychiatric expert who testified in the 2007 lawsuit said that Corona has no formal training in psychology and acted outside the scope of his training as a general practitioner. Two addiction experts interviewed by The Register criticized Corona's wide use of psychotropic drugs to treat people already hooked on controlled substances.

Dr. Harry Haroutunian, physician director at the famed Betty Ford Center in Rancho Mirage, says it is especially dangerous to prescribe drugs with sedative qualities when treating addicts in an out-patient setting, where they might score more drugs on the street.

"If he is telling you he is the highest prescriber," Haroutunian said, "that would be a dubious distinction by my measuring stick."

PSYCHOTIC BREAKDOWN

Corona's personal and professional lives have weathered considerable chaos over the last several years, public documents show.

On Dec. 17, 2007, Orange County Sheriff's deputies were sent to Corona's Laguna Niguel home and found him in his backyard having a "psychotic breakdown" and threatening suicide, an accusation from the Medical Board of California shows.

"Respondent was acting bizarre and was very aggressive, yelling and screaming incoherently. The officers had to taser respondent several times in order to subdue him," said the report by the medical board. Corona was hospitalized for nearly a month for psychological observation.

It was the same year that he published a book about treating mood disorders, entitled "Healing the Mind and Body."

In a 2008 interview with the Medical Board, Corona said he suffered an episode of hypomania three years prior. State documents say that he was prescribed Seroquel by his psychiatrist, but admitted to self-medicating from his sample drugs after his psychiatrist moved away.

"His disorder has impacted his ability to practice safely and led to his hospitalization for a psychotic breakdown," the state complaint said.

Corona was put on probation for five years in 2009.

Since opening a new office in 2008, Corona has focused on treating neuro-chemical imbalances that prevent the brain from reaching what he calls the "Wonder of Optimal Well-being" or the WOW state.

Sporting a flattop haircut and a Hawaiian shirt, Corona sees about 500 patients a month at his two-room suite, in a non-descript business center off Ivy Glenn Drive. Instead of a Rolodex, he keeps his phone numbers on a wrinkled piece of paper crammed inside his desk drawer.

Before his 2007 hospitalization, Corona said he had a 10,000-square-foot office with three other doctors. The practice foundered about the same time as his mental problems appeared. In 2008 he opened the solo practice.

Patient Madelyn Picascio, 72, of Laguna Niguel, said Corona brought her out of a deep depression.

"He is way better than any psychologist," Picascio said. "There's always a loony who will accuse the doctors of something. All I know is he helped me."

Dr. Carlos Montano, head of the drug rehabilitation center at Hoag Hospital in Newport Beach, says he often refers addicts to Corona. Montano estimated that up to 75 percent of the addicts he sees require drugs to stabilize their mood swings.

"Dr. Corona is a wonderful mental health physician," Montano says. "He gets referred some of the worst cases."

But not all experts in this field agree with such an approach – or that general practitioners like Corona should be treating mental patients.

Addiction specialists agree the limited use of drugs can be necessary, especially for addicts so physically dependant that removing all drugs could be fatal. But they say some doctors are now too quick to prescribe a chemical course rather than let the brain stabilize itself.

With these cases comes the danger – especially in an out-patient setting – that the addicts will supplement their prescriptions with street drugs, unbeknownst to the doctor, as in the case of Jarrod Barber.

"It's very dangerous out there," Haroutunian says.

Dr. Stefan Kruszewski, a Harrisburg, PA, psychiatrist who specializes in addiction, agrees that fewer psychotropic pills and more exercise, better food and therapy is the best way to heal the brain.

"It's better for the brain than adding more chemicals," says Kruszewski. "You need to let the brain establish itself and detoxify and you can't do that by adding more chemicals. You get more complications and more adverse effects when you administer more drugs. You can facilitate the brain's restoration with time, support and healthy living."

'LUDICROUS' STANDARD OF CARE

Corona was one of the doctors treating a mentally ill woman, Janene K. Johns, in August 2006. Johns fell asleep at the wheel with sedatives in her system, killing a young mother in Newport Beach, public documents show.

The family of the victim, Candace Tift, 31, is suing Corona and Johns' other physician, Dr. Jeffrey Barke, for wrongful death. Although none of the drugs prescribed by Corona were in Johns' system, according to a toxicological report, the family's attorney alleges her doctors should have hospitalized Johns or otherwise prevented her from driving because of the severity of her illness.

Attorney Sidney Martin, who is defending both doctors, said “I don’t think there was any negligence of any kind on the part of Dr. Barke and Dr. Corona.”

Court papers say Johns displayed a series of bizarre behaviors, such as stating that the shower in her home was causing cancer and that the voice of her recently deceased husband was passing messages through the television. Johns started filling one-gallon bottles with water and placing them throughout her house, for fear of disaster, documents say.

Johns' daughter took her to their family practitioner, Barke, who referred them to Corona as a "specialist in mood disorders," court documents charge.

Dominick Addario, a psychiatrist and professor at University of California, San Diego, testified in a declaration for the lawsuit that Corona has no formal training in psychology or psychiatry.

Corona's "assessment, care, treatment and handling of Ms. Johns' situation ...was not simply below the standard of care, but rather it was ludicrous," Addario testified.

For example, Addario testified, Corona did not perform any type of psychiatric evaluation of Johns. He did not document the history of the patient's behavior. He incorrectly assumed that Johns had stopped taking Ambien. He did not assess how much Xanax Johns was taking.

Corona prescribed Seroquel, which is commonly used for treating schizophrenia, and gave her a two-week supply from his samples, court documents say.

"Dr. Corona should have realized that Ms. Johns was in the midst of a psychotic breakdown and that she was irrational and her judgment impaired," Addario testified. "At minimum, Dr. Corona should have instructed/insisted that Ms. Johns be seen by him in a minimum of 3 days and that she not be left alone, not drive, and have her medication administration strictly supervised."

Addario said the accident would not have happened if Corona had been more diligent.

"It was ludicrous to assume that Ms. Johns could safely and reliably administer medication, drive a car, or be left alone," Addario says.

In a deposition in response to the lawsuit, Corona testified that he didn't recall talking to Johns about the details of her psychotic breakdown. He added her drug use would have been detailed in a questionnaire that his office gives.

In an interview, Corona labeled the lawsuit "lawyer fishing."

"It's nonsense, there was absolutely no basis for her hospitalization," Corona says. "You can't go back later and say, 'You should have known.'"

Johns is serving a 6-year prison sentence for gross vehicular manslaughter while intoxicated.

The Tifts' lawsuit is scheduled for trial in June.

A BAD MIX

Seeking help for their marijuana-abusing son, Jodi and her husband, Bill, were referred by a local psychologist to Corona in October of 2009. Corona prescribed Clonazepam, at Jarrod's request, the anti-depressant Pristiq and, later, the anti-depressant Cymbalta, according to a treatment chronology that Corona sent to the Register.

Corona saw Jarrod again two days before his death. He prescribed Seroquel because "it is not addictive and is safe, and could potentially help to resolve or decrease his anxiety and help to improve his sleep and appetite," the chronology says. The document notes that Jarrod told Corona he wasn't taking Clonazepam "as much over time."

Jarrod came out of Carona's office loaded up with Seroquel samples, so he could get started right away, Jodi Barber says.

Haroutunian as well as Kruszewski questioned why a doctor would prescribe Seroquel to someone taking Clonazepam – since both can act as sedatives.

"You're getting unintended adverse consequences from taking Seroquel and Clonazepam. And when you mix them with more sedatives, you can end in overdose," said Kruszewski, who has testified against the makers of Seroquel for marketing uses not approved by the federal government. Seroquel-maker AstraZeneca this week signed a $68.5 million settlement with attorneys general in California and 37 other states who had accused the company of marketing off-label uses for the drug.

Seroquel's government-approved use is for schizophrenia and bi-polar disorder, but Corona – as other doctors do – was using it off-label to help Jarrod sleep and eat. It's legal for doctors to prescribe drugs for off-label uses, but illegal for drug-makers to promote them.

Haroutunian called Seroquel and Clonazepam "a bad mix."

"Both depress the central nervous system. Together they can have an addictive effect," Haroutunian said.

Monitoring her son's drug intake, Jodi said she confiscated the drug samples from Jarrod, but missed a four-pill box of Seroquel. Jarrod apparently took three pills the night he died, which was the prescribed dosage, along with the illegally obtained Opana, the pain-killer. He also had Clonazepam and marijuana in his system, according to a toxicological report in the coroner's records.

Corona says he didn't mean for the Clonazepam and the Seroquel to be taken simultaneously.

"If they choose to do it anyway, against my advice, look what happens," he said.

Corona says he is being vilified by a small group looking to displace blame.

"It's disheartening when a few comments sway this completely imbalanced view of what I do by people who don't know what I do," Corona said.

Jodi Barber disagrees.

"He knew what he gave Jarrod," said Jodi Barber. "I'm horrified; just devastated."

THE DIAMOND PLAZA

Opana is a prescription drug relatively new on the street. A time-release pain killer, essentially synthetic morphine, it can induce euphoria but can also depress the respiratory system. Coroners weren't finding it in Orange County overdose cases until 2009; since then it's appeared in six cases.

Recovering addict Dimitri Zarate, 32, of Dana Point, said he got his Opana from Dr. Lisa Tseng.

"The hardest part was the drive to (her office in) Rowland Heights," says Zarate. "Once you got in the room, it took five minutes." Zarate said he paid $300 for the visit and got prescriptions for drugs with a street value of $4,000. His plan was to sell half the drugs and keep the other half – a typical pattern among abusers. Zarate entered a Dana Point recovery center late last year.

Tseng remains under investigation by the DEA, which searched her "AAA Advance Care Medical Center" in August and revoked her ability to prescribe federally-controlled narcotics. The osteopathic board is working with the state attorney general's office to revoke her license, officials said. Until then, her clinic remains open.

The Register visited Tseng's clinic earlier this month, but Tseng declined through a nurse to be interviewed. She provided the name of a lawyer, Mark Mermelstein of Los Angeles, but he also declined comment.

On one recent weekday night, her clinic remained busy, handling flu patients and young athletes seeking a quick physical.

Meanwhile, Dr. Corona is putting the finishing touches on his second book on treating addiction and mood disorders. Aimed at physicians, it will be titled, "Healing the Mind and Body, Part 2." He hopes to finish his probation with the medical board early.

Prescribe opioids more carefully: researchers

Some family doctors who often prescribe opioid painkillers such as OxyContin may not be doing it as safely as they could, a new Canadian study suggests.

Deaths involving prescription opioids are increasing in Canada and the U.S.

The findings of the study in the March issue of the journal Canadian Family Physician suggest that the deaths occur more often among those treated by physicians who frequently prescribe the drugs.

Dr. Irfan Dhalla, a general internist at St. Michael's Hospital in Toronto and his co-authors found the 20 per cent of family doctors who were frequent prescribers wrote 55 times as many prescriptions as those who prescribed the drugs the least.

What's more the study found, doctors who frequently prescribed opioids are also more likely to write the patient's final prescription before death. The conclusions are based on an analysis of prescriptions filled by Ontarians aged 15 to 64 in 2006 and a review of coroner's records for deaths related to opioid use.

Reducing risk of harm

On one hand, family physicians are caught between patients suffering terribly from chronic pain who can't get relief, and on the other hand, there's weak evidence that opioids actually help as a long-term treatment for non-malignant pain, said Dr. Philip Berger, a family physician at St. Michael's who commented on the study.

The pharmaceutical industry aggressively markets opioids to doctors, Berger said.

But the drugs carry significant risks, such as addiction and death from overdose, he noted.

"Our findings also suggest that family physicians might be able to reduce the risk of opioid-related harm by writing fewer opioid prescriptions," the study's authors concluded. "Achieving this goal will likely involve re-examining the appropriateness of prescribing for individual patients in light of the limited evidence for the utility of opioids in chronic nonmalignant pain."

To assist doctors in taking a closer look at the appropriateness of their prescribing, the authors suggested targeting the minority of physicians who prescribe a high-volume of the painkillers. Educating doctors about the best use of opioids and then auditing and monitoring their prescription patterns may help reduce the toll of opioid-related deaths, the team said.

The authors acknolwedged their study has limitations. It only looked at prescriptions paid for by government drug plans. It is also recognized that it couldn't examine at individual prescriptions and match them with patients. And they couldn't rule out that some doctors who prescribed a lot of opioids may be doing so with a very low risk of harm.