Preet Bharara, the U.S. Attorney for the Southern District of New York, discusses the efforts in the fight against painkiller abuse, Sept. 3, 2015 in his office in Manhattan.
Pain-pill abuse has ignited a heroin crisis, but prosecutors say their efforts to get ill-gotten pills off the streets have been blocked by the New York state Department of Health.
The Health Department failed to provide narcotic prescribing data that local and federal prosecutors requested while targeting a growing trend of deadly and illegal pain-pill sales in Westchester, Rockland and Putnam counties, a Journal News/lohud investigation has found.
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“That is the purpose of this data in the first place, so you’re able to find the pharmacist or the doctor who is prescribing, like candy, the thousands and thousands of pills that are putting people in the ground,” U.S. Attorney Preet Bharara said.
At least 170 people have died in the Lower Hudson Valley in connection with pain-pill abuse since 2010.
Meanwhile, misuse of pain pills has spawned a heroin crisis. Costly painkillers have created opioid addicts, who fueled a resurgence of the cheap street drug after decades of decline. Drug dealers fetch up to $80 per ill-gotten pill, while a hit of heroin can go for as little as $5 and feed the same opioid cravings.
The cycle of drug use has prompted record numbers of overdose deaths, The Journal News/lohud found by analyzing medical examiner records. Heroin alone has been tied to nearly 230 deaths in the Lower Hudson Valley from 2010-14, having more than doubled in Westchester County, from 21 deaths per year to 47. In those years, Westchester County has registered 182 deaths and Putnam 29. Rockland saw 10 deaths last year; data was unavailable from 2010-13.
One of those lives lost was Justin Salomone, 29, of Mahopac, who died in 2012 of a heroin overdose. He started using heroin after beginning with pain pills, his parents said. They said Justin likely obtained pain pills from drug dealers. He didn’t have a prescription, which is how so many other suburbanites get hooked on opioid painkillers.
When told by The Journal News/lohud of the state Health Department’s failure to cooperate on efforts to curb opioid abuse, Susan Salomone shook her head and said: “It makes you sick.”
Undisclosed state records on narcotics-prescribing data that contain details about patients, pharmacies and doctors also affected investigations by Rockland District Attorney Thomas Zugibe, who oversees a regional drug task force.
“You could have clearly identified who the real pill doctors were, and at least intervened and said, ‘From a licensing point of view, you (doctors) are not acting in accordance with your oath,’” Zugibe said. “Nobody was saying just arrest them because they were a top prescriber, but it would give you certain leads and at least bring you in for a basis for questioning.”
The state Health Department, headed by Dr. Howard Zucker, would not discuss why it failed to provide narcotics-prescribing data that Zugibe and Bharara say they requested. Zucker’s media office said state law generally prevents the Health Department from disclosing certain confidential medical data.
“Further, DOH responds to requests for information, but does not publicly confirm or deny whether it has received such requests, nor does it publicly comment on the status of any request it receives,” the office said.
Bharara said his office has repeatedly asked the Health Department to use its prescription data to identify possible over-prescribers and refer those matters to law enforcement. .
“People are rightly sensitive to medical information, and people need to be careful how you go through medical information and prescribing information and make sure that it is anonymized in a way that people’s privacy is not harmed, and yet there is a public interest and public health responsibility to making sure that you are able to find (illegal prescriptions),” he said.
Beyond fallout from hidden state records, The Journal News/lohud uncovered gaps in oversight of pain pills nationally by reviewing federal Medicare records for Lower Hudson Valley doctors and nurse practitioners.
One doctor’s Medicare pain-pill records are connected to a New City office where he doesn’t seem to have ever worked. Some doctors and nurse practitioners are also prescribing significantly more pain pills than peers, which raises questions about potential abuses tied to the federal program.
As concern about pain pills mounted, the U.S. Centers for Disease Control and Prevention declared related overdoses a national epidemic. Deaths tied to the drugs have quadrupled since 1999, killing 16,000 people in 2013 nationally, the most recent data show.
Pharmaceutical companies, including Connecticut-based Purdue Pharma, have also paid millions of dollars to settle lawsuits claiming they misled the public about pain pills’ addiction risks. By contrast, sales revenues from the drugs have exceeded billions of dollars.
Zugibe and Bharara say they requested narcotics prescribing data controlled by the state Health Department’s Bureau of Narcotic Enforcement. That information includes details about patients, pharmacists and doctors, which the two prosecutors say is critical to criminal investigations.
While those records have been withheld, some federal records were made public in April that provide a glimpse into how pain pills and other drugs are prescribed nationally. Medicare, the federal health insurance program for elderly and disabled people, released some of its billing data, including for New York, as part of the Affordable Care Act.
The Journal News/lohud dug into those records on opioid (oxycodone) pain pills connected to Lower Hudson Valley doctors and nurses. While they don’t contain the details sought by Zugibe and Bharara, they are an important step towards improving how pain pills are tracked.
Medicare data analysed by The Journal News/lohud reflected prescriptions in 2013, the most recent year available. The review focused on the highest prescribers by community based on drug cost, which includes fees and other money paid out by Medicare.
Prescribing data is affected by several factors, such as patient volume and medical specialty, and doling out the most pain pills doesn’t inherently mean wrongdoing is present. Gaps in some state and federal records, however, raise concerns about abuses.
Dr. Jesus Serrano, an internist, prescribed thousands of pain pills related to a New City address, but his son, who has a physical therapy practice there, said his father never worked there.
Richard Serrano said his father has been working at clinics in Florida and San Diego. According to the records tied to the New City address, he prescribed more than 102 Medicare patients with 9,020 days’ supply of pain pills.
Karen Doblin, a nurse practitioner, handled prescriptions for 167 Medicare patients with pain pills connected to a 220 Westchester Ave. office in White Plains. Those prescriptions covered 20,494 days’ supply.
Doblin stopped working at the Pain Medicine and Wellness Center of New York in White Plains at some point after 2013. This month, a receptionist at the center said she still receives at least two calls per week from pharmacists, insurance agencies and others looking to authorize prescription claims connected to Doblin.
Doblin worked at Mount Sinai Beth Israel’s department of pain medicine and palliative care for a time, before leaving in June, a hospital worker said, to work at Manhattan Spine & Pain Medicine, a private clinic with offices in New York and New Jersey.
She didn’t return several messages left at the Manhattan office.
‘How much pain do you have?’
Dr. Sudhir Vaidya prescribed more pain pills through Medicare than some of his peers, but said every script brought him anxiety.
“It is always worrying when I prescribe… but if someone comes in complaining of pain, you are trained to be a caregiver and you are not trained to be a cop,” he said.
Still, Vaidya, who is affiliated with hospitals in Yonkers and White Plains, said he has turned away patients showing signs of drug abuse.
Vaidya is director of sports medicine and pain management at Burke Rehabilitation Hospital in White Plains. He is also affiliated with St. Joseph’s Family Health Center, a teaching clinic in Yonkers connected to his Medicare prescribing records, which show 2,374 days’ supply of pain pills in 2013.
Addressing the Medicare records, Vaidya said he handles a lot of patients with chronic pain. A major portion of his practice involves people recovering from knee and hip replacements, which he said requires pain medication.
Vaidya and many other doctors trace the spike in pain pills to the late 1990s. They point to marketing campaigns and lawsuits claiming patients’ pain was improperly treated. Then came shifts in prescribing methods and standards, such as a key question doctors ask during checkups: “How much pain do you have, from zero to 10?
“When I started 30 years ago, we never gave narcotics,” Vaidya said.
Supply and demand
Purdue Pharma has been sued and indicted in connection to OxyContin, a potent prescription opioid pain pill.
In a settlement of a Virginia criminal case in May 2007, Purdue and three executives pleaded guilty to federal charges that they intentionally misled doctors, regulators and patients about OxyContin’s addiction risk and potential for misuse, USA Today reported. Purdue agreed to pay $600 million in fines; the executives, $34.5 million total.
By contrast, OxyContin brought Purdue about $2.8 billion in revenue during the period related to the settlement, USA Today reported.
Last month, Purdue agreed to a settlement with New York. State Attorney General Eric Schneiderman’s office accused the company of failing to prevent its sales representatives from contacting doctors showing patterns of improperly prescribing pain pills, along with other practices.
The agreement required Purdue to improve its marketing and sales oversight and pay $75,000 to the state.
“For more than a decade we’ve implemented industry-leading programs designed to reduce the abuse and diversion of prescription medicine,” Robin Abrams, a lawyer for Purdue Pharma, said of the New York settlement. “We’ve relied on the input and encouragement of law enforcement officials, like the attorney general, to continually upgrade and improve our programs.”
After losing their son to an overdose, Steven and Susan Salomone co-founded Drug Crisis in Our Backyard, a grass-roots group raising awareness about the links between pain pills and heroin. They bring charts showing spikes in pain pill sales and opioid overdose deaths to neighborhood meetings.
“There is some kind of disconnect when you can see all these deaths occurring,” Steven Salomone said during a recent interview.
Addressing the pathway from pain pills to heroin, Bharara, the federal prosecutor, broadened the scope of the epidemic’s death toll.
“That increase in demand for heroin is a direct pipeline to more poppy production and more essentially child enslavement in places like Mexico, which is a direct pipeline to more drug murders and violence in other countries and this country,” he said.
A drug bust this week in the Bronx and Yonkers that seized 141 pounds of heroin, with a $30 million street value, served as the latest example of a push to flood New York with heroin.
Zugibe, the Rockland prosecutor, had another take on prescription drugs’ upward trend. He cited CDC data that show pain-pill sales nationally quadrupled from 1999 to 2010, when one in 20 people, age 12 or older, reported using prescription painkillers for non-medical reasons.
“Until something happens with the pharmaceutical companies, it’s going to be hard because they’re making them way too available and they know that, but they’re doing it for profit at the expense of people’s lives.”
When law enforcement raided a Harlem apartment last year, they found a printer primed to churn out forged pain-pill prescriptions.
The phony scripts appeared to be the latest batch in a scheme to dupe pharmacists, who allegedly and unknowingly supplied a major chunk of 50,000 pain pills sold by drug dealers in the Lower Hudson Valley.
Basically, to beat narcotic prescribing controls in New York it took just a few things: some Internet savvy, a printer and a team of low-level “runners” to buy the pain pills at pharmacies. Some of the drug dealers even posed as doctors when called by pharmacists to confirm the forged scripts, court records show.
Police arrested 29 people in March on charges tied to selling those pills, heroin and other drugs at local shopping malls and motels.
But the pills would have never reached the streets if New York had fully implemented laws passed to prevent such schemes.
One of those laws requires mandatory e-prescribing for doctors, which would make all prescription narcotics transactions digital and eliminate more easily forged paper prescriptions.
Despite being part of a 2012 law seeking to reduce prescription drug abuse, the e-prescribing mandate has been stalled. It’s now due to go into effect in March.
But some portions of the 2012 program called I-STOP (Internet System for Tracking Over-Prescribing) have started to gain traction. One aspect is that doctors are required to check a prescription drug monitoring program database, which state officials report has reduced “doctor shopping” by addicts.
Dr. James Mussman, an internist, prescribed 5,159 days’ supply of opioid pain pills to Medicare patients in 2013. He said a new sign that reads “no new patients on controlled substances” went up at his New Rochelle office last year.
Gaps in record-keeping and inter-agency cooperation, however, make tracking controlled substances even more complex. One reason, according to The Journal News analysis of Medicare records, are flaws in the national provider identifier accounts linked to prescription claims.
Claims information for some of the Lower Hudson Valley’s highest pain-pill prescribers, including addresses and billing information, appeared to be inaccurate or lacking other important details about their medical practices, suggesting limited oversight of billions of dollars in pain pills and other drugs charged each year to Medicare.
Despite flawed records and absence of coordinated prevention effort, federal Drug Enforcement Administration agents reported increases in their arrests in New York during the past five years, The Journal News has found.
Prescription drug diversion arrests, including illegal pain-pill sales, increased 42 percent, from 148 to 210. Heroin busts have more than doubled, from 238 to 484.
Still, doctors don’t face many prescribing-related penalties, according to a report last year by the Poughkeepsie Journal, an affiliate of The Journal News,
One case involved Dr. David Brizer of Rockland County. He admitted selling several million dollars worth of pills, and failing to pay $500,000 in related state income taxes, but he got no jail time. Most debate over sentences for doctors focuses on their lack of prior criminal records. State laws also view selling prescriptions as a less serious crime than selling a drug, the report shows.
“The difficulty in investigating those is because the vast majority of doctors are legitimate,” said James Hunt, DEA special agent in charge. “It’s not like when you investigate the drug dealer; We know everything they’re doing is illegal.”
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