Kokomo Tribune; Kokomo, Indiana

March 29, 2013

Zoeller cracking down on doctors

Attorney general says prescription abuse rampant.

By Scott Smith
Tribune staff writer

Kokomo — When Indiana Attorney General Greg Zoeller calls prescription drug abuse “one of the gravest issues facing Hoosiers today,” he means it quite literally.

With hundreds of Hoosiers dying from prescription drug overdoses each year, Zoeller and other state officials have formed a task force aimed at stopping the flow of prescription drugs, with a particular emphasis on the doctors who prescribe them.

Since the start of 2012, Zoeller has filed actions against 14 doctors, alleging each of the doctors over-prescribed narcotics to patients.

The four Kokomo doctors under threat of a medical license suspension — Don Wagoner, Marilyn Wagoner, William Terpstra and Robert Brewer — are just the latest in a string of doctors specializing in pain management to come under Zoeller’s scrutiny.

Kokomo isn’t the only place which has seen a massive increase in overdose deaths. Nationwide, the number of overdose deaths has quadrupled since the late 1990s.

The last year tabulated, 2009, more than 15,000 Americans overdosed and died on prescription painkillers, according to the U.S. Centers for Disease Control.

The four doctors associated with the Wagoner Medical Center clinics in Burlington and Kokomo are alleged to have contributed to the deaths of 26 patients from multiple drug toxicity. That means the patients either overdosed or died from a lethal drug interaction.

Attitudes on prescribing painkillers have changed in recent years, as the scope and breadth of the problem has become apparent.

A decade ago, the makers of one of the most abused opiate drugs, oxycodone, were claiming their drug was essentially non-addictive. The number of prescriptions written for those drugs has tripled since the 1990s.

The drug maker, Purdue Pharma, paid $643 million in fines to settle state claims in 2007.

A series of sobering statistics were presented at the state’s 3rd annual Prescription Drug Abuse Prevention Symposium last year, not the least of which were a number of studies showing the majority of addictive painkillers were prescribed by a small minority of doctors.

One study, from Oregon’s public health agency, showed 79 percent of the painkillers prescribed were coming from just 8 percent of the health care providers in that state.

Those are the doctors Zoeller and his Prescription Drug Task Force are scrutinizing.

One allegation in the petition filed against the four Wagoner Medical Center doctors stated that patients were receiving ever-increasing doses of opiate painkillers, despite tenuous medical circumstances to support those treatments.

One patient who died of an overdose was receiving the equivalent of 600 mg of morphine per day, according to the petition. Investigators called it “an excessive and lethal amount of medication.”

One of the presentations at the symposium showed that risk of overdose increases eightfold for patients receiving just one-sixth that amount.

The study also showed the majority of opiates in this country are consumed by patients receiving those kind of high daily doses.

Dr. Timothy King, president of Advanced Pain and Anesthesia Consultants, told the symposium attendees that it’s unlikely the patients abusing pain medication will cease to do so, or will quit trying to get doctors to prescribe narcotics.

“It does seem prudent, however, to continue the pursuit of public safety by requiring medical providers to practice in an ethical manner,” King said in his presentation.

To that end, Zoeller is backing legislative efforts to crack down on pain management clinics.

The biggest effort this current legislative session is Senate Bill 246, authored by Jeffersonville pharmacist Sen. Ron Groom.

The bill requires that the majority ownership interest of a pain management clinic be held by someone who holds an Indiana Controlled Substance Registration number, and that the remaining interest must be held by a licensed health care provider.

Legislators are hoping that simply preventing out-of-state and absentee owners from running pain management clinics will improve the level of care. The bill would also allow the attorney general’s office to take enforcement action against practitioners who over-prescribe and would help the AG’s office obtain records needed for investigations.

Scott Smith can be reached at 765-454-8569 or at scott.smith@kokomotribune.com.