Kokomo Tribune; Kokomo, Indiana

April 25, 2013

Pain doctors on board with crackdown

Up to 700 Hoosiers die of overdose each year

By Scott Smith
Tribune staff writer

— Indiana Attorney General Greg Zoeller is unleashing a major crackdown on the state’s medical community, and a spokesman for Indiana’s pain management doctors says it’s about time.

“It basically just got out of control, to where we’re prescribing six to eight times as much as we were in the early ‘90s,” said Dr. Michael Whitworth, M.D., chairman of the Indiana Pain Society.

Indiana is one of only two states with no regulations, rules or state guidance as to how much pain medication doctors can prescribe.

That could be changing, due to legislation pending in the Indiana General Assembly, but the feeling among doctors is that too many patients have died, Whitworth said.

Absent more regulations, Zoeller has gone after the state medical licenses of 14 doctors in the past two years, including four doctors connected with the Wagoner Medical Centers in Burlington and Kokomo.

All four of those doctors are charged with felonies and it’s doubtful any of the four will ever issue a prescription for narcotics again. But the actions against the doctors come after police linked 27 deaths to the Wagoner clinics.

“[Zoeller] is trying to bring some common sense back into [prescribing]. Unfortunately, he’s done it after a lot of people have died,” Whitworth said.

Whitworth disagrees frequently with the physician who prosecutors will be using against the Wagoner doctors at trial, Dr. Timothy King, M.D., president and chief medical officer of Advanced Pain and Anesthesia Consultants Group.

One point of disagreement is how many patients should be eligible for the long-term, prescribed use of opioid painkillers such as oxycodone, methadone and morphine. In testimony supporting the charges against the doctors, King opined that numerous Wagoner patients should never have received “chronic opioid therapy” due to preexisting medical and mental health issues.

Whitworth called King’s medical opinions “extremist” and said King is an outlier to the general medical consensus, particularly in King’s stance that a prior diagnosis of depression should disqualify a person as a candidate for COT.

At the same time, the fact that anywhere between 560 and 700 Hoosiers a year are dying from overdoses from prescribed narcotics is evidence that overprescribing is a huge problem, he acknowledged.

Whitworth also said using drug screens to weed out COT patients who are abusing or “diverting” medication is critical, and said allegations that the Wagoner doctors ignored drug screen results are serious.

Indiana now ranks 16th per capita in the number of prescription drug overdose deaths, but Whitworth said he thinks Zoeller’s initiative is having a positive effect.

“It’s having a chilling effect on the prescribing of narcotics, and I say that in a good way,” Whitworth said. “We’ve got to do a better job.”

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