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Doctors under scrutiny as painkiller abuse rises

A North Carolina doctor is the latest to be held accountable for overprescribing narcotics.

By Special to The Christian Science Monitor / March 26, 2002



RALEIGH, N.C.

Broad jowls and wisps of white hair only accent Joseph Talley's visage as a gentle country doctor, a soft-spoken man who soothes folks in need.

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In fact, by handing out large quantities of painkillers to his patients, Dr. Talley claims that he was only doing what he was trained to do – helping people suffering from painful ailments.

But authorities say that Talley's over-the-phone prescriptions of OxyContin and other painkillers from his Grover, N.C. office, went too far. He was giving over-the-counter drugs to patients as far away as Oklahoma, earning him a reputation as a Mayberry-esque "Dr. Feelgood."

Last week, the North Carolina State Medical Board deemed Talley's behavior "unprofessional" and, as a result, is likely to yank his medical license. The Drug Enforcement Administration (DEA) is on his trail, too: Agents say that 23 people whose deaths may be due to overdoses had ties to him, though no criminal charges have yet been filed.

The Talley case is the latest attempt by authorities to crack down on what they believe is a growing nationwide problem of overprescribing painkillers.

Only six years ago, medical regulators began assuring doctors that they would not be prosecuted for liberally prescribing medicines like OxyContin, Percocet, and Codeine, as long as the treatments were closely monitored.

But today the National Institute on Drug Abuse estimates that 4 million Americans are using painkillers simply to get intoxicated. Consequently, both medical boards and drug-enforcement agencies are closely monitoring doctors' prescription records.

In turn, more doctors are staying their prescription pens, afraid that they might be perceived as contributing to the "drugging of America."

The result is a budding debate over the fundamental role of doctors and the degree to which Americans should and shouldn't be using painkillers.

"I don't think there are a lot of doctors out there going out of their way to intoxicate people," says Dr. Barry Cole, a policy expert at the American Association of Pain Management in Sonora, Calif. "But today, it's easier for physicians to say, 'I'm going to get in trouble if I write too much.' These cases are scaring off good doctors."

Investigators say doctors can bear responsibility when people overdose, especially if patients aren't diagnosed or monitored correctly. The AG's office is not commenting on the Talley case, but Chris Brewer, a Medicaid investigator at the North Carolina Attorney General's Office, confirms that authorities across the US have stepped up investigations.

On Friday, Florida doctor James Graves was sentenced to 63 years in jail after four people overdosed on his perscriptions. Some of his OxyContin prescriptions also ended up being sold illegally on the street. Last year, a doctor in Virginia lost his license for prescribing too much Oxycontin – and, in Utah, a similar punishment was meted out to a doctor after he was tied to the overdose deaths of five people.

According to testimony to the North Carolina Medical Board on Friday, many of Dr. Talley's patients were drug addicts. One of them has relied on his prescriptions for 16 years. She would call him up and beg to be taken off the drugs, only to call back five minutes later, pleading for him to prescribe more or she'd "commit suicide."

"That favor will be granted with enthusiasm by me, despite my skepticism," Dr. Talley wrote in his notes.

After a two-day hearing that ended Friday, the North Carolina Medical Board agreed that Talley didn't examine patients closely enough, and seemed to just take them at their word. "Pain management needs to be thought of as not just covering it up with medications," says Dr. Richard Rauck, a Winston-Salem, N.C., specialist. "In this case, adherence to control was woefully absent."

In the past two years, 171 Americans have died from prescription overdoses, the majority using self-administered doses.

Talley and others argue that it's not a doctor's fault if a patient dies, knowing the risks of overuse. "It makes no sense that we should establish a public policy based on trying to prevent drug addicts from killing themselves, and make it so people who need narcotics for legitimate purposes can't get [them]," says Dr. C. Stratton Hill, a pain-management expert at the University of Texas at Houston.

Dr. Talley, his supporters say, may have made mistakes, but they say that many of his patients couldn't afford, or didn't have access to, alternatives such as surgery. Talley used his intuition, according to testimony, to gauge the patient's problems, rather than ordering extensive, and expensive, tests.

"He may have gotten drawn into just the way some patients will take advantage of a compassionate person, a man who's a little too easy," says Dr. Cole.

Others worry that further prosecutions of doctors may make some medical practitioners skittish about prescribing certain kinds of drugs.

"The situation is stacked against the doctor," says Dr. Hill. "Now, that doctor is going to say, 'Ma'am, you need pain medicine. The DEA's office is down on 6th street. Go down there and work it out with them.' "

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