This is from june but still good reading



'WAR ON PAIN' TARGETS PHARMACIST


Crackdown on Oxycontin Stirs Fear in Medical Profession
By John Ryan
Daily Journal Staff Writer
June 11, 2004

LOS ANGELES - For now, Richard Ozar still owns and operates the Victoria Village Pharmacy in Ventura. With a 33-count federal indictment hanging over Ozar's head, however, the pharmacist may find his days as a local proprietor and free man numbered.

A grand jury in November accused Ozar of conspiring with Oxnard physician Michael Huff to unlawfully distribute prescription painkillers like Oxycontin, also known as "hillbilly heroin," the drug that talk-show host Rush Limbaugh publicly confessed he was addicted to for years. The drugs ended up in the hands of recreational pill-poppers and dealers instead of legitimate patients, the indictment charged.

Sympathizers claim Ozar is the latest victim in the federal government's immoral war against pain-care professionals. Patient advocates say that doctors, and an increasing number of pharmacists like Ozar, are being persecuted for treating chronic and severe pain aggressively, as state medical boards recommend.

Victor Sherman, a veteran defense attorney who represents Ozar, said that including a respected community pharmacist in the prescription-drug crackdown is outrageous. All Ozar did was fill legal prescriptions, written by a licensed doctor, Sherman noted.

"This is a man who's never had a traffic ticket," Sherman of Santa Monica's Sherman Sherman said recently. "He thinks he's doing the community a service, then he turns around, and they indict him. It's devastating. "It's an example of Big Brother coming in after the fact, seeing the new hot drug and trying to teach the medical profession a lesson."

Prosecutors, however, say that medical professionals like Ozar have dispensed drugs in such huge quantities and to such obviously healthy patients that they must have known the pills were destined for the streets. Assistant U.S. Attorney Mark Young, who is prosecuting the case, said that local investigators determined that a staggering amount of illegal narcotics circulating in Ventura County were prescribed by Huff and dispensed by Ozar.

"Ventura County law enforcement discovered a major problem in Oxycontin use and sales and even deaths linked to the drug," Young explained. "These incidents involved drugs that for the most part were traced back to Dr. Huff and Richard Ozar."

Young said that the U.S. attorney's office in Los Angeles took the case because of the seriousness of the allegations and because evidence indicated that some of the drugs crossed state lines. The federal indictment lists dozens of counts - 33 against Ozar and 55 against Huff - for unlawfully distributing tens of thousands of pills of controlled substances like Oxycontin, methadone and other opiates that mimic the effects of morphine or heroin.

Both men pleaded not guilty after their December arrests and are free pending the outcome of the case. Huff, too, claims to be a victim of a misguided prosecution.

Young conceded that the Ozar prosecution is unusual. Pharmacists typically are charged with siphoning off pills for direct sales to nonpatients or with some type of billing fraud, he acknowledged. Instead, the indictment accuses Ozar of filling out prescriptions for drugs that he knew would not be used for legitimate medical purposes.

Critics see increased attacks on pharmacists as an unfortunate but inevitable evolution of the federal government's campaign against pain-management professionals, led by the Drug Enforcement Administration and the Justice Department under Attorney General John Ashcroft.

For the most part, these cases have focused on doctors, who often are portrayed as drug kingpins.

The prosecutions have made it increasingly difficult for patients to find practitioners willing to prescribe effective amounts of pain medication, said Siobhan Reynolds, the executive director of the Pain Relief Network, which supports pain doctors facing prosecution.

Going after pharmacists, Reynolds said, will only make things worse. Patients lucky enough to find doctors willing to write the prescriptions may not find pharmacists bold enough to take the risks.

"The chilling effect will be terrifying," Reynolds said. "If you were a pharmacist and you knew you could face criminal prosecution because a doctor you didn't even know wrote a prescription to somebody who turned out not to be a legitimate patient, why would you ever fill prescriptions for controlled substances?"

The Drug Enforcement Administration's Oxycontin "action plan" dates to 2001, when the agency determined that nonmedical use of the drug and emergency-room treatment for overdoses and deaths were skyrocketing. Oxycontin pills release oxycodone, a powerful pain reliever similar to morphine, slowly over a long period of time to provide extended pain relief. The controlled-release method makes Oxycontin especially effective for moderate-to-severe pain that is expected to last a long time. However, to provide long relief, the pills must contain large amounts of medication, which abusers can get all at once by chopping up and snorting or shooting.

Doctors' groups routinely have questioned the DEA's dire statistics on the drug, noting that most Oxycontin-related medical incidents occur when users recklessly combine the drug with other medications or alcohol. Nevertheless, the action plan called for increased cooperation by federal, state and local authorities to halt abuse of the drug.

In a March announcement, the Bush administration's drug czar, John Walters, head of the Office of National Drug Control Policy, promised an unprecedented and "comprehensive effort," including increased investigative work by the DEA, to combat the diversion of prescription drugs to the black market.

The Pain Relief Network has followed a hundred state and federal prosecutions against pain doctors in the past three years. As in the Huff-Ozar prosecution, Reynolds explained, authorities in most of these cases discover illegal behavior on the part of a small number of patients, then work their way backward to the medical professionals who were the source of the medications.

Prosecutors have had mixed success in some of the better-known cases. Last year, federal prosecutors in Virginia failed to convict pain doctor Cecil Knox on any of 69 counts, including illegally dispensing drugs leading to bodily harm and death. The jury cleared Knox on 30 of the charges and deadlocked on the rest, leading to a mistrial. A federal grand jury charged Knox again in a fresh indictment.

Ending one of the longest-pending state cases, a Redding jury in May cleared Shasta County physician Frank Fisher of numerous Medi-Cal fraud charges. The misdemeanor counts for improper billing were all that remained after prosecutors in the California Department of Justice failed to prove that Fisher and his co-defendants, the owners of the Shasta Pharmacy, improperly distributed painkillers.

Most of the cases tracked by Reynolds' network have resulted in convictions, however, including five from a single pain clinic in Myrtle Beach, South Carolina, she said. In February, a federal judge imposed sentences ranging from 2 to 24 years on five doctors from the clinic for their roles in distributing Oxycontin.

In a pending case, McLean, Va.-based pain doctor William Hurwitz faces a 49-count federal indictment for allegedly running a nationwide trafficking operation involving Oxycontin and other narcotics.

"We will continue to pursue vigorously physicians, patients and others who are responsible for turning Oxycontin from a legitimate painkiller to a vehicle of addiction and death," Ashcroft said in September when announcing the arrest.

Last fall, the Association of American Physicians and Surgeons issued a statement in support of Hurwitz and other doctors, urging federal authorities to work with medical professionals on controlling drug abuse instead of pursuing legal actions that compromise the treatment of patients and equating doctors with terrorists.

Indictments and arrests alone are enough to scare doctors away from prescribing controlled substances improperly, Reynolds added, even if the prosecutions fail.

The charges against Ozar will have a similar effect on pharmacists, she said.

When announcing the arrests of Huff and Ozar last year, Ventura County authorities accused the pair of ushering a new drug culture into the region. State and federal law-enforcement representatives called the scope of the case unprecedented, claiming that the oversupply of Oxycontin fueled by Huff and Ozar's distribution racket cut the street price of the drug from $80 to $10 a pill.

The Medical Board of California suspended Huff for nine months following its own investigation, according to Los Angeles attorney Mark Beck, who is defending the Oxnard doctor.

Huff can continue his family medical practice, though he no longer can prescribe controlled substances. Beck said that treating patients with chronic or severe pain accounted for 10 percent of Huff's medical practice before the disciplinary action.

A state Board of Pharmacy investigation into Ozar's pharmacy is pending. Both defense attorneys said that Huff and Ozar barely know each other, having only engaged in the occasional phone conversation. The indictment provides details on Huff's treatment of 10 patients, who are identified only by their initials. Huff prescribed tens of thousands of pills to these patients in 2002 and 2003, the indictment alleges, at times without seeing their medical records. Huff renewed prescriptions before his patients should have gone through their pills supplies, the indictment says, and ignored warnings that patients had been overheard discussing the street value of the drugs. U.S. v. Huff, CR03-1197 (C.D. Cal., filed Nov. 20, 2003).

Beck said his client was never put on notice that any of his patients were diverting the drugs to trafficking, however. Like Ozar, the attorney pointed out, Huff is not charged with taking kickbacks from alleged dealers. Prosecutors only allege that his practice benefited from his willingness to write the prescriptions.

"He got $80 per office visit," Beck of Beck, De Corso, Daly, Kreindler Harris explained. "He wasn't doing anything to line his pockets." Beck conceded that it may sound like his client prescribed a whole lot of pills. Huff prescribed more painkillers than other doctors because he was willing to put his patients first, even if doing so risked his profession and his freedom, Beck said.

Beck said he plans to put the federal government's war against pain doctors on trial. The central issue, he said, is whether cops and prosecutors should be practicing medicine.

"I would trust the doctors before I would trust John Ashcroft to determine what's appropriate," he said.

Sherman said he also plans to confront Ashcroft's campaign head-on. He noted that neither the DEA nor the state Medical Board have placed upper limits on the amount of painkillers a doctor may prescribe, so long as there is a legitimate need for pain treatment.

But even assuming Huff did something wrong, Sherman said, liability should not extend to a pharmacist merely for filling out what appeared to be valid prescriptions.

Young, who works in the narcotics section of the U.S. attorney's office, said that the quantities and combinations of some of the drugs prescribed for individual patients should have alerted Ozar that something was amiss.

Pharmacists are not at liberty to fill any prescriptions that come their way, Young explained.

"There is a corresponding duty to evaluate the prescription," Young said. "Under the circumstances and facts of this case, a grand jury concluded that he knew or should have known that those prescriptions were not valid."

In some situations, the prosecutors added, Ozar dispensed massive amounts of painkillers to patients who appeared youthful and healthy. At other times, he said, patients paid Ozar's pharmacy with $10,000 in cash for large amounts of Oxycontin.

"It's still legal to pay cash in this country," Sherman responded. He added that cash payments formed only a small part of Ozar's business. The insurance companies who paid the bills for the bulk of Ozar's patients never questioned the validity of the prescriptions, Sherman said. When his client had questions about certain prescriptions, Sherman added, he called the doctors who wrote them.

Sherman agreed with Young that every pharmacist has a duty to evaluate the prescriptions that come into his office for possible illegal activity. He insisted, however, that his client did just that.

"We're not saying [Ozar] didn't make any independent judgments, because he did," Sherman explained. "These kinds of medications are legitimate ways to fight pain, and he believes that pain medications can be given in these quantities. Maybe other pharmacists would have made different judgments. But that doesn't make our guy a criminal. Certainly, there's no criminal intent."

Sherman acknowledged that medical experts for the U.S. attorney's office will suggest differently.

"So the government's medical opinion will be that he shouldn't have written the prescriptions," Sherman said. "But who are they? Are they the doctors now?"



DAILY JOURNAL NEWSWIRE ARTICLE

Hi Caregiver,
That would be a fitting example of prosecutorial hysteria in your report caregiver instigated by DEA and the feds with a boss who has been in the hospital awhile back with a very painful ailment...wouldn't it be a happy justifiable reversal of these zealots when this VIP atty gen
was in the hospital that they would not give him pain killers on the assumtion he might become addicted ..Then he would get an upfront and personal taste of unrelenting pain which would give me a great pleasure as if i'd just been given iv morphine! yeah i'm mad at these b------s for going after pain drs!
hehhehheh,
Alan

Al
I would like for one of these uppity ups to walk one day in the life of a chronic pain patient. lets see if they could tell us they woulddnt rather live on pain meds then to have no life at all. I know for most of us pain meds help to live productive lives.That is something they dont understand. They make you jump through hoops to get disability. they try to control our actions. and even free speech isnt free speech anymore. and if your a middle class american thats even worse cause now your on that borderline where you scratch your butt to make ends meet. but yet your to rich for anykind of help. I know this is kinda off topic but it pisses me off to no end at how these a**holes operate. So yes i agree letum have a surgery,fall or something else that requires meds and see if their way of thinking doesnt turn around.I think its really sad that now they arent just goin after doctors but the pharmacists who fill them? Crazy!
Care~