By Jared Chausow
By Katie Toth
By Elizabeth Flock
By Albert Samaha
By Anna Merlan
By Jon Campbell
By Jon Campbell
By Albert Samaha
Lutful Chowdhury, 62, a Baldwin, Long Island, pharmacist indicted in February on conspiracy to distribute oxycodone and fentanyl (a drug for post-surgery pain), allegedly told his customers not to use the same name on their prescriptions. Chowdhury had been prescribing drugs to Kayla Gerdes, 20, of Freeport, Long Island, who was sentenced earlier this year to nine years in prison for killing a Hempstead doctor in 2010 while high on oxycodone and Xanax.
If you think doctors are carefully securing their prescription pads, consider this: In the June raid, authorities caught 11 people throughout Long Island using forged prescriptions from 11 different doctors. In September, Suffolk police arrested a man who was so rabidly obsessed with obtaining the drugs, he hung around emergency rooms and doctors' offices trying to steal their ID card so he could use them to buy pills.
In January 2010, police arrested Arnaldo Gonzalez for possession of forged prescriptions. He told police that on visits to Long Island doctors, he just lifted them. "I noticed a prescription pad on the desk and took a bunch of prescriptions when no one was looking," Gonzalez said.
While the oversight of painkillers might appear to be highly regulated, it is riddled with loopholes, information gaps, delays, and poor monitoring. State public health law blocks law-enforcement agencies from obtaining patient information. The state Bureau of Narcotic Enforcement, which is supposed to oversee these issues, might have information about illegal prescribing, but it is barred from sharing it. The bureau can't initiate that process—the police have to know something first.
Another problem is the lag of up to 45 days between the time pills are sold and when the sale is reported to state authorities. That makes tracking illegal prescribing more difficult.
Pharmacies and doctors can check a free state database of patient prescription histories, but only about 2 percent of them actually do it. If a pharmacy assistant is fired for stealing drugs, no record is kept. That employee can get the same work again.
Even though medical professionals have to get a DEA license to write prescriptions, there's no requirement for initial training, board certification, or ongoing education in federal or state law in prescribing painkillers.
On the plus side, last August, Cuomo signed the so-called I-Stop legislation, which creates a prescription monitoring registry and mandatory electronic prescribing (making prescriptions easier to track in real time). The teeth of the law won't go into effect until the end of 2014.
The bill was introduced by State Senator Andrew Lanza, from Staten Island, an epicenter of the epidemic.
Last June, Lanza described the problem as a "medicinal Trojan horse."
"On the outside," he said, it was "a medicine born legitimately, something we're all accustomed to seeing in our society as something that helps us. And meanwhile, on the inside, there's a killer lurking."
The Medical Society of the State of New York and seven other doctors' associations had qualms with the legislation, however, saying doctors didn't have time to check a database every time they wrote a prescription.
A much deeper problem is the medical community's philosophy about the treatment of pain. Brennan points out that hospitals commonly prescribe 30-day supplies of multiple pain drugs even to patients who were admitted for fairly routine injuries. Because they believe insurers won't pay for a second visit, doctors often prescribe a much larger amount than might be necessary. They are also afraid of being sued or receiving a lower rating on claims for not fully treating pain. But the practice floods the market with unneeded, incredibly addictive drugs.
"The medical community has to take a hard look at its prescribing practices," Brennan says. "There are doctors who were trained to liberally prescribe opioid drugs without a lot of thought about their addictive properties. The solution has become worse than the problem."
Brennan supports mandatory training for medical staff as well as relabeling the drugs from "for moderate to severe pain" to variants of "for severe pain" or "for severe pain and to ease terminal cases," so they aren't applied to such a wide variety of pain. She believes these steps will sharply reduce the black-market supply. "You would see the number of prescriptions written go way down," she says.
Reynolds of the Long Island Council on Alcoholism says a lot more needs to be done, including increasing the penalties against doctors. He is also urging health officials to do a better job of monitoring doctors who are prescribing a lot of painkillers. "I-Stop was a great step in the right direction, but if you cut off supply without addressing demand, it will get worse," he says. "That demand goes somewhere. It's like squeezing a balloon."
Reynolds now wants the state legislature to focus on the responsibility of insurance companies for the epidemic. Insurers, he says, are quick to pay millions for medication, but they balk at treatment. "They say the patient has to fail at outpatient treatment before they'll pay for inpatient," he says. "A chronic addict needs 30 days. But the insurers will only pay for three to five days. That's just not enough time, and, of course, the patient relapses. Then we ask the insurer to send them again, and they say no, it didn't work the first time. It's akin to using a Band-Aid to treat a severed arm."