DPS: One bottle of hydrocodone pills worth $18,000

New law puts heat on 'doctor shoppers'

By Cindy Horswell

Houston Chronicle

Sunday, March 18, 2012

For nine months, a 32-year-old petite redhead from Willis duped 52 area doctors into filling her shopping list for thousands of addictive pills, investigators say.

Rochelle Clark was allegedly netting more than five prescriptions a week, acquiring more than 12,800 tablets of the narcotic hydrocodone alone, prescription records showed, before her shopping spree ended with her arrest in February.

Harris County prosecutor Ryan Patrick has identified her as one of the growing number of premier "doctor shoppers" now awaiting trial under a new law that makes it a felony for a patient to fail to inform a physician of all the other practitioners prescribing controlled substances to him.

At the same time, some patients are using more than artful persuasion to develop their shopping networks. Several, such as Andrew Coleman, a 57-year-old Houston resident, are accused under the same law with the additional deception of using fake prescriptions.

Authorities said there were 85 doctors linked to Coleman's prescriptions for controlled substances (including 20,330 hydrocodone pills).

Fake prescriptions under three doctors' names - physicians who had never seen Coleman - were among those that were faxed and filled at 100 different pharmacies in Harris and Fort Bend counties from February 2009 to January 2011.

Neither Clark nor Coleman could be reached for comment. But investigators say both are examples of a new push to crack down on patients - not just the doctors and pharmacists that have made Houston a hot spot for prescription drug abuse.


Since the first of the year, Patrick estimates he has been filing at least four doctor shopping cases a week in Harris County.

The closing of dozens of so-called "pill mills" has so far not stemmed the tide of addictive drugs flowing into the eight-county Houston region, as the number of hydrocodone prescriptions climbed by 22 percent to 3.1 million last year compared to 2010. Harris County accounted for nearly one-fourth of all the hydrocodone prescriptions in the state last year, records showed.

Many of the doctor shoppers are not just addicts seeking drugs for themselves, they are also dealers, said U.S. Drug Enforcement Administration's agent in-charge Anthony Scott in Houston. His agency is targeting criminals who run "crews" of doctor shoppers to keep their illegal drug enterprises running.
"We see patients obtaining thousands of pills. No way they could stay alive if they consumed that much," said Patrick, the Harris County prosecutor.

The Centers for Disease Control and Prevention says 76 percent of the 12 million Americans abusing prescription drugs are consuming drugs that were prescribed to someone else.

Catching doctor shoppers will become much easier once the state's prescription monitoring program can be accessed online this summer, authorities say. Registered doctors, pharmacists and law enforcement officers can then obtain quick feedback from the database to determine if a patient has multiple prescriptions.


Dr. C.M Schade, a Texas Pain Society director, is helping test the new online system. He was surprised to discover some of his own patients were trying to mislead him and scam the system.

"They can be very good actors. They're usually the ones you'd least suspect of perpetrating a crime," he said. "They are well trained, and there's money in it." The Department of Public Safety estimates one bottle of hydrocodone pills is worth $18,000.

Tony Aucoin, a drug and alcohol therapist in Houston, recalls how he had once been easily lured into doctor shopping. He became addicted to prescription drugs for three years following a painful dental procedure in 2006.

"The drugs made me feel good. I never thought I was getting addicted until I started needing it just to function," said Aucoin of the time when he was a graduate student. As his need intensified, a friend taught him how to doctor shop.

"I was worried at first. But then I saw how easy it was. I just had to say my 'back hurt' and then say 'ouch' when they poked around," he said. Before long, he was obtaining controlled substances from three different doctors a month.

Now helping others overcome addictions, Aucoin would like to see the Texas Legislature make it mandatory for doctors and pharmacists to check the state's online database before dispensing drugs. State and federal law enforcement authorities agree.

But Schade does not think that responsibility should be placed on the medical profession's shoulders. He would rather have the Texas Department of Public Safety, which manages the state's computerized prescription monitoring system, run scans to detect any abuses and report them.

But all agree on one thing: "Doctor shopping continues to be a serious problem and the prescription monitoring program is the best tool we have to stop it," Schade said.

Prescription pill abuse in Houston-area schools

By Cindy Horswell
Updated 10:39 p.m., Friday, February 17, 2012
Houston Chronicle

In recent weeks, teens have covertly handed out addictive prescription drugs on three school campuses that have made scores of students sick in the Houston area.

A fourth campus also recently ended an undercover drug investigation with the arrest of a dozen students who authorities say were mostly peddling prescription drugs.

The recent movement of these abused drugs from so-called pill mills to school hallways has alarmed administrators and law enforcement.

"There's been a huge shift in what we're finding on school campuses compared to what we saw even a few years ago. Prescriptions are the new dope front, because they're cheap and accessible," said Angleton school district police Chief James Gayle, who ran the undercover operation. "This is not a localized problem. It's a national epidemic."

For four months, Gayle had an undercover agent pose as a student in his Brazoria County school district. This agent, Gayle said, was repeatedly approached to buy controlled substances such as hydrocodone, oxycodone and Ritalin - rather than the usual street drugs like methamphetamines or cocaine.

School administrators are particularly concerned about the prevalence of prescription drugs on school campuses because most drug dogs aren't trained to detect the new menace.

Also, students are lulled into a false belief that prescription drugs won't hurt them, even though authorities say the controlled substances are just as deadly. In recent years, Houston has become a national hot spot for prescription drug abuse with hundreds dying in Harris County from overdoses.

Oxycontin, Haldol

At least 16 students were exposed to a pill that contained a potent combination of Oxycontin (a narcotic pain reliever) and Haldol (an anti-psychotic drug) at Royal High School in Brookshire on Jan. 10. Nine were hospitalized for ailments such as convulsions that can be delayed for several hours after taking the drugs.

"We didn't know one kid had ingested any of this drug until he passed out the next day," said Royal ISD Superintendent Nathaniel Richardson. "He had a very bad reaction. We were afraid he was going to die, but now he's back at school."

The teenager who dispensed that drug has since been charged with possession and distribution of a controlled substance, and the others who took it have been sent to the district's alternative school.

A second incident occurred Jan. 31 at Cleveland High School when 16 students ingested Lorazepam, a drug used to treat anxiety, insomnia and acute seizures. The drug is also illegally sold for those wanting to get high or use its sedative effects as a "date rape drug."

"We don't know how many pills each student took," said Cleveland ISD spokeswoman Stacey Gatllin, but the district became aware of the problem when students became suddenly ill and started showing up at the nurse's office.

"Some were vomiting and stumbling around. Others were lethargic," she said. "I think they got scared when they saw their friends getting sick."

Nine of the 16 were rushed by ambulance to the hospital, where they were treated and released. Four have been charged with possession or delivery of a controlled substance and the rest assigned to the district's alternative school for 30 days.

'New frontier'

On Thursday, Gatlin said district officials discovered a small white pill had been illegally dispensed to seven students at Cleveland Middle School.

Only two students had ingested the pill and started vomiting and exhibiting other odd behaviors. One of them was taken to the hospital for treatment, while the other was released to his parent. The pill has been sent to a lab to be analyzed.

"We are still vigorously looking into this case," said Cleveland ISD police Chief Antonio Ford. "This is a new frontier, and we want to be pro-active."

Two cancer drugs may halt Ebola

By Don Finley
San Antonio Express-News
Thursday, March 1, 2012

Two off-the-shelf cancer drugs blocked the deadly Ebola virus from reproducing in the test tube — an early, promising advance in a disease and potential biological weapon with no approved treatments or vaccine, scientists report.

Testing of the drugs took place in the biosafety level-4 lab at Texas Biomedical Research Institute, in collaboration with government scientists and researchers in Houston and Atlanta.

The two leukemia drugs, nilotinib and imatinib, don't attack the virus directly, but instead target the patient's own infected cells, preventing the virus inside from reproducing and escaping.

“That's a concept that's been attractive for antiviral therapy, because if you can target a cellular protein that's required for the virus, it makes it a little harder for the virus to mutate to develop resistance,” said Dr. Gary Nabel, director of the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases, which led the study published today in Science Translational Medicine.

And while the drugs didn't completely clear the virus, researchers say what they've learned from outbreaks of the disease in Africa show that those with low levels of the virus in their bodies often survive.

The hope would be that a short-term course of treatment with the drug might eliminate enough of the virus that the patient's own immune system could eliminate the rest.

“Often in this disease if you can just shave a little bit of the viral load off of the infection, if you can just lower it tenfold even, that's what's going to give people a chance to survive it,” Nabel said. “That's really what we're aiming to do.”

Nabel cautioned the work is early but promising, and that the next step is to test it in animals. Because Ebola outbreaks in nature are so infrequent and unpredictable, it makes human testing almost impossible, researchers say.

Government rules will allow approval of vaccines and treatments in such cases if they demonstrate effectiveness in two animal models.

Ebola hemorrhagic fever, described by the World Health Organization as often fatal and one of the most virulent viral diseases on the planet, was named for a river in the Democratic Republic of the Congo, near the location it was first identified in 1976.

It causes illness in both people and nonhuman primates, and appears sporadically in a handful of African nations.

“It's very random,” said Ricardo Carrion, a virologist at Texas Biomed and co-author of the study. “We're still trying to identify the reservoir. We don't even know what maintains it in nature.”

Read more: http://www.mysanantonio.com/news/local_news/article/Two-cancer-drugs-may-halt-Ebola-3370912.php#ixzz1ntrjwoS7

Whitney Houston death: Subpoenas likely for doctors, pharmacies

From the LA Times:

Investigators are expected to serve subpoenas on doctors and pharmacies this week as they try to determine whether prescription drugs found in Whitney Houston's hotel room had anything to do with her death, according to a source with knowledge of the case.

“Subpoena power is one of the wonderful tools an investigator uses to get information from pharmacies and doctors,” said Dave Campbell, a retired captain from the coroner’s office. “You’re primarily seeking documents, not the persons who treated or prescribed, because you are doing a death investigation, not a criminal investigation.”

Campbell said investigators generally concentrate on the physicians most clearly connected to any prescription drugs recovered or conditions they know about. “Your saw a lot of this in the Michael Jackson case and I’m sure it will be useful in this incidence," Campbell added, referring to death investigation focusing on prescription drugs launched after the singer died in 2009.

He added that investigators would count the tablets in each container and compare them against the date of the prescription to see if the person was taking the correct dosage. "Sometimes you find other medications inside" the bottles, he said.

Authorities collected several bottles of drugs from Houston's suite at the Beverly Hilton Hotel, where she was found dead Saturday. But officials have said the amounts of drugs did not seem unusually large, leaving it unclear whether the medications had anything to do with the singer's death. Officials are waiting for the results of toxicology tests on Houston's body.

The source would not discuss specifics of the case but said it was standard practice to examine whether the drugs were dispensed properly and if there was any indication that she was receiving too many prescriptions. The source spoke on the condition of anonymity because the case is ongoing.

Defense attorney Ellyn Garofalo, who won acquittal for a physician charged with over-prescribing drugs to Anna Nicole Smith, said investigators were probably going to be looking at several specific areas.

They will compare the amounts of prescription medications gathered from Houston's room with the amounts of medication that were dispensed. They will look at which pharmacies dispensed the drugs and which doctor or doctors prescribed them. That information could be compared against the prescribing history of one or more doctors who treated Houston.

A red flag would be a single doctor prescribing enormous amounts of medication, Garofalo said.

After Jackson died in 2009, authorities spent months looking at bags full of prescription drugs found at his home. Prosecutors charged his doctor, Conrad Murray, in connection with the star's death.

Investigators will probably also use a state-created database with more than 100 million entries for controlled substances prescribed in California. The database has been used in past cases to determine the amount of drugs patients were receiving and how much doctors were prescribing.

Online mortality calculator could change healthcare

The Daily Beast reports: When a team of researchers at University of California, San Francisco, started collecting tools for predicting the likelihood of death, they thought their work would be used primarily by physicians. But the project ended up as an interactive tool that would be of interest to medical professionals, elderly patients—and the morbidly curious alike.

The site, ePrognosis.org, displays 16 different methods for determining a person’s chances of dying in the near future. The team designed the site so that doctors could have something better to go on than average life expectancy and intuition when deciding what treatments to recommend for elderly patients. The hope is that a better understanding of life expectancy will help patients and doctors decide on treatments—for instance, sparing a patient with advanced cancer from an invasive procedure for an ailment that likely will never have the chance to become a problem.

The tools aren’t new. Many were publicly available before, or kept behind medical-journal paywalls. But this is the first time so many have been assembled in one place, ranked according to their accuracy, and made so user friendly. A doctor—or anyone who clicks a button saying she’s a doctor—can plug in the relevant medical information and get a prognosis: 59 percent chance of dying within four years for an elderly diabetic male smoker with a history of congestive heart failure, for example.

The hazards of treating loved ones

It was a busy day for the cardiologist. Between juggling patients, he received a phone call from his mother. She said she had heartburn and complained that none of the usual over-the-counter medications had helped.

So the cardiologist quickly called in a prescription for her for an acid blocker and went back to seeing patients. Later that afternoon, his mother called again -- this time from an emergency department. The doctors there said she had a heart attack.

It's a story that Humayun Chaudhry, DO, president of the Federation of State Medical Boards, told medical students during his teaching days. The cardiologist, a former colleague of Dr. Chaudhry's who was well-respected in the field, couldn't believe he had missed the diagnosis in his own mother.

Interesting story in American Medical News.

Texas readies a new weapon against 'doctor shopping'

In today's Austin American Statesman:

As prescription drug abuse increases, Texas is readying a new weapon to catch patients who "doctor shop" for multiple prescriptions and physicians who prescribe too many painkillers.

The Texas Department of Public Safety has been collecting prescription histories of Texans for years, but by this summer the data are expected to be online so doctors, pharmacists and law enforcement officials can more quickly identify the patients abusing pain medications and the medical establishments profiting from the drug trade.

The Legislature last year made "doctor shopping" a felony in most cases and has tried to curb so-called pill mills that supply popular painkillers. Next year, the Legislature will consider whether to make it mandatory for doctors and pharmacists to check the state database before writing or filling a prescription....

"Prescription drug abuse is an epidemic in our state and the nation," said Sen. Tommy Williams, R-The Woodlands, who has authored several laws addressing the issue.

He said last year were 188 overdose deaths attributed to prescription drugs in Harris County alone. He said the problem with pill mills in Texas spiked after Louisiana cracked down.

"They've run a lot of this business into Texas," Williams said.

Click here to read the full article.

Ear Doctors Performing Face-Lifts?

That's not going as far afield as some might think. As one Texas physician points out,

Most otolaryngology training includes significant facial cosmetic training, including face lifts, rhinoplasty eyes etc, probably at least as much as plastics.The tummy tuck, not so much.

Here's an excerpt from a recent New York Times story:

After moving from New York to Los Angeles in 2010 to take a job with a financial services firm, Joan, now 59, believed she needed to freshen her look. So she got a face-lift and tummy tuck from a board-certified doctor in Beverly Hills.

What she did not realize was that his certification was in otolaryngology — ear, nose and throat — not plastic surgery. The outcome was less than ideal: thick scars on her temples and a wavy abdomen.

“I had to use all my savings to get a real plastic surgeon to fix what he did to me,” said Joan, who asked that her last name be withheld to protect her privacy. “I have an M.B.A. I’m not stupid. But when the doctor has a nice clinic and all those diplomas and certifications on the wall, you think he knows what he’s doing.”

With declining insurance reimbursements, more doctors, regardless of specialty, are expanding their practices to include lucrative cosmetic procedures paid for out of pocket by patients.

You can easily check a doctor's board certification on TMB's website. On the upper left side of the homepage, click on "Look Up a Doctor." Accept the useage terms, enter the physician's name, then click on the name to reach the doctor's full profile. Scroll down to the section titled "Specialty Board Certification."

For the NYT story, click here: http://www.nytimes.com/2012/01/31/health/non-specialists-expand-into-lucrative-cosmetic-surgery-procedures.html

Tick tally reveals Lyme risk locations

For four years, researchers combed through hundreds of state parks and bushy areas looking for the culprit responsible for Lyme disease. The blacklegged tick, also known as a deer tick, transmits the disease through a bite.

About 20 percent of the 5,332 ticks collected in the Eastern half of the country were infected with the bacterium that causes Lyme disease.

Lead author Maria Diuk-Wasser says her suspicion about where her team would find infected ticks — and the subsequent risk for the disease — was confirmed when she mapped the data.

"We suspected strongly that we wouldn't find [infected ticks] in the South," the Yale epidemiologist tells Shots. "The tick is found in the South, but it's not infected and it doesn't feed on humans, but on lizards." Researchers found the highest risk of infection for humans in the Northeast, Mid-Atlantic and Upper Midwest.

Read the story on Minnesota Public Radio's website:
http://minnesota.publicradio.org/features/npr.php?id=146211699

Screen teens for HIV: American Academy of Pediatrics

From Reuters Health:

All sexually active adolescents should be screened for HIV, the American Academy of Pediatrics said Monday (Oct. 31) in a new policy statement that broadens earlier recommendations.

And in areas with higher rates of the infection, all teens over 16 should get the test, the group added in its statement.

More than 1.1 million Americans are infected with HIV, and 55,000 of them are between 13 and 24 years old.

"Forty-eight percent of the youth who are infected don't know they are infected," said Dr. Jaime Martinez of the University of Illinois in Chicago, who helped write the new report, published in the journal Pediatrics.
"It's important to realize that those who don't know they are infected drive the epidemic," he told Reuters Health.

HIV usually proceeds to AIDS in the absence of treatment, but newer drugs can keep that from happening for many years. And knowing you're infected may also help stem transmission of the disease to others -- a benefit that isn't seen with cancer screening, for instance.

Today, many doctors only offer testing to patients they deem at risk, such as prostitutes, drug addicts and homosexual men. But since 2006, the U.S. Centers for Disease Control and Prevention have urged everybody older than 13 to get an HIV test regardless of risk factors in areas with many undiagnosed cases.

The new statement is a bit more conservative, said Martinez, lest pediatricians be uncomfortable testing younger teenagers. He added that in 12th grade, more than 60 percent of adolescents say they are sexually active -- and that often they're having sex while under the influence.

An HIV test costs about $14, according to Martinez, and is accurate more than 99 percent of the time.