PHARMACIST STEVE

This could very well be the title of free training the U.S. Drug Enforcement Administration is offering next week to doctors and others who prescribe or store powerful pain pills and other controlled substances.

The federal crackdown on opioids and rogue doctors has caused a divide between physicians and law enforcement who target those who overprescribe highly addictive pain medicines. Many doctors say they’re worried they could be arrested even if they do what they determine is best for their patients.

Legitimate pain patients, many of whom are left adrift when their clinics are raided, become “collateral damage” in the fight against the nation’s worst drug epidemic, said Dr. Wayne Tuckson, president of the 4,000-member Greater Louisville Medical Society.

Good doctors can become collateral damage too, he said.

The DEA training for doctors brings both sides together to discuss what is expected in administering, prescribing or storing controlled drugs. It will include a breakdown of federal laws as well as, “Hey, if you’re doing something wrong, this is what you can be charged with,” said Martin Redd, diversion program manager for DEA’s Louisville Field Division.

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“We’re not in it to take them to jail,” he said. “Our job is compliance.”

DEA officials are flying in from Washington, D.C., for sessions Monday and Tuesday at the Seelbach Hilton in downtown Louisville to detail what federal law requires and tips on spotting drug seekers.

This is the only time these sessions are planned for Kentucky — the second state to receive training, after Florida. The next training is scheduled for Sept. 29-30 in Charleston, West Virginia.

Across Kentucky, there are more than 19,000 professionals registered with the DEA to administer, prescribe or store controlled drugs, in addiction to pharmacies and clinics, Redd said. They include oral surgeons, pain specialists, addiction-treatment specialists, emergency room physicians, pharmacists, veterinarians and medical researchers. 

The training will detail how to count the quantity of each narcotic, when to do the inventory and how to safely store the medications. 

Doctors agree that there are rogue physicians who value profits over patient care who should be stopped and punished. But many say these criminals in lab coats are outliers.

Dr. James Patrick Murphy, a Kentuckiana pain and addiction specialist, said many well-intended doctors are unfairly arrested “all the time” in the hunt for those who recklessly contribute to patients’ addictions and fatal overdoses.

“I call those the dolphins that get caught in the tuna net,” he said.

Murphy said a few of the chronic pain patients at his New Albany clinic have asked him, “What am I going to do if you get arrested?”

Instead of reassuring them by pointing out that he is well-trained, careful and honest, he vowed to help them find another doctor if he becomes the target of an investigation.

“We’re putting ourselves at risk” by using opioids to treat chronic pain sufferers, Murphy said.

When a clinic is raided, federal agencies won’t confirm the raid happened. Details are shielded unless there are criminal charges — preserving privacy rights of those under investigation, but contributing to feelings of uncertainly and vulnerability within the medical community.

“The feds came in, shut down an office and we don’t know why,” Tuckson said, referring to news reports after DEA and FBI agents were seen conducting a recent raid on a Louisville pain clinic. “Of course I’m going to be afraid.”

And on the DEA’s website on the Diversion Control Division page, there is a link entitled “Cases Against Doctors” detailing actions taken by the agency across the nation.

“A lot of new doctors, a lot of general practitioners, say: ‘I‘m just not gonna prescribe this stuff. This is out of my comfort zone,’” Murphy said.

Fear has contributed to a local and national shortage of addiction and pain specialists to treat patients coping with chronic pain.

And when a pain clinic or addiction treatment center is raided, more patients must search for another doctor to treat their addiction or chronic pain, saidDr. Kelly Clark, a Louisville addiction specialist who heads the American Society of Addiction Medicine.

Kevin McWilliams, spokesman for the DEA’s Louisville Division, said doctors should know the laws that detail what they can and can’t do with narcotics: “If a doctor is practicing medicine in a responsible and ethical manner, where does the fear come from?”

While fear of arrest may be pervasive, only a small fraction of physicians end up behind bars. 

Last year, five medical professionals registered with the DEA to access controlled substances were arrested across Kentucky, Redd said.

“These doctors we’re taking to jail, civilly fining, bringing administrative actions, it’s probably 2 percent” of all physicians, he said.

Much more often — 40 times last year — the DEA issued letters of admonition, ordering corrective steps, or more formal memorandums of agreement, which can involve federal oversight for months or years.

“I think a lot of the doctors will use the DEA as kind of an out,” Redd said.

Patients will sometimes call agents to complain, “My doctor won’t allow me to get 120 (opioid pain pills). I only got 60 a month,” due to concerns of being arrested, he said.

“We have to reiterate, ‘We don’t dictate what the doctors prescribe.'”

Tuckson disagrees, saying federal agents ultimately are impacting what some doctors do and don’t prescribe.

“Don’t lie to me,” said Tuckson, a colon and rectal surgeon. The arrests send a message: “If you prescribe this, I will come after you and ask questions.”

He said it’s unfair to judge doctors on pain medicine dosages because each case is singular as patients tolerate pain differently and respond differently to various pain medicines.

“I do not have a pain-o-meter in my office,” he said. “There is no objective measure.”

Federal agents have access to databases that analyze which doctors prescribe the highest volume of potentially addictive opioids and other controlled drugs — and which have lost the most patients to fatal overdoses.

Investigators also look for potential red flags, such as patients driving two or three hours to a particular pharmacy or doctor and patients paying cash to fill prescriptions that would have been covered by insurance, Redd said.

During investigations, agents consult with medical professionals. For example, in a recent arrest of a Louisville doctor, they first consulted with a pharmacist and investigator with the state Office of Inspector General. 

“If they’re doing something repetitively, we’ll know if it’s malicious or not,” Redd said.

The training for medical professionals will also include guidance from Jill E. Lee, a pharmacist consultant with the state Office of Inspector General. She will explain how to get the most out of the Kentucky’s prescription monitoring program, which has a new feature to help spot drug abusers. The Kentucky Board of Medical Licensure approved two hours of continuing medical education and promoted the event on its website. 

Tuckson and Murphy said they’re anxious for the DEA’s training.

“I understand medicines, how the body works, how medicines work,” Murphy said. “I do not understand law.”

Conference information and registration is available online under the “Meetings and Events” link at DEAdiversion.usdoj.gov.