By Gilbert M. Gaul and Mary Pat Flaherty
Washington Post Staff Writers
Thursday, October 16, 2003
COLTON, Calif. --Even now, nearly a year after he lost his medical license for prescribing powerful painkillers to thousands of Internet customers, Jon S. Opsahl is convinced he did no wrong.
Sitting in his empty office, the 43-year-old physician said he never saw any of those patients, ordered lab work or conducted exams.
Instead, he accepted their word that they were in pain. "Can you legitimize pain over the phone?" he said. "I think you can just as well as you can sitting in a room."
Opsahl said many of the patients "didn't carry a diagnosis other than chronic pain," which he called "a diagnosis in and of itself." Forcing them to see more doctors and undergo additional tests would have been a costly form of medical blackmail.
"They say I committed an extreme departure from the standard of care and was a danger to society," said Opsahl, who was trained in addiction medicine. "I say I chose to believe my patients and was a blessing to them and their families."
In a typical eight-hour shift, he spoke with 30 patients for as many as 10 minutes and spent an hour on paperwork. Over 13 months, he wrote 24,000 prescriptions, including refills, for two Internet pharmacies. He was paid $60 for each telephone consultation and estimates that he received $360,000.
"I went into it totally unaware just how lucrative it could become," Opsahl said. Later, he wrote in an e-mail that he never realized there were "SO MANY chronic pain patients who were not getting the treatment they needed and deserved."
Opsahl said he thinks that patients have turned to Internet sites because the medical system does not adequately recognize pain. "Doctors are afraid to prescribe pain medications out of fear they will be disciplined," he said.
California regulators disagree. Earlier this year, they revoked his license for prescribing medications without "good faith" examinations.
"There is no way that any medically rational monitoring of these patients' ongoing problems can take place," Stephen E. Hjelt, an administrative law judge, wrote in an earlier order suspending Opsahl's license. "It is a supreme challenge to practice medicine with patients face to face. It is a virtual impossibility to do so . . . when the only contact between physician and patient takes place by phone."
Opsahl's online practice started in April 2001, when he began writing prescriptions for customers of thepillbox.com, a San Antonio Web site. When federal regulators closed that site's pharmacy operations a few months later, he switched to a Las Vegas site, prescriptiononline.com. It was shut in December 2002.
Opsahl said the prescriptions were for low-level doses, "a month's supply for patients with migraine headaches, back pain. They were all fairly young, thirties, forties, fifties, all employed, just trying to get through the day or a better night's sleep."
He said the medical records he received were "quite sketchy and inconsistent." Some of the doctors he took over for were "just taking an order for drugs over the telephone . . . cutting all kinds of corners."
A Washington Post analysis of Opsahl's prescribing patterns for prescriptiononline.com found that 95 percent of the 14,785 prescriptions he wrote were for three drugs -- the painkiller hydrocodone and generic Valium and Xanax. In some cases, the drugs went to multiple patients listed at the same address.
"This is new information," Opsahl said when shown the analysis. "I am surprised it is that extensive." In an e-mail, he wrote, "I was particularly disturbed by the incidence of multiple patients at the same mailing address."
These days, Opsahl is still helping patients get painkillers, though he stresses he no longer practices medicine. Through his Web site, optihealth.net, he collects medical records and arranges phone consultations for patients with another physician, whom he declined to identify. In return, he receives a share of the $100 consultation fee.
"I've taken on the role of an administrator," he said.