Doctors who prescribe oft-abused drugs face scrutiny

Hampton J. Jackson Jr. prescribed more of the narcotic painkillers OxyContin and Roxicodone than the next most prolific Medicaid provider in D.C., writing 63 prescriptions in 2008 and 191 in 2009.
Hampton J. Jackson Jr. prescribed more of the narcotic painkillers OxyContin and Roxicodone than the next most prolific Medicaid provider in D.C., writing 63 prescriptions in 2008 and 191 in 2009. "A lot of people say, 'I'm not getting in trouble with the board,' " he said. " . . . I have all these patients because doctors won't treat them." (Astrid Riecken For The Washington Post)
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By Christian Davenport
Washington Post Staff Writer
Saturday, January 1, 2011; 9:41 PM

Twice, the patient, a man in his mid-30s, said he lost his prescriptions for Valium and Percocet. Once, he said he was in a car accident that scattered his pills on the road. Another time, he said the medicine he was first prescribed was no good, so he "returned the pills." Another time, his wife called and said their house had been "searched by authorities" and the medicine had gone missing.

Each time, no matter the story, Peter S. Trent or Hampton J. Jackson Jr., doctors at the same orthopedic practice in Oxon Hill, refilled the prescription, according to the Maryland Board of Physicians. Over the course of 21/2 years, the doctors gave the patient 275 prescriptions, mostly for Percocet, a powerful, highly addictive painkiller.

Sometimes they wrote the patient more than one prescription for the drug on the same day. In a single month, they wrote him 11 prescriptions for Percocet, totaling 734 pills.

Jackson and Trent - who maintain that they did nothing wrong - are among a small group of doctors who were the top prescribers of tightly regulated drugs in their state Medicaid programs, according to a Washington Post analysis of state data.

Last year, Sen. Charles E. Grassley (R-Iowa) asked state regulators to provide lists of the top 10 Medicaid prescribers of eight drugs - some of which have high street value because of their popularity among abusers - in an effort to identify doctors who might be overprescribing pricey medicines at taxpayer expense.

The data he collected - which do not include prescriptions written outside of Medicaid - show that some doctors prescribe far more of the drugs than most of their peers. Grassley said the findings do not necessarily suggest "any illegal or wrongful behavior," because doctors on the lists may have a certain expertise or patient population that justifies their prescribing patterns.

But the findings "may also suggest overutilization or even health-care fraud," Grassley said. In one case, he noted, a Florida doctor wrote nearly 97,000 prescriptions for mental-health drugs over a 21-month period.

After receiving Grassley's data, The Post requested the same information from the District, Maryland and Virginia for other drugs - such as Percocet, Vicodin and Ritalin - that are prone to abuse.

The Post's analysis found not only that certain doctors routinely prescribe some medications far more than their peers, but also that some of them have a long history of sanctions by professional disciplinary boards for unethical and unprofessional behavior, including overprescribing medications to patients who may have been using them to get high instead of well.

The state boards that oversee medical misconduct say overprescribing is a huge problem that they take very seriously.

The top priority is to do "whatever you think is necessary to protect the public," said William Harp, executive director of the Virginia Board of Medicine. "I want us to be very objective and very fair to these doctors and the citizens they treat."

Regulators say they are caught between trying to keep doctors from prescribing drugs unnecessarily and satisfying doctors who say heavy-handed investigations discourage them from prescribing medication that patients need.

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