SAN DIEGO (CN) – Top California law enforcement officials joined forces with health care professionals Wednesday to tackle the growing opioid crisis and battle a major source fueling the epidemic: corrupt doctors and pharmacists.
Attendees at the statewide Opioid Policy Summit in San Diego discussed what needs to happen in order to “get to zero” deaths from opioid overdose. Solutions such as increasing access to overdose-reversal treatments Naloxone – including raising awareness the antidote can be obtained without a prescription – and giving patients safer dosage levels were repeated throughout the conference.
While California has one of the lowest rates of death from opioid overdose in the nation, its proximity to Mexico makes San Diego and the state a gateway for dangerous opioids like fentanyl, which has caused a spike in overdose deaths in San Diego County.
But prosecutors emphasized Wednesday the importance of taking down corrupt doctors and pharmacists who enable opioid addicts’ deadly habit, in addition to prosecuting drug traffickers.
Three of the four U.S. Attorneys in California attended the conference, according to Alana Robinson, acting U.S. Attorney for the Southern District.
While prosecutors emphasized their efforts in curbing the operations of “pill mill” doctors, health care professionals in attendance discussed the importance of holding themselves accountable for contributing to overdose deaths.
California State Board of Pharmacy spokesman Bob Davila said the board is encouraging pharmacists to be more involved in patient care via participation on “health care teams,” which are coordinated efforts among health care professionals in caring for individual patients.
“Pharmacists are more accessible than doctors, so we’re encouraging pharmacists to be more hands-on,” Davila said. “They’re the last barrier between opioids and the patient.”
Dr. Roneet Lev, chief of the Scripps Mercy Emergency Department, compiled “Death Diaries” using data from the medical examiner’s office in San Diego and prescriptions issued to opioid overdose victims for the 12 months prior to their deaths.
Lev said the majority of prescriptions came from primary care physicians, but was surprised the number two prescriber was psychiatrists. She said 70 percent of those who died have been given the same opioid medication for three or more months. Using opioids for that length of time, Lev said, leaves patients with two problems rather than resolving the one they got the painkillers for in the first place.
“Either you missed a diagnosis, or they have an addiction. It creates two problems, rather than the one they came in with,” Lev said.
The doctor said the data she’s collected has led to countywide emergency room department guidelines on prescribing opioids. She’s also helped draft “scripts” to help pharmacists ask the right questions when calling doctors to verify a prescription.
But prosecutor Ben Barron of the Central District in Los Angeles said you can’t teach bad doctors to be good doctors when they’re in it for the money.
“We’re going after negligent overprescribing, bad medicine. You can educate a corrupt doctor or pharmacist till the cows come home about safe prescribing, but they don’t care because they’re in it for the money,” Barron said.
He said while a doctor with a prescription pad “can dispense more opioids than an entire gang” it’s “almost more important to go after corrupt pharmacies” filling the prescriptions.
“A pharmacy is just as much of a gatekeeper as a doctor,” Barron said.
He said cases against corrupt doctors and pharmacies shouldn’t be thought of as drug cases, but rather fraud cases since they often involve false billing to Medicare and other public health programs.
Barron cited a case he prosecuted against Global Compounding Pharmacy, calling the owners and operators “really greedy and really stupid.” The owners, brothers Berry Kabov and Dalibor Kabov, were convicted of drug trafficking, money laundering and tax fraud conspiracy earlier this year.
The prosecutor said the fraudsters used one doctor who prescribed all narcotic prescriptions at the maximum strength and “leapfrogged” drug wholesalers until they were cut off and started manufacturing their own pills. Those practices were “red flags” prosecutors were able to track using prescription databases, Barron said.
“You need to identify red flags that might not be illegal, but are similar to the smell test – if you build up enough of these red flags, eventually it starts to stink,” Barron said.
“If you pursue every feasible avenue, you might discover a lot more than if you just focus on narcotics alone.”