Prescription Drug Abuse Rivals Illicit Drug Abuse, Some See Double Standard in Law Enforcement

DRUG USE TRENDS October 1996

Since millions of prescription pills enter the illicit drug market every year, some see a double standard in drug enforcement because of grants of leniency towards the doctors and their rich clientele who abuse the drugs (Dan Weikel, "Prescription Fraud: Abusing the System," Los Angeles Times, August 18, 1996, p. A1; Dan Weikel, "Prescription Fraud: Abusing the System," Los Angeles Times (Washington Edition), August 19, 1996, p. A1).

The DEA estimated that prescription drugs were sold for about $25 billion in 1993 in the illegal drug market, compared to an estimate of $31 billion spent that year on cocaine, including crack. About 2.6 million people in the U.S. use prescription drugs for "nonmedical reasons" -- more than the estimated number of users of heroin, crack and cocaine, according to surveys by the National Institute on Drug Abuse. According to the Drug Abuse Warning Network, prescription painkillers, sedatives, stimulants and tranquilizers are about 75% of the top 20 drugs mentioned in emergency room episodes each year.

The high likelihood of accurate dosage, purity, and lower price of prescription pills make them an attractive alternative to street drugs. Although some prescription drugs are smuggled into the country or stolen from distributors, a large portion comes from medical offices and pharmacies. The American Medical Association estimates that 1% to 1.5% of physicians dishonestly prescribe drugs, and another 5% are grossly negligent in their prescribing. At the "other end of the stethoscope" are "doctor shoppers," who deceive conscientious doctors with fake injuries or ailments to get prescriptions. One example is Vicki J. Renalso, who tricked 42 San Diego area doctors and 26 pharmacies into giving her codeine tablets during an eight-month period.

In view of this cornucopia of illegally distributed "legal" painkillers, stimulants and tranquilizers, many narcotics agents, politicians, insurance companies, and others feel that the drug war on prescription fraud has only been a skirmish. Nationally, the federal government spends $13 billion to $14 billion on the war on drugs, but only $70 million goes to the DEA to investigate prescription drug offenses. "There are two kinds of justice in this system, one for doctors, and one for everybody else," said Paul K. King, a former California narcotics agent who investigated prescription fraud in Los Angeles County.

Pursuing doctors and pharmaceutical companies doesn't make the headlines that other drug arrests do. "There is just no glory in it -- no guns, no piles of coke, and no bundles of cash to stack up for the TV cameras," said Special Agent Walter Allen III of the California Bureau of Narcotic Enforcement. Even when action is taken, the results are often small. In California, less than two dozen doctors, dentists and pharmacists are prosecuted annually for prescription fraud.

Even if convicted, sentences for doctors are small, compared to those implicated in the sale of cocaine, opiates, marijuana, etc. One case is that of Dr. Eric C. Tucker, who issued more than 7,000 questionable prescriptions for the stimulant Preludin® and another 7,600 for Dilaudid®. More Dilaudid®, sometimes called "drugstore heroin," was distributed from Tucker's office every year than from the County-USC Medical Center, the West Coast's largest public hospital. Tucker, then 59, pleaded guilty to two felony counts and lost his medical license, but was only sentenced to eight days in jail. In contrast, Daniel G. Siemianowski, who was prosecuted in Los Angeles at about the same time as Tucker, having been arrested with about four ounces of crack, a small fraction of the quantity of drugs the doctor distributed, received a year in prison.

Following the death of Hollywood producer Don Simpson, who died in January from a mix of cocaine and 20 prescription drugs, prescription abuse has gotten more attention in Los Angeles. "Abuse of prescription drugs is a serious problem in our society, but nobody pays attention until somebody big and powerful like Don Simpson drops dead," said Steve Simmons, the California Medical Board's senior investigator on the case. On August 16, federal law enforcement officials raided the offices of two doctors of more than a dozen suspected of unlawfully supplying Simpson with prescription drugs, and the home of another doctor was searched.

Assistant U.S. Attorney Alka Sager said that of the estimated 10 prescription fraud cases that she handled since 1990, one doctor received a short sentence; the rest pleaded guilty and were placed on probation. Part of the problem, according to law enforcement officials, is that medical practitioners are usually charged under laws that carry low prison penalties. Prosecutors say that the way the laws are written allows health care professionals to escape serious drug-trafficking charges if they have written a prescription, no matter how fraudulent.

Disciplinary records from state pharmacy and medical boards also reveal leniency to those who violate criminal and professional codes. Records show that about 75% of physicians convicted of prescription drug crime kept their license. Officials acknowledge the problems, but say that reforms made since the early 1990s ameliorate the problem. California law now requires the automatic suspensions of medical, dental and pharmacy licenses for such professionals if one is convicted of a felony. Medical and pharmacy board investigators added that they are seeking more court orders to suspend licenses after someone is arrested.