May 2007

News from Attorneys General Offices

  1. Twenty-six states and the District of Columbia reached a $19.5 million civil settlement with drug-maker Purdue Pharma concerning allegations of deceptive marketing and promotion of OxyContin. Arizona, Arkansas, California, Connecticut, Idaho, Illinois, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Montana, Nebraska, Nevada, New Mexico, North Carolina, Ohio, Oregon , South Carolina, Tennessee, Texas, Vermont, Virginia, Washington and the District of Columbia will receive a share of the proceeds from the settlement.
  2. New Hampshire Attorney General Kelly A. Ayotte announced that she will appeal a ruling by the U.S. District Court for the District of New Hampshire. The court held that the state?s Prescription Information Law, which prohibited the use of prescriber information for commercial use, unconstitutionally restricted free speech. IMS v. Ayotte, No. CV-06-280-PB (Apr. 30, 2007).
  3. Virginia Attorney General Bob McDonnell and U.S. Attorney for the Western District of Virginia announced earlier this month that The Purdue Frederick Company, Inc., along with its President, Chief Legal Officer, and former Chief Medical Officer pleaded guilty to charges of misbranding Purdue?s addictive and highly abusable drug OxyContin. Purdue and the three executives will pay a total of $634,515,475 in fines. The guilty pleas were the result of a four-year long criminal investigation that was initiated by the Virginia Medicaid Fraud Control Unit under the direction of then-Attorney General Jerry Kilgore. According to the State Medical Examiner in Roanoke, between the years of 1996-2005, 228 individuals died in the western part of Virginia from oxycodone overdoses. Oxycodone is the main ingredient in OxyContin. From the criminal fine, Virginia will receive $5.3 million for its Medicaid Fraud Control Unit and $20 million to fund the Virginia Prescription Monitoring Program.

Judicial Developments

In Life Partners, Inc. v. Morrison et al. No. 06-1370 (Apr. 30, 2007), the U.S. Court of Appeals for the Fourth Circuit upheld Virginia?s legislation concerning viatical settlements against a challenge that it was preempted by the federal McCarran-Ferguson Act. Viatical settlements are contracts where a dying person will sell his or her life insurance policies to provide money for the end months of life. Approximately 38 states have legislation governing these types of insurance settlements.

Legislative Developments

  1. Hearings were recently held in Washington, D.C., on the Online Pharmacy Consumer Protection Act, which would require that Internet pharmacies fill orders only for people who have a valid prescription issued by a doctor with whom the patient has a qualifying medical relationship. The bill, S. 980, is sponsored by Sen. Feinstein (D-CA) and co-sponsored by Sen. Sessions (R-AL), Sen. Coleman (R-MN), and Sen. Biden (D-DE). At the hearing in front of the Senate Judiciary Committee, former U.S. Secretary of Health Joseph A. Califano, Jr., released a White Paper from the National Center on Addiction and Substance Abuse at Columbia University. Titled, ?You?ve Got Drugs! IV: Prescription Drug Pushers on the Internet,? it reports that researchers found a total of 581 Web sites advertising or selling controlled prescription drugs in 2007 compared to 342 sites in 2006.
  2. Missouri?s Governor Matt Blunt has announced his support of S.B. 85 that would implement and enact a prescription drug monitoring program aimed at combating prescription drug and methamphetamine use in Missouri.
  3. The Texas legislature?s session ended without the passage of S.B. 439, which sought to change the law that allows hospitals to determine that care is futile for a patient. The current debate in Texas regarding the law was fueled by the case of Emilio Gonzales who died earlier this month.

Pain Management

  1. Military doctors are warning pain specialists that there is a ?coming tsunami? of chronic pain sufferers ? veterans returning from the wars in Afghanistan and Iraq. Lt. Col. Chester Buckenmaier, an acute pain specialist at Walter Reed Army Medical Center, and Dr, Rollin Gallagher of the University of Pennsylvania are beginning a study tracking veterans who have received continuous nerve blocks after injury and before medical evacuation to Germany and the United States to determine if this method can help prevent chronic pain after extreme injuries.
  2. The Seattle Times carried a story featuring a Washington woman who must drive nine hours to Oregon in order to renew her prescription for painkillers. The State of Washington in March issued an ?Interagency Guideline on Opioid Dosing for Chronic Non-Cancer Pain.? Although the guidelines do not dictate a limit on narcotics dosages and there are no sanctions for exceeding the guidelines, critics argue that the guidelines will keep doctors from appropriate prescribing to chronic pain patients. The guidelines suggest random urine testing and sending patients needing excessive dosages of pain medication to pain specialists.
  3. An article in U.S. Pharmacist discusses the use of antidepressants and anticonvulsants in treating chronic pain. Another article discusses a multidisciplinary approach to complex regional pain syndrome.
  4. JAMA's May 9 issue included an article titled, ?Scientists Probe Ways to Curb Opioid Abuse Without Hindering Pain Treatment.?
  5. The May 1 issue of Journal of Clinical Oncology has a study on suffering in patients with advanced cancer. The study looked at 380 hospitalized advanced cancer patients in Canada. The same issue includes a systematic review of pain management of hospitalized cancer patients.

Prescription Drug Diversion

  1. A federal jury has acquitted a New York pediatrician, Amara S. Conteh, on all charges that he dispensed Vicodin and Lorcet without a legitimate medical purpose
  2. A doctor and two office managers of southern Ohio clinics have been charged in federal district court with illegally distributing excessive amounts of controlled substances that led to the deaths of at least fourteen people. Also in May, Dr. Robert C. Gregori was sentenced to eighteen months? imprisonment and a fine of $15,000 following his pleading guilty to charges that he prescribed OxyContin outside the normal bounds of medicine. In Illinois, a 73-year old doctor, Thanam L. Paramanandhan, has been charged with six counts of unlawful delivery of a controlled substance. The U.S. Attorney for the Eastern District of New York announced charges against a Long Island doctor, David Morgan, for narcotics trafficking.
  3. An article in the Denver Post notes the increase in prescription drug abuse and quotes Dr. Richard Dart, director of the Rocky Mountain Poison and Drug Center as saying that people from between 20 and 30 years of age account for the greatest share of prescription-drug abuse in the Denver area. Dr. Dart also noted that no one drug is more a problem than any other.
  4. The April 2007 issue of Focus contains articles dealing with the diagnosis and treatment of substance abuse.
  5. A Houston, Texas, television reporter visited two Houston pain clinics to determine the difficulty of receiving pain medication. At the first, the reporter was able to obtain prescriptions from a doctor without any hands-on exam. At the second, he was checked by a physician?s assistant who suggested physical therapy but who also prescribed pain medication. In a follow-up interview, the first doctor suggested that a physical exam would not have revealed whether a patient is telling the truth about his or her pain. The report was prompted by the May death of teen-ager Pamela Harrison from an overdose of prescription drugs. One Houston doctor associated with a drug and alcohol rehabilitation center commented that his patients have told him that, for an under-age teen, it is easier to obtain prescription drugs from doctors than it is for them to purchase beer.

Other Developments of Interest

  1. Everyone interested in end-of-life issues will want to visit New Hampshire?s Reclaiming the End of Life Initiative?s website. The Initiative is a nonprofit, nonpartisan project, formed to use the New Hampshire presidential primaries and the national spotlight they command to engage candidates in a national conversation about how they plan to address the unmet needs of the large population of Americans in fragile conditions because of advanced age or illness and the strain on families who care for them. The Initiative is led by Ira Byock, MD, a physician, author, and national expert who has devoted his life to improving end-of-life care.
  2. The Gainesville Times published an extensive article regarding the Northeast Georgia Medical Center?s innovative perinatal hospice program. The program cares for families who have learned that the babies they are expecting will not survive very long after birth. Funded by donations to the hospice, the program helps families make decisions about a birthing plan and funeral arrangements and assists them in the grieving process.
  3. A new program at the Oregon Health and Science University pairs first-year medical students with patients who have a terminal illness. The program is designed to give future doctors a glimpse of caring for a dying patient through the eyes of the family and the patient, not through the eyes of health care. Weekly readings and discussions focus on aspects of end-of-life care. It is modeled after one established at the Harvard Medical School.
  4. A poignant account of a doctor?s interaction with a dying teen-ager and her mother was published in the New York Times on May 22.

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