COVER STORY

DOCTOR SHOPPING

New strategies are being developed in various states to catch offenders

Noelle Bush didn't commit a crime by driving to a Walgreen's pharmacy in Tallahassee, Fla., in January 2002. Her crime was posing as a physician to order a prescription for the antidepressant Xanax (alprazolam, Pharmacia) by telephone. An alert pharmacist caught the bogus script and called police when Bush arrived. The daughter of Florida's Gov. Jeb Bush was arrested and sent to a court-ordered residential drug rehabilitation program.

Noelle's arrest attracted international attention because of her family connections, but she is hardly unique. Patients gone bad—writing their own Rxs, duping prescribers and pharmacists, stealing drugs from friends or family—are major sources of drug diversion. Most diversion by patients is for their own use, say drug abuse experts. But patients are also important suppliers of Rx drugs sold on the street.

Diversion by patients is nothing new if you work in the field," said Dana Drooz, pharmacist, lawyer, and manager of drug enforcement for the Kentucky Department for Public Health. Drooz heads Kentucky's prescription drug moni-toring program (PDMP), widely hailed as one of the best in the country.

"But diversion by patients is new to the broader world," said Drooz. "Nobody recognized that prescription drugs are abused until OxyContin [oxycodone, Purdue Pharma] hit the scene. Now everyone knows about doctor shopping and forged scripts."

Doctor shopping involves a patient who either lies about pain, anxiety, or some other condition to a physician in order to obtain medication, or takes the same problem to multiple physicians to obtain and fill multiple Rxs. When Nevada began its PDMP in 1997, the typical doctor shopper was seeing 22 different prescribers, visiting 16 different pharmacies to fill 159 scripts, and receiving 9,351 doses of controlled substances yearly.

Law enforcement barely blinked. "For years, pharmacists and doctors would call us, and nobody responded," said Kevin Bernard, San Diego Police Department detective and head of RxNet, the countywide Pharmaceutical Abuse Task Force founded earlier this year. RxNet links local law enforcement, the Drug Enforcement Administration, Federal Bureau of Investigation, state board of pharmacy, and other enforcement groups concerned with Rx diversion and abuse. RxNet also alerts area pharmacies to potential doctor shoppers and fraudulent prescription patterns.

"If you take your typical police dispatcher, even your typical beat cop, they just didn't know that prescription drug use could be a violation," Bernard explained. "When a known doctor shopper came into a pharmacy, the pharmacist had to convince the dispatcher that the police had to get involved. By the time you got through all that, even if you got a response, the shopper was off to the next pharmacy to fill another prescription."

Internal server error