Do you know the Candyman?

  1. Who here knows exactly who the candyman in their town is (the doc who supplies the addicts with prescription drugs, or, worse case scenario - creates NEW addicts by encouraging unsuspecting patients to use narcotics when non-narcs would do just fine.)

    Does anyone know how the DEA polices script writing and distribution of narcs? I know the docs have their own ID number, but does anyone actually keep track of them and think - hmmmm.... he writes a lot of oxycontin scripts for a GP......

    I am frustrated that about 80% of our addicts list Dr. *** as their PCP. Makes you wonder how he sleeps at night....
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  2. 18 Comments

  3. by   Huganurse
    Here is another story r/t your topic:



    A Palm Beach County doctor accused of improperly prescribing the powerful painkiller OxyContin was charged Friday with first-degree murder - apparently the first time in the nation a physician has faced such charges in a prescription drug case.

    Dr. Denis Deonarine, 56, of Jupiter was also charged with racketeering and with trafficking a controlled substance in an 80- count indictment that remained under seal, keeping many details temporarily secret. State Attorney Barry Krischer said that was because other defendants were at large.

    The doctor was being held at the Palm Beach County Jail pending a bail hearing.

    Deonarine was charged with felony murder, meaning the death allegedly was caused in the commission of another crime - in this case, drug trafficking.

    Deonarine is charged with killing Michael Labzda, 21, of Jupiter, a patient who died of a drug overdose on Feb. 8.

    Labzda's family has filed a lawsuit against the doctor, the pharmacy that filled the OxyContin prescription and the drug manufacturer, Purdue Pharma.

    In a related case, Deonarine in May was charged with defrauding Medicare of $67,000 in improper prescriptions of OxyContin involving 72 unauthorized claims.

    - Wire reports

    Credit: Compiled from Wire Reports
    Last edit by Huganurse on Jun 30, '02
  4. by   adrienurse
    I fail to understand why all of a sudden everyone's got perscriptions for vicoden and percocet (are they the same thing) etc. and I'm not even talking about the people who are getting it illegally. I know that there are situations when a person is having severe pain due to a serious condition or they are terminal and it's given for comfort care, but when I got my wisdom teeth out, I sure wasn't offered anything stronger than tylenol with codein.

    Maybe the answer is to tighten up the availability of these drugs so that the flow can be better controlled.
  5. by   rnor
    I see red when I work on the Acute Care Floor of my hospital. We have one Doc that hands out Oxycontin and Demerol like it was candy...to respiratory pts., such as COPD, or Asthma...come on, why would they need such a powerful medicine???
  6. by   hoolahan
    I used to work for a medicaid hmo, and we were able to put a pt into "pharmacy lock-in", which meant they could only get their meds from one pharmacy. This prevented them from doc and pharmacy hopping.

    Other than that, I would report him to Medicare, Medicaid, or whoever the insurance compnaies are that he is affiliated with. You could try to report him to the state licensing board for MD's, God knows if a nurse did something like this, and we were reported to our state board, we'd have our licesnses supended pending investigation.

    Let us know if anything comes of it.
  7. by   Nurse Ratched
    His prescription business is a cash-only deal. An area doc here was also recently busted, but only because, like the one in the article above, he was using Medicare and there was attending fraud. I think this one figures as long as he accepts cash, then there's not much chance he'll get caught.

    I do like the idea of a "pharmacy lockout" - very inventive. Most of our folks get their stuff from him or on the street, tho - they don't have insurance or they're waiting 'til they've completely fried themselves so they can go on disability/Medicaid.

    I do agree that these meds are WAY overprescribed. When my hubby went to get his wisdom teeth out (perhaps five years ago) he was given a Vicoden script as a matter of that office's routine. Took ONE and a 1/2 hour later said they made him feel a lot *too* good and flushed the rest immediately.
  8. by   rnor
    Thanks Hoolahan! Didn't know about the pharmacy lock-in, sounds good. Most of our patients are Medicare or Medicaid.
  9. by   fab4fan
    I'm probably going to take some flak here, but I'm going to forge ahead with an alternative opinion.

    Yes, there are doctors who prescribe inappropriately. But, for many years, pain has been undertreated, not just with cancer pts., but with those who have a chrnoic non-malignant pain dx. For those pts., narcotics can be a god-send, allowing them to have productive, full lives.

    People with chronic pain should not be expected to "suck it up", or all of those other phrases people use to imply that someone is just a whiner looking for drugs. Imagine the most painful condition you've ever had...now think about what it would be like to feel that way, day in, day out, with no respite. Imagine that there was medication to make you more comfortable, but no one would give it to you. Imagine friends, family, medical professionals telling you you need to learn how to "deal with it." Not too pretty, is it?

    Yes, there will always be unethical dosc who will try to profiteer from situations, and substance abusers will always be with us, too. But the potential good still outweighs the bad. No one reads the stories of how these meds help people...that's not news.

    BTW, narcotics are sometimes used with chronic pulm conditions to improve breathing; decreases resp effort. dries secretions, decreases card. effort. Saw it all the time in home care and hospice.
  10. by   pappyRN
    AMEN! AMEN! and THANK YOU!!! fab4fan!!!

    I have to vent- so this is really long. I'm NOT sorry because this needs to be said if in saying it even ONE patient is spared what I have endured.

    I am a chronic pain patient with Reflex Sympathetic Dystrophy head to toes on rt and hip to toes on lt. In addition to fibromyalgia/CFIDS and many other diagnoses involving pain, I have sustained primary nerve injuries to my brachial plexus and have had a surgeon accidentally LIGATE my FEMORAL NERVE.

    Imagine how you would feel if someone took a clamp to a rather large nerve and squeezed. Would you sit quietly and suck it up or would you be begging for some relief in the form of whatever works whether it be Oxycontin or MS Contin etc.???

    By the way, I am also on Disability and Medicare. As I have been permanently injured through NO FAULT of my own and am unable to work and that my husband has been unable to work for the last year- I may soon find myself on Medicaid. It's no one's business whether a patient is on Medicare or Medicaid when it comes to determining what pain medicine to use. It is a MEDICAL, not NURSING, decision. Are they any less deserving of pain relief because they receive governmental assistance? I paid into this system for 23 years before I was injured as did my husband for 27 years before his company went out of business. The type of insurance a patient has is a matter for the business office and only for the health care personnel when it pertains to whether they will or will not approve a certain procedure. Being on Medicare or Medicaid does not predispose someone to be more likely to abuse medications.

    If a person needs Vicodin to relieve their pain after wisdom tooth extraction- that is their business and it is between the patient and their doctor.

    Walk a mile in their shoes before you sit in judgement of how much pain you THINK they should have. Someday it may happen to you that you need to have a narcotic for pain relief. MANY nurses end up with RSD. If you aren't familiar with it I suggest you do a search. It could happen to you. It can happen from a SCRATCH!

    Imagine that someone threw gasoline all over you- THEN imagine that they struck a match and lit you on fire. That's about as close as I can come to describe the pain of RSD and the burning of any chronic neuropathic non-malignant pain. Now, think about how long EACH MINUTE feels when you are feeling on fire and because of stigma or attitude you are not given medication that will come even close to taking even just the edge off because a nurse or doctor doesn't think you should need a strong medicine such as a narcotic for relief.

    I've put up with accusations, attitudes, name calling, disbelief, unfair judgement, poor judgement, arrogance, fear, suspicion, indecision, erroneous diagnosis, too late treatment, refusal, poor technique, wrong treatment, negligence, wrong surgical procedures, operative accidents, and outright malpractice for 5 of the seven years since my injury. I am on MS Contin and guess what? A WONDERFUL day for me is getting my pain level to a 7+ for a few hours. And NO, MS Contin does NOT last for 12 hours. Ask any legitimate pain patient AND ask the manufacturer because they are well aware of this problem even if they act as if they don't. Many patients need to take MS Contin or Oxycontin tid rather than bid. AND many Duragesic patch users need to change their patch every 2 days instead of every 3 days. And just because a doc follows an equianalgesic chart made up by a drug manufacturer does NOT mean in real life that the patient will get the needed amount of pain relief.

    PAIN IS SUBJECTIVE and EVERY PATIENT HAS DIFFERENT NEEDS and every patient metabolizes medications at their own rate. For patients with patches, an elevated temperature of even a low grade nature can affect how rapidly the drug is absorbed. My medical problems are such that I have a low grade temp of around 100.4 almost every day. Just because of that when I was on the Duragesic patches they needed to be changed every 2 days instead of every 3 days. Are you going to say I shouldn't have to use them more frequently because my pain shouldn't be that bad? What about the unforeseen circumstance of elevated temperature?

    My point is there are many circumstances that can not be seen. Should a patient be judged for these things which are totally NOT their fault? When you use your opinion about a person's pain med requirements how do you know that you have all the information needed to make the decision about what they do or don't require for relief? Did you already know that body temperature can affect the rate of absorption with Duragesic patches? Many pain management physicians do not even know it.

    If and when I ever get to the point where I can practice again it will absolutely be in the area of pain management and patient advocacy for the humane relief of their pain. This experience has been an eye opener to the prejudices and judgements of health care providers and of fellow nurses. I guess I was naive to think any of these experiences wouldn't happen. I had to wise up really quickly for self preservation reasons.

    Patients who have pain have a FEDERAL RIGHT to have their pain treated and relieved.

    Just because there are some bad docs who don't do the right thing doesn't mean those of us who are legitimately in pain should not be treated.
    Remember, this could be you someday.

    I don't want pain medicine to get high. I'll settle for just being able to THINK threw this mind numbing excrutiating pain. Please take some time to educate yourselves regarding the difference between addiction, physical dependence, and tolerance. For those who throw the word "addiction" around to docs who do know the difference, don't be surprised when the doc doesn't listen to you regarding your concerns because all he has to do is listen to the terminology you are using and that will tell him you don't really understand what you are saying.

    Addiction is created by the person who takes drugs for the PSYCHOLOGICAL high- the ADDICT!

    Regards,
    PappyRN

    PS: I also have Asthma
  11. by   adrienurse
    I know what you're saying up there. I knew that I was putting forth a contravesial oppinion that was gonna get some flak. I do believe strongly in adequate pain control, and am usally the first to advocate for it when it comes to my own patients.
  12. by   Nurse Ratched
    I appreciate the experiences related here. I stand by my assessment of the doctor in question, however. The people who are our mutual patients are largely "addicts" - the requested definition (and an accurate one) being that they take the drugs to get high. They readily admit this. Many were already alcoholics.

    I don't think anyone suggested that people with or without insurance or on certain kinds of insurance were more or less likely to use prescription meds recreationally - just that if there was a concern or the record looked suspicious then there are options to prevent pharmacy and doctor hopping for the purposes of getting drugs for getting high.

    There is legitimate pain and there is addiction. And if I went great guns treating with the PRN pain meds every person on my unit who said his pain was 5 (top of scale) despite the fact that he is laughing, smoking and talking with copatients, eating his whole tray and then looking for the extra one, VS not only normal but lower than mine, then I wouldn't be using very good judgement in my area of specialty.
  13. by   hoolahan
    Nurse rached and others, I also didn't get the impression that you were dismissing anyone's pain, but rather referring to those who abuse medication for the thrill of it. This is why I can't call in a refill for a duragesic patch or oxycontin for my patient's pain. This is why not only must the pt have the RX in hand, take to the pharm, but the doc MUST put "A box of 10" on the RX or the pahrm's won't fill it. I always caution my pt's if they are down to the last patch on a Wed, you better call the doc right then to get a RX for more, or you will be sunk b/c a doc CANNOT call it in on the weekend. This is all b/c pt's who DO abuse the drugs, and they are the ones we are talking about.

    BTW, the latest trend in my area is selling Ensure on the street. A person can get Ensure for free on Medicaid. So, they get their free case, then turn around and sell it for a dollar a can. I was discussing this w one of my younger male caid pt's and I said who would buy ensure off the street?? He said I do. I said Why? You are well-nourished, why would you need ensure? He said, I like the taste. Next thing you know, we'll be jumping through ridiculous hoops to get ensure into homes and refilled for the people who really need it.

    That is why docs like this really peeve me!!!!! There are far reaching consequences to this abuse of rx privaleges, that will end up hurting those who do need the meds for pain.

    I am curious though, how does he accept cash? How does he get a supply of these meds the way the regs are right now?? He definitely needs to be investigated, b/c I don't know of any doc who has "samples" of narcs in the office. This doc sounds like a junkie himself.
  14. by   JeannieM
    I'm with pappyRN and Fab4RN, for personal reasons. I only recently heard the case of an end-stage diabetic woman with neuropathy whose doctor refused to refill her Vicodin because she was "addicted". Unfortunately, this woman died before her daughter could avail them of my advice to "get another doctor!" My own mother died in pain from peripheral vascular disease because, as a nurse, she didn't want anyone to get the idea that she was "one of those addicts who use that stuff" and refused to ask for, or accept, anything for pain.
    I have trigeminal neuralgia. I can answer all of those pain assessment questions that some of my peers think are ridiculous: my current pain (as I type this) is a 3-4. The best it ever gets is a 2. I can handle a 5 and still function well (hell, I've been doing it for 19 months, ever since this condition broadsided me). I am also an active, functional "addict" who now requires two Darvocet instead of one when my pain really gets severe, who uses a 30-tablet prescription in one to two months, and who has a neurologist who looks at me sideways and asks, "Do you STILL need that stuff?" (I'm also on Neurontin and Pamelor, and don't even GET me started on people who look at a "psych" prescription given for pain and assume you are "nuts"!) Naturally I never take my Darvocet when I'm working or driving. And yes, I've learned to hide my pain pretty well. I'm the person in the hall (with my labcoat, but no clipboard) who's smiling, working, visiting with patients, families and my peers, and feeling like the right side of my face is going to burn off. We don't all roll on the floor and scream. So when I hear the comment of "the patient was just laughing with his grandkids and now he wants pain medication" I say, give it to him!
    Am I ashamed that I have a poor pain tolerance? Absolutely. Do I wish that I could flush those pills? Hell, yes!!! I've even been desperate enough that I, a reasonably sane healthcare professional (psych med notwithstanding) have resorted to seeing alternative practitioners to try complementary therapy and have even seen an accupuncturist.
    I will gladly live with Dr. Candyman as long as he can live with himself. It's a lot better than the alternative. Thanks for letting me vent! JeannieM

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