diversion of controlled drugs pain management services edwin rogers investigator alabama board of...

Diversion of Controlled

Drugs

Pain Management

Services

Edwin Rogers

Investigator

Alabama Board of Medical Examiners

Hydrocodone

3

Hydrocodone 2006

Methadone

5

Methadone 2006

Oxycodone

7

Oxycodone 2006

Hydrocodone Prescribed in the State of Alabama

Alprazolam Prescribed in the State of Alabama

Diazepam Prescribed in the State of Alabama

Methadone Prescribed in the State of Alabama

# Number of Claims Total Quantity Total Day Supply1 29,919 3,651,322 870,3342 24,956 3,337,931 722,9713 59,460 3,295,864 1,231,7974 27,895 2,374,735 728,3935 20,498 2,250,692 601,0826 14,632 2,098,955 372,3267 23,528 2,053,229 673,9058 27,227 2,018,910 681,4599 24,588 1,790,463 685,999

10 17,958 1,752,027 549,05111 22,189 1,695,774 537,97712 24,067 1,651,776 711,02113 17,085 1,624,997 501,02714 16,816 1,620,862 497,47615 26,895 1,607,957 823,98716 18,880 1,601,391 543,47017 20,602 1,601,198 544,18918 18,841 1,533,881 571,06019 16,923 1,499,017 494,23420 11,426 1,313,246 314,66621 15,453 1,300,176 471,98922 17,393 1,296,601 483,93523 16,701 1,295,592 445,90724 11,525 1,268,070 322,86225 13,768 1,204,911 392,081

2014 Top 3% by County

8

15

3 12

2

3

2

1

1

3

1

4

10

44

1

11

4

9

3

4

152

4

2

1

15

9

67

Lauderdale-7

4

7

2

1

27

1

4 17

34

19

8

2

2

3

1

9

2611

2

20

14

2

3

Other Specialties

Psychiatry

Pain Management

Neurology

Internal Medicine

Family Medicine

Anesthesiology

010

020

030

0

Specialties

# of Physicians

2014 Top 3%

by Specialt

y

Fill Date Product, Str, Form

A.B. Qty Days Prescriber Written RX# N/R* Pharm

12/17/2012

OXYCODONE HCL 30 MG TABLET 90.000 30 4 12/17/2012 5684 N 9

10/22/2012

HYDROCODON-ACETAMINOPH 7.5-325 30.000 10 9 10/11/2012 606606 R 8

10/22/2012


10/22/2012

HYDROCODON-ACETAMINOPHN 10-500

30.000 30 4 10/22/2012 567755 N 8

10/11/2012

HYDROCODON-ACETAMINOPH 7.5-325 30.000 10 9 10/11/2012 606606 N 8

10/08/2012

HYDROCODON-ACETAMINOPH 7.5-325 30.000 3 9 10/01/2012 505861 R 0

10/01/2012


09/26/2012


30.000 30 4 09/20/2012 4416281 N 1

09/26/2012


09/25/2012


30.000 7 9 09/12/2012 505088 R 0

09/13/2012


30.000 7 9 09/12/2012 505088 N 0

09/10/2012


15.000 2 9 09/10/2012 504925 N 0

09/10/2012


30.000 8 9 09/03/2012 4301459 R 2

09/03/2012


30.000 8 9 09/03/2012 4301459 N 2

07/06/2012


60.000 30 2 07/02/2012 502458 N 0

07/06/2012


02/22/2012


01/05/2012

CLORAZEPATE 15 MG TABLET 28.000 28 7 01/05/2012 777623 N 8

01/05/2012


12/06/2011


12/06/2011

ENDOCET 10-325 MG TABLET 56.000 28 7 12/06/2011 774596 N 8

12/06/2011

ALPRAZOLAM 2 MG TABLET 28.000 28 7 12/06/2011 774595 N 8

10/25/2011


10/19/2011


180.000 30 7 10/19/2011 769916 N 8

10/19/2011


09/27/2011


09/15/2011


180.000 30 7 09/15/2011 766383 N 8

09/15/2011


09/15/2011


09/01/2011


180.000 30 7 09/01/2011 4787077 N 9

09/01/2011


07/26/2011


180.000 30 7 07/26/2011 4783610 N 9

07/26/2011


07/26/2011


06/25/2011


180.000 30 7 06/25/2011 4781063 N 9

06/25/2011


06/25/2011


06/25/2011


180.000 30 7 06/25/2011 4781063 N 9

Prescribers for prescriptions listed: A.B.

8168 HOLLYWOOD FL 33020

2047 MIAMI FL 33183

8897 MIAMI FL 33174

4332 MOBILE AL 36609

3219 HUNTSVILLE AL 35801

1174 MONTGOMERY AL 36106

8069 NORTH MIAMI FL 33161


D.B.Qty Days Prescriber Written RX# N/R* Pharm

11/28/2012 OXYCODONE HCL 30 MG TABLET 120.000 30 4 11/28/2012 2004750 N 711/26/2012 CLORAZEPATE 15 MG TABLET 30.000 30 4 11/26/2012 4511232 N 111/26/2012 HYDROCODON-ACETAMINOPHN 10-500 60.000 30 4 11/26/2012 4511233 N 111/02/2012 OXYCODONE HCL 30 MG TABLET 120.000 30 4 11/01/2012 209113 N 8

11/01/2012 CLORAZEPATE 15 MG TABLET 30.000 30 4 11/01/2012 607650 N 8

11/01/2012 HYDROCODON-ACETAMINOPHN 10-500 60.000 30 4 10/22/2012 4510796 N 109/21/2012 HYDROCODON-ACETAMINOPHN 10-500 60.000 30 4 09/20/2012 4510081 N 109/21/2012 OXYCODONE HCL 30 MG TABLET 120.000 30 4 09/20/2012 561190 N 106/30/2012 OXYCODONE HCL 30 MG TABLET 168.000 28 2 06/29/2012 1049137 N 106/30/2012 OXYCODONE-ACETAMINOPHEN 10-325 60.000 30 2 06/29/2012 1049136 N 106/30/2012 ALPRAZOLAM 0.5 MG TABLET 90.000 30 2 06/29/2012 1049135 N 102/14/2012 OXYCODONE HCL 30 MG TABLET 168.000 30 7 02/09/2012 200282 N 002/13/2012 ENDOCET 10-325 MG TABLET 56.000 28 7 02/09/2012 200278 N 002/13/2012 ALPRAZOLAM 1 MG TABLET 28.000 28 7 02/09/2012 300242 N 001/06/2012 CLORAZEPATE 15 MG TABLET 28.000 28 7 01/06/2012 777760 N 801/06/2012 OXYCODONE HCL 30 MG TABLET 168.000 28 7 01/06/2012 777759 N 812/06/2011 ENDOCET 10-325 MG TABLET 56.000 28 7 12/06/2011 774609 N 812/06/2011 ALPRAZOLAM 1 MG TABLET 30.000 30 7 12/06/2011 774610 N 812/06/2011 OXYCODONE HCL 30 MG TABLET 168.000 28 7 12/06/2011 774608 N 811/04/2011 HYDROCODON-ACETAMINOPHN 10-500 180.000 30 7 11/04/2011 771578 N 811/04/2011 OXYCODONE HCL 30 MG TABLET 180.000 30 7 11/04/2011 771576 N 811/04/2011 ALPRAZOLAM 2 MG TABLET 60.000 30 7 11/04/2011 771577 N 810/05/2011 OXYCODONE HCL 30 MG TABLET 180.000 30 7 10/05/2011 768332 N 810/04/2011 ALPRAZOLAM 2 MG TABLET 60.000 30 7 10/04/2011 768237 N 810/04/2011 HYDROCODON-ACETAMINOPHN 10-500 180.000 30 7 10/04/2011 768238 N 809/02/2011 ALPRAZOLAM 2 MG TABLET 60.000 30 7 09/02/2011 765025 N 809/02/2011 HYDROCODON-ACETAMINOPHN 10-500 180.000 30 7 09/02/2011 765026 N 809/02/2011 OXYCODONE HCL 30 MG TABLET 180.000 30 7 09/02/2011 765024 N 808/08/2011 OXYCODONE HCL 30 MG TABLET 210.000 30 7 08/08/2011 762301 N 808/06/2011 HYDROCODON-ACETAMINOPHN 10-500 180.000 30 7 08/06/2011 762148 N 808/06/2011 ALPRAZOLAM 2 MG TABLET 60.000 30 7 08/06/2011 762149 N 807/08/2011 HYDROCODON-ACETAMINOPHN 10-500 180.000 30 7 07/08/2011 748980 N 807/08/2011 ALPRAZOLAM 2 MG TABLET 60.000 30 7 07/08/2011 748979 N 807/08/2011 OXYCODONE HCL 30 MG TABLET 210.000 30 7 07/08/2011 748978 N 806/10/2011 OXYCODONE HCL 30 MG TABLET 210.000 30 7 06/10/2011 746300 N 806/10/2011 ALPRAZOLAM 2 MG TABLET 60.000 30 7 06/10/2011 746299 N 806/10/2011 HYDROCODON-ACETAMINOPHN 10-500 180.000 30 7 06/10/2011 746298 N 803/24/2011 HYDROCODON-ACETAMINOPH 7.5-500 15.000 2 9 03/24/2011 4132531 N 7

Prescribers for prescriptions listed: D.B.

----------------------------------------------------------------------------------------------------------------------------------









8897 MIAMI FL 33174


2047 MIAMI FL 33183

1171 CAMDEN AL 36726

Fill Date

Product, Str, Form

G.B.Qty Days Prescriber Written RX# N/R* Pharm

01/04/2013


12/06/2012


11/07/2012


10/09/2012


07/02/2012


07/02/2012


02/23/2012


12/10/2011

ENDOCET 10-325 MG TABLET 56.000 28 7 12/10/2011 775147 N 8

12/10/2011


10/25/2011


10/19/2011

HYDROCODON-ACETAMINOPHN 10-500 120.000 30 7 10/19/2011 769914 N 8

10/19/2011


09/15/2011


09/15/2011


09/15/2011


08/22/2011


08/22/2011


08/22/2011


07/21/2011


07/21/2011


06/06/2011

HYDROCODON-ACETAMINOPHEN 5-500 20.000 10 0 06/06/2011 220046 N 7

05/03/2011


03/11/2011


04/09/2010


03/12/2010


02/26/2010


04/03/2008


09/22/2007

LYRICA 75 MG CAPSULE 60.000 30 0 09/22/2007 843553 N 7

12/04/2006

HYDRO PC II SYRUP 240.000 6 4 12/04/2006 452346 N 2

04/09/2010


02/26/2010


12/04/2006

HYDRO PC II SYRUP 240.000 6 4 12/04/2006 452346 N 2

09/22/2007

LYRICA 75 MG CAPSULE 60.000 30 0 09/22/2007 843553 N 7

12/06/2012


11/07/2012


10/09/2012


Prescribers for prescriptions listed: G.B.


1350 BROWNSBORO AL 35741


4337 MADISON AL 35758

2047 MIAMI FL 33183

8897 MIAMI FL 33174





J.B.

Qty Days Prescriber Written RX# N/R*

Pharm

01/05/2013 OXYCODONE HCL 30 MG TABLET 90.000 30 4 01/05/2013 827159 N 612/28/2012 HYDROCODON-ACETAMINOPH 7.5-325 12.000 2 4 12/28/2012 4160899 N 711/28/2012 OXYCODONE HCL 30 MG TABLET 90.000 30 4 11/26/2012 2213353 N 411/28/2012 CLORAZEPATE 15 MG TABLET 30.000 30 4 11/26/2012 4437632 N 410/31/2012 OXYCODONE HCL 30 MG TABLET 90.000 30 4 10/25/2012 2002713 N 710/31/2012 CLORAZEPATE 15 MG TABLET 30.000 30 4 10/25/2012 4008535 N 709/24/2012 CLORAZEPATE 7.5 MG TABLET 28.000 28 9 08/22/2012 1034467 N 909/24/2012 OXYCODONE HCL 30 MG TABLET 150.000 25 9 08/22/2012 1034468 N 912/28/2011 CLORAZEPATE 15 MG TABLET 28.000 28 7 12/28/2011 776761 N 812/28/2011 OXYCODONE HCL 30 MG TABLET 150.000 28 7 12/28/2011 776760 N 810/25/2011 OXYCODONE HCL 30 MG TABLET 180.000 30 7 10/25/2011 770384 N 810/19/2011 HYDROCODON-ACETAMINOPHN 10-500 180.000 30 7 10/19/2011 769841 N 810/19/2011 ALPRAZOLAM 2 MG TABLET 60.000 30 7 10/19/2011 769840 N 810/05/2011 POLY-TUSSIN DHC LIQUID 90.000 4 9 10/05/2011 989593 N 109/14/2011 ALPRAZOLAM 2 MG TABLET 60.000 30 7 09/14/2011 766057 N 809/14/2011 OXYCODONE HCL 30 MG TABLET 180.000 30 7 09/14/2011 766055 N 809/14/2011 HYDROCODON-ACETAMINOPHN 10-500 180.000 30 7 09/14/2011 766056 N 8

08/22/2011 OXYCODONE HCL 30 MG TABLET 180.000 30 7 08/22/2011 763727 N 808/19/2011 ALPRAZOLAM 2 MG TABLET 60.000 30 7 08/19/2011 763519 N 808/19/2011 HYDROCODON-ACETAMINOPHN 10-500 180.000 30 7 08/19/2011 763518 N 8

07/21/2011 HYDROCODON-ACETAMINOPHN 10-500 180.000 30 7 07/21/2011 760477 N 8

07/21/2011 OXYCODONE HCL 30 MG TABLET 180.000 30 7 07/21/2011 760475 N 807/21/2011 ALPRAZOLAM 2 MG TABLET 60.000 30 7 07/21/2011 760476 N 805/03/2011 ALPRAZOLAM 2 MG TABLET 60.000 30 7 05/03/2011 4263415 N 205/03/2011 HYDROCODON-ACETAMINOPHN 10-500 180.000 30 7 05/03/2011 4263414 N 2

01/21/2011 ALPRAZOLAM 2 MG TABLET 60.000 30 8 01/20/2011 4255227 N 201/21/2011 HYDROCODON-ACETAMINOPHN 10-500 180.000 30 8 01/20/2011 4255225 N 2

01/21/2011 OXYCODONE HCL 30 MG TABLET 180.000 30 8 01/20/2011 2065670 N 212/23/2010 OXYCODONE HCL 30 MG TABLET 180.000 30 8 12/22/2010 2064776 N 212/23/2010 HYDROCODON-ACETAMINOPHN 10-500 180.000 30 8 12/22/2010 4252891 N 2

12/23/2010 ALPRAZOLAM 2 MG TABLET 60.000 30 8 12/22/2010 4252890 N 211/25/2010 ALPRAZOLAM 2 MG TABLET 60.000 30 8 11/25/2010 4250359 N 211/25/2010 HYDROCODON-ACETAMINOPHN 10-500 180.000 30 8 11/25/2010 4250358 N 2

11/25/2010 OXYCODONE HCL 30 MG TABLET 180.000 30 8 11/25/2010 2063837 N 210/28/2010 OXYCODONE HCL 30 MG TABLET 180.000 30 8 10/28/2010 2062982 N 210/28/2010 HYDROCODON-ACETAMINOPHN 10-500 180.000 30 8 10/28/2010 4247976 N 2

10/28/2010 ALPRAZOLAM 2 MG TABLET 60.000 30 8 10/27/2010 4247974 N 2

Prescribers for prescriptions listed: J.B. ----------------------------------------------------------------------------------------------------------------------------------


9513 WAILUKU HI 96793



8766 NEW MARKET AL 35761


2000 NASHVILLE TN 37205

8768 NORTHPORT AL 35473


2047 MIAMI FL 33183



2654 HAYDEN AL 35079 6474 HUNTSVILLE AL 35801

6289 MADISON AL 35758



8897 MIAMI FL 33174


2011 Totals

Alprazolam: 1168 Hydrocodone: 3965 Oxycodone: 3058


N.G. Qty Days Prescriber Written RX# N/R* Phar

m


07/02/2013 ALPRAZOLAM 1 MG TABLET 90.000 30 9 07/02/2013 4455061 N 606/20/2013 AMPHETAMINE SALTS 20 MG TABLET 40.000 20 9 06/18/2013 2246323 N 106/18/2013 ALPRAZOLAM 1 MG TABLET 90.000 30 9 06/18/2013 803953 N 506/18/2013 HYDROCODON-ACETAMINOPHN 10-500 120.000 30 9 06/18/2013 803926 N 5

06/12/2013 CARISOPRODOL 350 MG TABLET 30.000 30 9 06/12/2013 803632 N 506/05/2013 HYDROCODON-ACETAMINOPHN 10-500 60.000 15 9 06/05/2013 4036562 N 2

05/30/2013 ALPRAZOLAM 1 MG TABLET 90.000 30 9 05/30/2013 4036457 N 205/25/2013 CARISOPRODOL 350 MG TABLET 30.000 30 9 05/24/2013 4522046 N 905/20/2013 HYDROCODON-ACETAMINOPHN 10-500 120.000 30 9 05/20/2013 4553939 N 0

05/20/2013 ALPRAZOLAM 1 MG TABLET 90.000 30 9 05/20/2013 4553938 N 005/20/2013 AMPHETAMINE SALTS 20 MG TABLET 60.000 30 9 05/20/2013 2223777 N 005/13/2013 HYDROCODON-ACETAMINOPHN 10-500 120.000 30 9 05/13/2013 263375 N 5

05/13/2013 ALPRAZOLAM 1 MG TABLET 90.000 30 9 05/13/2013 263374 N 505/10/2013 PHENTERMINE 37.5 MG TABLET 30.000 30 9 05/10/2013 263055 N 505/09/2013 HYDROCODON-ACETAMINOPHN 10-500 40.000 6 9 05/09/2013 4036126 N 2

05/07/2013 OXYCODONE-ACETAMINOPHEN 10-325 30.000 10 9 05/07/2013 2214613 N 6

05/05/2013 HYDROCODON-ACETAMINOPH 7.5-500 30.000 5 9 05/03/2013 4553794 N 0

05/05/2013 CARISOPRODOL 350 MG TABLET 30.000 10 9 05/03/2013 4553793 N 004/23/2013 ALPRAZOLAM 1 MG TABLET 90.000 30 9 04/23/2013 4035846 N 204/12/2013 ALPRAZOLAM 1 MG TABLET 90.000 30 9 04/12/2013 4453738 N 604/05/2013 CARISOPRODOL 350 MG TABLET 60.000 30 9 04/05/2013 4672409 N 103/28/2013 ALPRAZOLAM 1 MG TABLET 120.000 30 9 03/27/2013 4672138 N 103/28/2013 HYDROCODON-ACETAMINOPHN 10-500 120.000 30 9 03/28/2013 4672137 N 1

03/25/2013 HYDROCODON-ACETAMINOPHEN 5-500 120.000 30 9 03/25/2013 4553408 N 0



03/19/2013 ALPRAZOLAM 1 MG TABLET 90.000 30 9 03/19/2013 4553341 N 003/19/2013 CARISOPRODOL 350 MG TABLET 30.000 30 9 03/13/2013 4553344 N 003/17/2013 HYDROCODON-ACETAMINOPHN 10-500 60.000 15 9 03/15/2013 4671797 N 1

03/14/2013 PHENTERMINE 37.5 MG TABLET 30.000 30 9 03/14/2013 4671701 N 103/14/2013 HYDROCODON-ACETAMINOPH 7.5-500 120.000 30 9 03/14/2013 4671700 N 1


03/13/2013 MEPERIDINE 50 MG TABLET 12.000 12 9 03/13/2013 2223579 N 003/09/2013 HYDROCODON-ACETAMINOPHEN 5-500 60.000 10 9 03/09/2013 4671545 N 1





N.G.Qty Days Prescriber Written RX# N/R* Phar

m

07/02/2013 ALPRAZOLAM 1 MG TABLET 90.000 30 9 07/02/2013 4455061 N 606/18/2013 ALPRAZOLAM 1 MG TABLET 90.000 30 9 06/18/2013 803953 N 505/30/2013 ALPRAZOLAM 1 MG TABLET 90.000 30 9 05/30/2013 4036457 N 205/20/2013 ALPRAZOLAM 1 MG TABLET 90.000 30 9 05/20/2013 4553938 N 005/13/2013 ALPRAZOLAM 1 MG TABLET 90.000 30 9 05/13/2013 263374 N 504/23/2013 ALPRAZOLAM 1 MG TABLET 90.000 30 9 04/23/2013 4035846 N 204/12/2013 ALPRAZOLAM 1 MG TABLET 90.000 30 9 04/12/2013 4453738 N 603/28/2013 ALPRAZOLAM 1 MG TABLET 120.000 30 9 03/27/2013 4672138 N 103/19/2013 ALPRAZOLAM 1 MG TABLET 90.000 30 9 03/19/2013 4553341 N 003/06/2013 ALPRAZOLAM 1 MG TABLET 90.000 30 9 03/06/2013 4671429 N 106/20/2013 AMPHETAMINE SALTS 20 MG TABLET 40.000 20 9 06/18/2013 2246323 N 105/20/2013 AMPHETAMINE SALTS 20 MG TABLET 60.000 30 9 05/20/2013 2223777 N 006/12/2013 CARISOPRODOL 350 MG TABLET 30.000 30 9 06/12/2013 803632 N 505/25/2013 CARISOPRODOL 350 MG TABLET 30.000 30 9 05/24/2013 4522046 N 905/05/2013 CARISOPRODOL 350 MG TABLET 30.000 10 9 05/03/2013 4553793 N 004/05/2013 CARISOPRODOL 350 MG TABLET 60.000 30 9 04/05/2013 4672409 N 103/19/2013 CARISOPRODOL 350 MG TABLET 30.000 30 9 03/13/2013 4553344 N 005/05/2013 HYDROCODON-ACETAMINOPH 7.5-500 30.000 5 9 05/03/2013 4553794 N 003/19/2013 HYDROCODON-ACETAMINOPH 7.5-500 120.000 20 9 03/19/2013 4553342 N 003/14/2013 HYDROCODON-ACETAMINOPH 7.5-500 120.000 30 9 03/14/2013 4671700 N 103/25/2013 HYDROCODON-ACETAMINOPHEN 5-500 120.000 30 9 03/25/2013 4553408 N 003/23/2013 HYDROCODON-ACETAMINOPHEN 5-500 30.000 4 9 03/23/2013 4672024 N 103/13/2013 HYDROCODON-ACETAMINOPHEN 5-500 20.000 2 8 03/12/2013 4553305 N 003/09/2013 HYDROCODON-ACETAMINOPHEN 5-500 60.000 10 9 03/09/2013 4671545 N 103/08/2013 HYDROCODON-ACETAMINOPHEN 5-500 20.000 3 8 03/08/2013 4553257 N 007/02/2013 HYDROCODON-ACETAMINOPHN 10-500 120.000 30 9 07/02/2013 4455062 N 606/18/2013 HYDROCODON-ACETAMINOPHN 10-500 120.000 30 9 06/18/2013 803926 N 506/05/2013 HYDROCODON-ACETAMINOPHN 10-500 60.000 15 9 06/05/2013 4036562 N 205/20/2013 HYDROCODON-ACETAMINOPHN 10-500 120.000 30 9 05/20/2013 4553939 N 005/13/2013 HYDROCODON-ACETAMINOPHN 10-500 120.000 30 9 05/13/2013 263375 N 505/09/2013 HYDROCODON-ACETAMINOPHN 10-500 40.000 6 9 05/09/2013 4036126 N 203/28/2013 HYDROCODON-ACETAMINOPHN 10-500 120.000 30 9 03/28/2013 4672137 N 103/17/2013 HYDROCODON-ACETAMINOPHN 10-500 60.000 15 9 03/15/2013 4671797 N 103/06/2013 HYDROCODON-ACETAMINOPHN 10-500 120.000 30 9 03/06/2013 4671430 N 103/13/2013 MEPERIDINE 50 MG TABLET 12.000 12 9 03/13/2013 2223579 N 005/07/2013 OXYCODONE-ACETAMINOPHEN 10-325 30.000 10 9 05/07/2013 2214613 N 605/10/2013 PHENTERMINE 37.5 MG TABLET 30.000 30 9 05/10/2013 263055 N 503/14/2013 PHENTERMINE 37.5 MG TABLET 30.000 30 9 03/14/2013 4671701 N 1 Total from 03/06/2013 to

07/02/20132712.000


M.L.QTY Days Prescriber Written RX# N/R* Pharm

04/13/2009 PHENTERMINE 37.5 MG TABLET 60.000 60 9 04/13/2009 801638 N 3

04/11/2009 HYDROCODONE-APAP 7.5-500 TAB 45.000 8 0 04/11/2009 412804 R 7



04/06/2009 HYDROCODONE-APAP 7.5-500 TAB 45.000 7 0 04/06/2009 4444707 N 2




03/27/2009 PHENTERMINE 37.5 MG TABLET 30.000 30 0 03/19/2009 410370 R 7































W.C.Qty Days Prescriber Written RX# N/

R*Pharm

11/03/2009 ENDOCET 10-650 MG TABLET 90.000 30 8 11/03/2009 200369 N 6

11/03/2009 METHADONE HCL 10 MG TABLET 180.000 30 8 11/03/2009 200368 N 6

10/26/2009 HYDROCODON-ACETAMINOPHN 10-500 45.000 10 H8 10/26/2009 301263 N 6

10/15/2009 SUBOXONE 8 MG-2 MG TABLET SL 60.000 30 4 10/15/2009 301179 N 6


10/07/2009 HYDROCODON-ACETAMINOPHN 10-650 42.000 15 4 09/23/2009 301011 R 6

10/01/2009 HYDROCODON-ACETAMINOPHN 10-500 50.000 9 8 09/16/2009 300952 R 6


03/09/2009 HYDROCODON-ACETAMINOPH 7.5-500 60.000 15 4 02/27/2009 4495486 R 4







02/10/2009 ENDOCET 10-650 MG TABLET 60.000 15 02/10/2009 2000467 N 5

02/05/2009 ENDOCET 10-650 MG TABLET 60.000 30 4 02/05/2009 65595 R 8









12/29/2008 SUBOXONE 8 MG-2 MG TABLET SL 30.000 30 9 09/24/2008 60703 R 8






Prescribers for prescriptions listed: W.C 4373 DOTHAN AL 36301

3346 DOTHAN AL 36301 0397 DOTHAN AL 36301 6252 DOTHAN AL 36302 6386 DOTHAN AL 36305 0297 ENTERPRISE AL 36330 2910 MODESTO CA 95350 9021 DOTHAN AL 36305 1251 DOTHAN AL 36301 5620 OZARK AL 36360 3623 DOTHAN AL 36303 7619 DOTHAN AL 36305 2950 SALEM MA 01970 3175 DOTHAN AL 36301 3027 MONTGOMERY AL 36117 3224 DOTHAN AL 36303 5774 TROY AL 36081 6346 DOTHAN 5488 DOTHAN AL 36305 1051 MONTGOMERY AL 36116 8049 ENTERPRISE AL 36330 6040 DOTHAN AL 36305 0244 BIRMINGHAM AL 35234 4419 BIRMINGHAM AL 35233 8692 OZARK AL 36360 6969 DOTHAN AL 36301 4436 ENTERPRISE AL 36330 9902 ENTERPRISE AL 36330 2884 DOTHAN AL 36303 3751 DOTHAN AL 36305 4858 TALLAHASSEE FL 32308 2104 TALLAHASSEE FL 32308 8458 OZARK AL 36360 1605 OZARK AL 36360 1612 DOTHAN AL 36305 3983 BIRMINGHAM AL 35233 5720 DOTHAN AL 36305 1480 GRACEVILLE FL 32440 7483 DOTHAN AL 36301 4877 FT WALTON BEACH FL 32547 8516 OZARK AL 36360 8033 MIDLAND CITY AL 36350 5147 DOTHAN AL 36301 0438 24 WOODMERE DRIVE, DOTHAN AL 36305 0339 DOTHAN AL 36303 6551 DOTHAN AL 36303 5097 DOTHAN AL 36303 4337 ALEXANDER CITY AL 35010 5389 ENTERPRISE AL 36330

DR. “A”

• Investigation into billing fraud by Dept. of Justice/FBI

• Several patients died under this doctor’s care

• #1 prescriber in Alabama for two years:• Over 213,000,000 doses, fully 25% more than the

#2 prescriber

• Increased by 3,000,000 doses from one year to the next

• “VIP” (concierge) program ($500-1200 to join; $150/visit)

• ACSC summarily suspended and surrendered prior to a hearing

DR. “B”

• Using van to transport patients from distant town

• At least two patients died of OD under his care

• #1 prescriber of c.s. in his county for four years

• Concern from area pharmacists

• Providing patients with expired meds

• Medicaid reviewed showed no medical necessity for prescribing practices

• Voluntarily surrendered Schedules II and III

• Received letter of thanks from the city where doctor practiced

DR. “C”

• Initial complaint to Board involved sex for drugs

• Federal investigation involving Medicare fraud, running a pill mill

• Prescribing opiates, benzos, amphetamines all on same day for same patient

• Essentially identical form records

• ACSC Summarily Suspended

DR. “D”

• Complaints from pharmacists in several counties about quantities, patients coming in at night, all young people, cash payment

• Some pharmacists refused to fill scripts from this physician

• Not registered for PDMP, not using Board guidelines

• Patients continued receiving scripts after:• negative UDS for meds prescribed,

• positive for drugs not prescribed,

• positive for illegal substances

• falsified UDS

• admitted abusing medications

• ACSC summarily suspended and subsequently revoked

Characteristics of Prescription Drug Abuse

Intent--medical use is to treat a diagnosed medical illness. Non-medical use is for neuropsychiatric effect--usually side effect.

Consequences--standard is that it improves quality of life. Typically, non-medical use leads to a deterioration of user’s life.

Control--Medical Treatment controlled cooperatively. Non-Medical Use controlled by abuser.

Characteristics of Prescription Drug Abuse

Legality--Medical Use Legal, Non-Medical illegal.

Pattern--Medical use more stable without simultaneous non-medical use of other drugs. Non-medical use unstable, often poly drug.

Drug Seeking Patient

Unscheduled visits, took too many, pharmacy shorted me

Spilled in the sink or toilet--always controlled

Multi-sourcing--PDMP

Intoxicated--at office,pharmacy, community

Pressuring behaviors--begging, pleading, commenting (you are the best)

Boundaries or threats (sex for substance)

Act 2013-256Prescription Drug Monitoring Databank

• Practitioners may now self-query

• Physicians may designate up to 2 employees to access on their behalf

Act 2013-257Alabama Pain Management Act

• Began Jan. 1, 2014

• Registration and regulation of physicians providing pain management services

• Requirements for registration

• Investigations and inspections

• Medical director required

• Authority to suspend registration

Changes to Pain Management Rules

• Top 10% of c.s. prescribers registration requirement changed to top 3%

• Eliminated registration for physicians whose practice is >50% pain management

• Dispensing definition amended – required to register if dispense c.s. from the office (not if write prescriptions only)

• Eliminated criminal background check requirement

• Additional locations for pain management services

CHAPTER 540-X-19STANDARDS FOR PAIN MANAGEMENT SERVICES

540-X-19-.01 Preamble.

To assist in preventing diversion, abuse and misuse of controlled substances, the Board is authorized by law to regulate physicians who provide pain management services, including requiring registration with the Board, suspending registrations for pain management services when there is an immediate danger to the public health, and sanctioning, disciplining or placing conditions upon physicians providing pain management services in a manner other than that prescribed in these rules. These rules do not apply to the treatment of acute pain, and physicians are encouraged to be involved in the appropriate care of acute pain.


540-X-19-.02 Definitions.

(7)DISPENSE. To provide, distribute or give to a patient for the patient's use any controlled substance, except prepackaged samples and/or starter packs, where such controlled substances are purchased by the physician or osteopath for resale to a patient whether or not a separate charge is made for the controlled substance. Controlled substances which are consumed by or which are administered to patients while being treated in the physician's office, clinic, hospital or other facility are not considered to be dispensed for the purposes of this rule. Dispensing occurs when a physician or osteopath provides, gives or distributes controlled substances for consumption or administration by patients off the premises of the clinic, hospital or other facility where the physician or osteopath practices, without respect to whether such controlled substances are purchased by an individual physician or osteopath, a professional association or professional corporation, a for-profit or not-for-profit corporation, a hospital, clinic or other medical facility.

For purposes of this Chapter, dispensing shall not apply to the dispensing of controlled substances to patients treated in any hospital emergency room provided that (a) the patient has registered for treatment in the hospital emergency room and was treated by the emergency room physician on duty and (b) the controlled substances dispensed are subject to inventory, accounting and security controls and policies of the hospital pharmacy or the emergency room department. For purposes of this definition, a controlled substance is any drug or substance listed in Schedules II through IV of the Alabama Uniform Controlled Substance Act, Code of Ala. 1975, §§20-2-1, et seq.


540-X-19-.02 Definitions.

(9) PAIN MANAGEMENT SERVICES. Those medical services that involve the prescription of controlled substances in order to treat chronic non-malignant pain by a physician who treats pain. For the purposes of this rule, the provision of pain management services shall mean:

(a) A physician practice which advertises or holds itself out to the public as a provider of pain management services; OR

(b) A physician practice which dispenses opioids; OR

(c) A physician practice in which any of the providers of pain management services are rated in the top three percent (3%) of practitioners who prescribe controlled substances in Alabama in Schedules II, IIN, III, IIIN and IV, determined by the Alabama Prescription Drug Monitoring Database on an annual basis.


540-X-19-.03 Pain Management Registration Required.

1) Beginning January 1, 2014, and continuing every year thereafter, all physicians who provide pain management services must obtain a pain management registration from the Board.

(2) All physicians who otherwise meet the criteria established by the Board shall obtain a pain management registration from the Board.

(3) To obtain a pain management registration, a physician applicant shall submit the following to the Board:

(a) A completed application on a form prescribed by the Board.

(b) Proof of a current Drug Enforcement Administration (DEA) registration.

(c) Proof of an Alabama Controlled Substance Certificate (ACSC).

(d) Proof of a current registration with the Alabama Prescription Drug Monitoring Program (PDMP).


The physician applicant shall provide the Board with a physical address for each location where he or she provides pain management services and a list of all physicians who work at the practice location, including the name of the physician who will serve as the medical director.

(5) Exemptions.The provisions of this rule shall not apply to any of the following:(a) A hospice program as defined by and licensed by the Alabama Department of Public Health, or any physician while performing work or providing pain management services for that program.

(b) A facility maintained or operated by the United States or any of its departments, offices or agencies, or any physicians while performing work for that facility.

(c) In addition, the Board shall provide individual, entity and any categorical exemptions as, in its discretion, it deems appropriate.

(d) Any physician who is not included in subparagraphs (a) and (b) above may petition the Board for an exemption from the requirements of this rule for working at a particular entity. The Board shall have the sole discretion in determining whether the requested exemption shall be granted or denied.


(6) Fees.

(a) Initial Application Fees. All applicants for pain management registration

shall submit an initial application fee in the amount of One Hundred Dollars ($100.00).

(b) Renewal Fee. All applicants for renewal of their pain management registration shall submit a renewal fee in the amount of One Hundred Dollars ($100.00).

(7) Miscellaneous.

(a) An applicant practicing in more than one location shall submit a separate registration for each location.


540-X-19-.04 Ownership and Operation.

(1) All registrants must provide pain management services at a location owned and operated by one of the following:

(a) One or more physicians licensed to practice medicine in Alabama.

(b) A business entity registered with the Alabama Secretary of State’s Office.

(c) A governmental entity or body, or political subdivision, or any combination thereof, including state universities and schools.

(2) In order to be registered, a physician shall certify that each practice location is under the direction of a medical director who shall be a physician who possesses a current, unrestricted license to practice medicine or osteopathy in Alabama.

(3) Every registrant providing pain management services is required to register with the Alabama Department of Public Health (ADPH) in order to obtain access to the Alabama Prescription Drug Monitoring Program (PDMP) maintained by the ADPH.


540-X-19-.05 Training Requirements.

(1) Each physician serving as the medical director at a practice location shall meet at least one of the following requirements:

(a) Successful completion of a residency program in physical medicine and rehabilitation, anesthesiology, addiction medicine, neurology, neurosurgery, family practice, preventive medicine, internal medicine, surgery, orthopedics, or psychiatry approved by the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association Bureau of Osteopathic Specialists (AOABOS).

(b) Board certification in physical medicine and rehabilitation, anesthesiology, addiction medicine, neurology, neurosurgery, family practice, preventive medicine, internal medicine, surgery, orthopedics, or psychiatry approved by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association Bureau of Osteopathic Specialties (AOABOS).

(c) Specialty certification in pain management, pain medicine, hospice and palliative medicine, geriatric medicine, rheumatology, hematology, medical oncology, gynecologic oncology, infectious disease, pediatric hematology-oncology, or pediatric rheumatology recognized by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association Bureau of Osteopathic Specialists.

(d) Board certification by the American Board of Pain Medicine.

(e) Board certification by the American Board of Interventional Pain Physicians.

(f) At least one of the following:

1. Completion of 40 in-person, live participatory AMA PRA Category 1 Credit or AOA Category 1-A credits in the area of pain management completed within three years of implementation of these rules or prior to serving as a

medical director for the practice location, whichever is more recent.

2. Completion of a Board approved course of medical education in the area of prescribing controlled substances completed within three years of implementation of these rules or prior to serving as medical director for the practice location, whichever is more recent, and completion of 40 in-person, live participatory AMA PRA Category 1 Credit or AOA Category 1-A credits in the area of pain management within three years of commencement of service as medical director.

(2) The Medical Director shall be physically on site for a minimum of ten percent of the clinic’s operating hours.


540-X-19-.06 Inspections.

(1) The medical records and documents of every physician registered under these rules shall be open to inspection to the extent authorized by Ala. Code § 34-24-608 and the Administrative Rules of the Board as set out below.

(2) All inspections of physician records undertaken by the Board may be conducted without prior notice to physician, clinic or its staff.

(3) Physicians registered under these rules shall make all records, notes, and files of the registrant open to inspection. In carrying out the intent of these rules, the Board shall have all of the power and authority it currently possesses in its current capacity under §§ 34-24-363 to 34-24-365, Code of Alabama 1975, as amended, inclusive, and all of the power and authority therein may be applied under these rules for purposes of pain management services registration and enforcement.


(4) If the Board finds that danger to the public health, safety, or welfare requires emergency suspension of a registration and states in writing its reason for that finding, it may proceed without hearing or upon any abbreviated hearing that it finds practicable to suspend the registration under these rules. The suspension shall become effective immediately, unless otherwise stated therein. The suspension may be effective for a period of not longer than 120 days and shall not be renewable. The Board shall not suspend the same registration for the same or substantially similar emergency within one calendar year from its first suspension unless the Board clearly establishes that it could not reasonably be foreseen during the initial 120-day period that such emergency would continue or would likely reoccur during the next nine months. When such summary suspension is ordered, a formal suspension or revocation proceeding under § 34-24-361, Code of Alabama 1975, as amended, or § 20-2-53, Code of Alabama 1975, as amended, shall also be promptly instituted and acted upon.


540-X-19-.07 Investigations

(1) The Board or its agents, on the Board’s own motion or in response to a written complaint, may investigate known or suspected violations of §§ 34-24-600, et seq., Code of Alabama 1975, as amended, and may issue subpoenas.

540-X-19-.08 Disciplinary Action and Sanctions.

540-X-19-.09 Requirements for the Use of Controlled Substances for the Treatment of Pain1.

CHAPTER 540-X-4CONTROLLED SUBSTANCES CERTIFICATE

540-X-4-.01 Registration For Alabama Controlled Substances

Certificate.

(1) Every physician licensed to practice in Alabama

who distributes, prescribes, or dispenses any controlled

substance within Alabama or who proposes to engage in the

distributing, prescribing or dispensing of any controlled

substance within Alabama must obtain annually a registration

certificate. The fee for such certificate is $150.00, which

includes the fee payable to the Alabama Department of Public Health Prescription Drug Monitoring Data Bank required by Code of Ala. 1975, §20-2-217, or as otherwise set by law.

540-X-4-.08 Requirements For The Use Of Controlled SubstancesFor The Treatment Of Pain.

(2) Requirements.

(a) Evaluation of the Patient. A medical history and

physical examination must be conducted and documented in the medical record. The medical record should document the nature and intensity of the pain, current and past treatments for pain, underlying or coexisting diseases or conditions, the effect of the pain on physical and psychological function, and history of substance abuse. The medical record should also document the presence of one or more recognized medical indications for the use of a controlled substance.


(b) Treatment Plan. The written treatment plan should state objectives that will be used to determine treatment success, such as pain relief and improved function, and should indicate if any further diagnostic evaluations or other treatments are planned. After treatment begins, the physician should adjust drug therapy to the individual medical needs of the patient. Alternative non-opioid treatment modalities or a rehabilitation program may be necessary and should be considered.


(c) Informed Consent and Agreement for Treatment. The

physician shall discuss the risks and benefits of the use of

controlled substances with the patient, persons designated by the patient or with the patient’s surrogate or guardian if the

patient is incompetent. Written agreements between physician and patient outlining patient responsibilities should be utilized for all patients with chronic pain, and should include:

1. Drug screening with appropriate confirmation;

2. A prescription refill policy; and

3. Reasons for which drug therapy may be discontinued

(e.g., violation of agreement).


4. The patient should receive prescriptions from one

physician and one pharmacy where possible.

(d) Periodic Review. At reasonable intervals based on the individual circumstances of

the patient, the physician shall review the course of treatment and any new information about the etiology of the pain. The physician shall monitor patient compliance in medication usage and related treatment plans.


(e) Consultation. The physician should be willing to

refer the patient as necessary for additional evaluation and

treatment in order to achieve treatment objectives. Special

attention should be given to those pain patients who are at risk

for misusing their medications and those whose living

arrangements pose a risk for medication misuse or diversion. The

management of pain in patients with a history of substance abuse

or with a co-morbid psychiatric disorder may require extra care,

monitoring, documentation and consultation with or referral to an

expert in the management of such patients.


(f) Medical Records. The physician shall keep

accurate and complete records to include:

1. the medical history and physical examination;

2. diagnostic, therapeutic and laboratory results;

3. evaluations and consultations;

4. treatment objectives;

5. discussion of risks and benefits;

6. treatments;

7. medications (including date, type, dosage and

quantity prescribed);

8. instructions and agreements; and

9. periodic reviews.

These records shall remain current, be maintained in an

accessible manner, and be readily available for review.


(g) Compliance With Controlled Substances Laws and

Regulations. To prescribe, dispense or administer controlled substances, the physician must be licensed in the state and must comply with applicable federal and state regulations. (3)

Definitions. For the purposes of this rule, the following

terms are defined as follows:

(a) Acute Pain. The normal, predicted, time-limited physiological response to nociceptive stimuli such as injury, trauma or illness.


(b) Addiction. Addiction is a neurobehavioral

syndrome with genetic and environmental influences that results

in psychological dependence on the use of substances for their

psychic effects and is characterized by compulsive use despite

harm. Physical dependence and tolerance are normal physiological consequences of extended opioid therapy for pain and should not be considered addiction.

(c) Chronic Pain. A state in which pain persists beyond the usual course of an acute disease or healing of an

injury (e.g., more than three months), and which may or may not

be associated with an acute or chronic pathological process that causes continuous or intermittent pain over a period of months or

years.


(d) Substance Abuse. Substance abuse is a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances.

(e) Tolerance. Tolerance is the need for greatly increased amounts of a substance to achieve intoxication (or the desired effect) or a markedly diminished effect with continued use of the same amount of the substance.

# OF PRESCIBING CASES:

2014-30

2015-21

# PM Facilities-390

# PM Licenses-501

# OF ACSC-12,645

Alabama Board of Medical Examiners

Edwin Rogers, InvestigatorDirect: (334) 833-0179

Cell: (334) 320-5569

Fax: (334) 265-5860

E-mail: [email protected]

Brandi MadderraDirect: (334) 833-0189

Fax: (334) 240-3037

E-mail: [email protected]

Address: 848 Washington Avenue Montgomery, AL 36104

mailto:[email protected]

mailto:[email protected]

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