In Florida, Dr. James Graves is serving 63 years for manslaughter in the deaths of four patients.
In Virginia last year, a doctor was hit with a 313-count indictment after federal prosecutors accused him of having illegally distributed a fortune in OxyContin. A Tucson, Ariz., doctor stands accused of "drug dealing with a pen."
And in Virginia, again, a pain treatment specialist faces 49 felony counts, including drug trafficking resulting in death or serious injury, conspiracy and running a criminal enterprise.
All, like former Anderson physician Frank Fisher, were or are accused of what state and federal drug agents view as overzealous prescriptions of opioids, including OxyContin.
It is doctors such as these that one assistant U.S. attorney promised to "root out ... like the Taliban."
Sunday and today, the Record Searchlight looks at how an Anderson doctor and two Redding pharmacy owners have battled murder charges, dealt with losing their livelihoods, how their patients have had to cope and the issue of pain management.
Sunday's stories Frank Fisher and Stephen and Madeline Miller have beat charges against them, but the battle has ruined their professional lives and destroyed their personal lives, too.
Frank Fisher became a target of state and federal officials because of his aggressive pain management prescriptions.
Read the complete series of articles online at redding.com.
Pain patients' advocates agree that the doctors are at war -- they are victims of "the failed war on drugs," said Siobhan Reynolds of New York, founder of the Pain Relief Network, which advocates for pain patients and the physicians who treat them.
Drug agents have had so little luck stemming the flow of illegal drugs that they have turned their attention to easier targets, doctors who prescribe legal medicine for legitimate patients, the advocates say.
The American Pain Foundation estimates that some 50 million Americans suffer from chronic pain.
But several studies over the past 30 years have found that pain is undertreated, even in terminal cancer patients.
The experts agree that opioids are the most effective way to treat pain, minimizing the risks of liver and gastrointestinal damage caused by nonsteroidal anti-inflammatory drugs such as acetaminophen and ibuprofen.
The problem is that long-term opioid use does lead to dependency. Pain patient advocates, with a number of studies to back them up, argue that dependency does not mean addiction, that it is no different than insulin dependency for diabetics.
"There's this myth of available pain care," Reynolds said. "I thought everybody who needed it got it, but, no, it's the high levels of doses - -- that's what draws the authorities."
Even doctors disagree about what is too much, or too little, when it comes to pain relief.
In 2001, for example, an Alameda County jury awarded $1.5 million to the family of a Hayward man who died of cancer after finding that the internist committed elder abuse and reckless negligence by underprescribing for his pain.
"It worries me because the message is: You're damned if you do and you're damned if you don't," Dr. Scott Fishman, who heads the University of California at Davis Medical Center's pain medicine department, told the San Francisco Chronicle at the time.
Drug agents and prosecutors are worried, too, especially about oxycodone and hydrocodone, narcotic pain medications that include drugs such as Vicodin, OxyContin and Percocet.
Last month, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) released figures showing that in 2002 some 40 percent of 119,000 mentions of narcotic pain medications in emergency rooms involved either oxycodone or hydrocodone.
The administration estimates that about 6.4 million Americans illegally used opium-based painkillers in 2001.
"Narcotic pain medications are wonders of modern medicine for patients with serious pain who are under the care of physicians," said SAMSHA administrator Charles Curie.
"When diverted from their legitimate use, however, they are highly addictive narcotics that the body perceives exactly as if the person were taking heroin."
It's that kind of comparison, patients' advocates said, that attracted drug abusers to the prescription drugs in the first place. They blame media hype for teaching drug abusers how to circumvent OxyContin's time-release formula.
As DEA agents focused increasingly on doctors, more doctors became reluctant to give patients the help they needed, Reynolds said.
That's not necessarily bad, a DEA official told The Washington Post last year.
"There have been a number of very high-profile cases, and they have been a learning lesson to other physicians," said Elizabeth Willis, chief of drug operations for the DEA Office of Diversion Control. "We think doctors are much more aware of appropriate guidelines for prescribing OxyContin now."
Not only are they aware, the doctors are frightened, said Jane Orient, executive director of the Association of American Physicians and Surgeons.
The group has placed a warning on its Web site admonishing physicians to be wary of beginning to prescribe opioids and to consider phasing out that portion of their practices if they already do.
"Doctors all over the country are being prosecuted relentlessly for doing exactly what medical guidelines say they should do," Orient said.
And the prosecutors "repeatedly tend to hold doctors responsible for anything really, really stupid that their patients do, ... like not following directions and taking the prescription in combination with alcohol and clearly illegal drugs."
Fisher's lawyer, Patrick Hallinan of San Francisco, has likened the prosecutions to arresting a car dealer who sold a car to someone who killed another in an accident.
"The DEA keeps saying this shouldn't affect patient care," said Reynolds, whose husband is a chronic pain patient. "Well, I should be able to click my heels together three times, too, and get to Kansas.
"It makes them look like they're doing something, getting tough on crime," she said. "It's getting tough on patients that they're doing."
A large part of the problem, Reynolds said, is people's perception that anyone who uses drugs is an addict.
"My whole family thought that my husband was an addict and I was an enabler," she said. "We were finally able to turn that around.
"Now we're working with patients, trying to have them 'come out' as pain patients. It's that bad. Everybody tells you to get off drugs, get clean ..there's all this presidential propaganda against sick people. It's unconscionable."
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