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Tag: overprescribing opioids

  • How Do The Feds Find Pill Mills?

    How Do The Feds Find Pill Mills?

    Although regulations have clamped down some on over-prescribing, authorities are still finding pill mills in operation.

    Since late last year, federal authorities have charged 87 doctors with operating pill mills where they overprescribed opioids. Data collection has allowed the feds to make those arrests and has helped contribute to guilty pleas from nine of the doctors so far.

    Brian Benczkowski, head of the Justice Department’s Criminal Division, told CNN that while traditional tips are helpful, collecting and analyzing data on prescribing practices allow authorities to work efficiently at targeting the most egregious over-prescribers. 

    He said, “I think before we employed a data driven model it was a lot harder to find them in the first instance. You had to rely on local law enforcement providing tips. You had to rely on individuals in the community providing tips. The data tells us exactly where to go very quickly.”

    How They Locate Pill Mills

    The feds look at a few different pieces of information when analyzing prescription data: they see how far patients are traveling to a doctor, how many deaths are linked to that doctor, and the dosage strength that the doctor provides.

    Federal guidelines recommend that doctors not prescribe opioids that measure more than 90 morphine milligram equivalents, or MMEs, per day. However, doctors operating pill mills prescribe up to 500 MMEs per day to patients. When that is outlined in hard data, it’s easy to know who to investigate, because “usually nothing can justify” writing prescriptions for so many pills, authorities say. 

    Once law enforcement knows where to look, spotting a pill mill is easy. 

    “When you go and observe this doctor’s office and you see lines down the block, you see people shuffling around waiting to go into the doctor’s office, you see behavior that looks very much like behavior you see in traditional street corner hand-to-hand drug distribution, it’s stark. It’s readily apparent what’s going on,” Benczkowski said. 

    How Do Pill Mills Work?

    He explained how the pill mill operations work. 

    “They [the doctors] are taking cash and putting it in their pockets. [Patients] go into the doctor’s office, they leave $300 with the receptionist. They have a two-minute consultation with the doctor who writes them an opioid prescription and they walk out the door. And that line is processed like a conveyor belt all day every day. It doesn’t look like a normal doctor’s office.”

    A Drug Enforcement Administration official said that investigating pill mills is a unique operation. 

    “We’ll do surveillance or send a confidential source in, and we’re really looking at the type of prescriptions doctors are writing and then asking medical experts, are these within the norms? It’s more of a chess game in a way than a traditional narcotics investigation. We’re a cross between investigating white collar crime and narcotics.”

    Although regulations have clamped down on over-prescribing, authorities are still finding pill mills in operation, something that frustrates Father Brian O’Donnell of Catholic Charities West Virginia. 

    “I thought the fear of God had been put into doctors in the past few years,” he said. “I’m very disappointed to hear this is still going on.” 

    Patients Not Targeted in Opioid Prescription Crackdown

    Benczkowski emphasized that the feds are focused on charging the doctors, not people addicted to opioids.

    “We recognize that we can’t just prosecute our way out of this problem,” he said. “The individual patients are not criminal defendants, they’re victims. And we wanted to make sure that they had access to appropriate medical care and appropriate treatment resources.”

    View the original article at thefix.com

  • Consulting Firm Urged Johnson & Johnson, Purdue To Sell More Opioids 

    Consulting Firm Urged Johnson & Johnson, Purdue To Sell More Opioids 

    The firm urged Johnson & Johnson to “get more patients on higher doses of opioids” and find techniques “for keeping patients on opioids longer.”

    The well-known consulting firm McKinsey & Company urged Johnson & Johnson and Purdue Pharma to sell more of their opioid products, according to recent reports. 

    McKinsey & Company urged Johnson & Johnson to “get more patients on higher doses of opioids” and find techniques “for keeping patients on opioids longer,” according to reporting by The New York Times. High doses of opioids and long-term use are both associated with increased risk of dependency and misuse. 

    The information was revealed as part of opioid trials in Oklahoma, Massachusetts and New Jersey. 

    During the Oklahoma trial, the state argued that Johnson & Johnson used misleading and irresponsible marketing for its fentanyl patch, Duragesic, at the urging of McKinsey & Company consultants.

    Powerpoint Tells All

    The state showed a Powerpoint presentation that McKinsey consultants made for Johnson & Johnson executives in 2002, which questioned whether the company was marketing opioids enough. 

    “Are we properly targeting and influencing prescription behavior in pain clinics?” one slide read. 

    The presentation recommended specifically marketing opioids to doctors who worked with patients in long-term care and those who treated elderly people with back pain. 

    In the Massachusetts case, the state presented documents including a 2013 report from McKinsey with recommendations for Purdue to “turbocharge” sales of OxyContin, which was already linked to opioid addiction at that point. The consulting firm even recommended that Purdue begin a mail order system in order to avoid pharmacies, which were beginning to clamp down on opioid prescriptions at that time. In addition, the firm called on Purdue to target doctors with more sales meetings. 

    Stepping Back

    McKinsey & Company said in a statement that it no longer provides consulting services related to opioids. 

    “Our historical work for clients in this industry was designed to support the legal prescription and use of out clients’ products. Opioids have had a devastating impact on our communities, however, and we are no longer advising clients on any opioid-specific business on a global basis,” the statement said. 

    The consulting firm said that the presentation prepared for Johnson & Johnson was “designed to support the legal use of a patch that was then widely understood to be less susceptible to abuse.”

    Testifying at the Oklahoma trial, Johnson & Johnson representative Kimberly Deem-Eshleman said that the blunt language about marketing was “McKinsey’s words,” not those of Johnson & Johnson. However, she confirmed that the company did not terminate its relationship with McKinsey over the recommendations. In fact, the companies still work together today for “different projects.” 

    View the original article at thefix.com

  • DEA Database Tracked Every Pain Pill Sold In The US, Here's Where They Went

    DEA Database Tracked Every Pain Pill Sold In The US, Here's Where They Went

    The data depicts a clear “opioid belt” comprised of more than 90 counties across West Virginia, Virginia and Kentucky.

    Where the pills went, death followed.

    This is clear to see in a side by side comparison of recently released data showing exactly where—and to what extent—76 billion oxycodone and hydrocodone pills were distributed between 2006 and 2012, and CDC opioid death data from the same time period.

    Record-Making Civil Action

    The DEA’s database tracked the “path of every single pain pill sold in the United States,” the Washington Post reported. The Post and HD Media (the publisher of the Charleston Gazette-Mail in West Virginia) were granted access to the database last Monday (July 15) after a year-long effort to make the data available, in the largest civil action in U.S. history.

    The Post analyzed millions of transactions from 2006 to 2012, and made the data searchable by state or county. It found that 75% of the pain pills (oxycodone and hydrocodone) were distributed by just six companies in this time period—McKesson Corp., Walgreens, Cardinal Health, AmerisourceBergen, CVS and Walmart.

    The Post then compared this data alongside CDC opioid death data. This showed a clear correlation between the number of pain pills that were sent to a region and how many people died of opioid-related causes there.

    The data, visualized in two separate maps, depicts a clear “opioid belt” comprised of more than 90 counties covering Webster County, West Virginia, southern Virginia, and Monroe County, Kentucky.

    Rural communities in West Virginia, Kentucky and Virginia experienced the highest per capita opioid death rate during this time period.

    As the Post reported, the national opioid death rate was 4.6 deaths per 100,000 residents. “But the counties that had the most pills distributed per person experienced more than three times that rate on average.”

    Even more shocking was that “13 of those counties had an opioid death rate more than eight times the national rate… Seven of them were in West Virginia.”

    “What [the drug companies] did legally to my state is criminal,” said U.S. Senator Joe Manchin of West Virginia. “The companies, the distributors, were unconscionable. This was not a health plan. This was a targeted business plan. I cannot believe that we have not gone after them with criminal charges.”

    So far Rochester Drug Cooperative, a drug distributor based in New York, has been the first and only to be hit with felony criminal charges for the illegal distribution of controlled substances.

    Nearly 2,000 lawsuits against drug companies, including Johnson & Johnson and Purdue Pharma, are pending in federal court. The lawsuits claim that the companies irresponsibly marketed and distributed powerful opioid drugs with little consideration for the risk of patients becoming addicted or dying.

    View the original article at thefix.com

  • How 76 Billion Opioid Pills Flooded The Country

    How 76 Billion Opioid Pills Flooded The Country

    Shocking data from a federal opioid lawsuit has been unsealed and made available to the public.

    Data that was recently unsealed by a panel of federal judges has revealed that drug companies flooded the country with 76 billion opioid pills between 2006 and 2012, enough to supply every American adult and child with 36 pills each year.

    In some rural areas in Appalachia, the rate was more than 300 pills a year for every resident. 

    The data was reported on by The Washington Post. It comes from a database maintained by the Drug Enforcement Administration (DEA), the Automation of Reports and Consolidated Orders System, or ARCOS. The ARCOS maintains a record of every legal drug sale in the country. 

    The ARCOS data has been instrumental in the federal lawsuits involving opioid manufacturers. However, the data was sealed by federal judge Dan Polster, even though he had said “the vast oversupply of opioid drugs in the United States has caused a plague on its citizens” and that releasing the data “is a reasonable step toward defeating the disease.”

    Making It Public

    The Washington Post and Charleston Gazette-Mail in West Virginia sued for access to the data, and in response the ARCOS was made public this week. 

    “The data provides statistical insights that help pinpoint the origins and spread of the opioid epidemic—an epidemic that thousands of communities across the country argue was both sparked and inflamed by opioid manufacturers, distributors, and pharmacies,” said Paul T. Farrell Jr., a lawyer for the newspapers. 

    The data shows that the distribution of opioid pain pills increased rapidly during that six-year period. In 2006, 8.4 billion pills were distributed, and that rose more than 50% to 12.6 billion pills in 2012. For comparison, morphine doses remained relatively steady during that period, with about 500 million per year. 

    The Culprits

    The ARCOS also showed that the biggest players in the opioid epidemic are not the ones commonly talked about. The three biggest opioid manufacturers controlled the vast majority of sales: SpecGx with 37.7% of the market, Actavis Pharma with 34.6% of the market, and Par Pharmaceutical 15.7% of the market. Purdue Pharma was the fourth-largest manufacturer, but controlled just 3.3% of the market. 

    Likewise, the three largest drug distributors were responsible for distributing more than half of the opioid pills during that time. They were McKesson with 18.4% of the market, Walgreens with 16.5% and Cardinal Health with 14%. The fourth largest manufacturer, AmerisourceBergen, controlled 11.7% of the market. 

    A spokesperson for AmerisourceBergen told The Washington Post that the data “offers a very misleading picture.”

    The database also helps show that the areas that received the most opioid pills were also those with the highest overdose rates. West Virginia, which had the highest death rate between 2006-2012, received an average or 66.5 pills per person during that time period, nearly double the national average.

    Other hard-hit states also had very high opioid sales: Kentucky with 63.3 pills per person, South Carolina with 58, Tennessee with 57.7 and Nevada with 54.7.

    View the original article at thefix.com

  • Will Nearly 2,000 Pending Opioid Lawsuits End In A Master Settlement?

    Will Nearly 2,000 Pending Opioid Lawsuits End In A Master Settlement?

    Attorneys are attempting to put together a settlement that would make a “meaningful impact on the deeply tragic opioid crisis.”

    There are now nearly 2,000 opioid lawsuits pending in federal court. States, counties and cities across the U.S. are seeking to hold drug companies like Purdue Pharma, Johnson & Johnson and McKesson accountable for fueling the national opioid epidemic.

    The companies are accused of aggressive and improper marketing of opioid drugs like OxyContin and downplaying the risks of developing a drug use disorder.

    With so many lawsuits seeking money damages for the devastating impact that opioid abuse has inflicted on American communities, the question of how they will be dealt with remains.

    The Master Plan

    In June, a group of attorneys representing 1,200 counties, cities and towns proposed a plan to reach a settlement with two-dozen drugmakers and distributors. One of the attorneys, Joe Rice, was the architect of the 1998 Master Settlement between 46 states and major U.S. cigarette manufacturers, WBUR reported. “Tens of billions of dollars would be needed to make a significant—a real significant impact on this epidemic,” said Rice.

    The plan is “ambitious and creative but fundamentally flawed,” according to attorney Mark A. Gottlieb, executive director of the Public Health Advocacy Institute at Northeastern University School of Law. Gottlieb, wary of its potential impact, emphasized the importance of making a strong statement with the massive settlement that would provide closure for both parties. Ideally it would be a symbolic end to the opioid crisis.

    “While any new ‘master settlement’ must primarily compensate the plaintiffs for their losses, a settlement that simply moves money around, as the tobacco settlement did, has no chance at having a meaningful impact on the deeply tragic opioid crisis,” wrote Gottlieb in his commentary.

    Safeguarding The Future

    Gottlieb proposed securing a portion of the settlement that will go to future safeguards against similar crises. He suggests an independent foundation to serve as a watchdog over the pain management and addiction treatment industries, to provide opioid prescribing education, to fund treatment and prevention programs, to fund addiction-related medications such as naloxone and buprenorphine, and to advise policymakers on relevant legislation.

    “We must ensure that we do not squander the opportunity to address the opioid crisis through a coordinated public health approach in the next settlement,” Gottlieb wrote.

    View the original article at thefix.com

  • Why Are Judges Sealing Court Evidence Related To Opioid Settlements?

    Why Are Judges Sealing Court Evidence Related To Opioid Settlements?

    Experts are calling into question the unexplained decisions to seal evidence surrounding opioid settlements with Big Pharma companies.

    Eighteen years ago, West Virginia Judge Booker T. Stephens saw evidence that Purdue Pharma had engaged with misleading and aggressive marketing practices that were getting people hooked on opioids in his state. But instead of allowing that information to become public, Stephens sealed the evidence. Purdue settled with the state, and the damning information was never made public.

    “This case was sealed because both sides agreed and asked me to seal it,” he said to Reuters recently. “Obviously when you settle a case of this magnitude and of this nature, Purdue Pharma would not want to let the world know they had engaged in deceptive marketing practices.”

    State and federal laws allow court evidence to be sealed when there is a privacy concern, but a recent Reuters analysis found that the practice has become widespread. Although federal law mandates that most evidence be made public, Reuters found that over the past 20 years judges have sealed evidence in about half of multidistrict litigation cases, often without explanation.

    This is alarming in cases like that of Purdue, where making the evidence public would have raised awareness of a public safety issue, and potentially saved lives.

    “Information that could have really made a difference sometimes doesn’t come to light,” Judge and judicial educator Jeremy Fogel said.

    Judges are supposed to explain why they seal evidence, and only seal the documents that contain sensitive information, like medical records or trade secrets. But as sealing evidence has become more common, judges like Stephens simply seal evidence without explanation.

    In 1991, Arthur Miller, a New York University law professor, wrote a paper claiming there was no proof that sealing evidence could result in public harm. Reached recently, however, he said that the opioid epidemic and the Reuters analysis of how evidence is handled show that there is a public interest in keeping evidence open.

    “Certainly, anything relating to public health or things tied to social policy, you would want to have an explanation as to why something is sealed,” he said.

    The question is particularly relevant as a federal judge in Ohio sorts through 2,000 lawsuits against the drug manufacturing industry. Judge Dan A. Polster has sealed most of the evidence in those cases.

    A recent court case in Massachusetts has made public reams of internal documents from Purdue, which have highlighted the unscrupulous practices at the company. The outcry shows the importance of having transparency around evidence in the judicial system.

    Stephens, the judge who sealed the Purdue evidence 18 years ago, still sees the affects of opioids in his courtroom today. Yet, West Virginia University College of Law professor Jennifer Oliva said that Stephens could have helped fuel earlier awareness of the opioid epidemic if he had not sealed the case.

    “That’s bananas,” Oliva said. “He’s not allowed to do that without providing reasons.”

    View the original article at thefix.com

  • Surgeons Are Still Prescribing Too Many Opioids

    Surgeons Are Still Prescribing Too Many Opioids

    Though opioid prescriptions have declined, surgeons are still prescribing more than the recommended number of pills.

    Surgeons are still prescribing far too many opioids to their patients following surgical procedures, increasing their risk of long-term opioid use or addiction. 

    According to a recent analysis by Kaiser Health News and Johns Hopkins, surgeons still prescribe many times the recommended amount of pain medications. By analyzing Medicare data, the researchers found that some patients who undergo coronary bypass and knee surgeries took home more than 100 pain pills for the first week following their operations. Thirty pills would be the maximum amount recommended by current standards, researchers noted. 

    Andrew Kolodny, director of the advocacy group Physicians for Responsible Opioid Prescribing, said, “Prescribers should have known better.” 

    The researchers looked at data from 2011 to 2016. Even though opioid prescriptions started to decline during that time, the number of pills being prescribed was well above the recommended safe levels. Dr. Chad Brummett, associate professor at the University of Michigan, said that even if the prescription amounts have continued to fall since 2016 they are likely still too high. 

    “When prescribing may have been five to 20 times too high, even a reduction that is quite meaningful still likely reflects overprescribing,” he said. 

    Members of the medical community pointed out that surgeons were taught for years to mitigate pain by using opioids, but now they are being asked to drastically change the way they manage patients’ pain. Dr. David Hasleton, senior medical director in Utah said that it can be difficult to talk to doctors about their prescribing habits. 

    “Globally, we were overprescribing by 50%,” he said Dr. David Hasleton, senior medical director. “If you go to a prescriber to say, ‘You are overprescribing,’ it never goes well. A common reaction is, ‘Your data is wrong’ or ‘My patients are different than his.’”

    In fact, that’s exactly what happened when Kaiser reached out to the top prescribers. Most didn’t comment, but some expressed surprise that they were prescribing more opioids than their colleagues. Others said that their patients are not at risk for long-term opioid use, although data shows that 6% of people who receive opioids after a surgery will go on to use them long term. 

    “I can absolutely tell you I don’t have even 1% who become long-term opioid users,” said Nebraska surgeon Janet Grange.

    Oregon surgeon Audrey Garrett, was surprised to learn that she was a top prescriber, and equally surprised to hear that 6% of patients given opioids will develop long-term use. 

    “That is a shocking number,” she said. “If it’s true, it’s something we need to educate physicians on much earlier in their medical careers.”

    View the original article at thefix.com

  • Can Taking Opioids During A Hospital Stay Lead To Long-Term Risk?

    Can Taking Opioids During A Hospital Stay Lead To Long-Term Risk?

    Researchers found that 48% of patients who had never before had opioids were given opioids during their hospital admission.

    While the medical community has rethought outpatient opioid use in recent years and drastically reduced prescriptions, little has changed in the way that opioids are prescribed to patients in a hospital setting.

    Now, a new study indicates that receiving opioids even in a hospital setting can increase a patient’s risk of long-term opioid use.

    The study, published in the journal Annals of Internal Medicine, found that prescribing opioids is still extremely common for hospitalized patients.

    “I was surprised by the level of opioid prescribing to patients without a history of opioid use,” lead author Julie Donohue, professor in Pitt Public Health’s Department of Health Policy and Management, told Science Daily. “About half of the people admitted to the hospital for a wide variety of medical conditions were given opioids. The stability of this prescribing also was surprising. Nationally and regionally, as people have become more aware of how addictive opioids can be, we’ve seen declines in outpatient opioid prescribing. But we didn’t see that in inpatient prescribing.”

    In fact, researchers found that 48% of patients who had never before had opioids were given opioids during their hospital admission.

    The study, which looked at 191,249 hospitalizations between 2010 and 2014, found that people who were prescribed opioids for the first time in an inpatient setting were twice as likely to still be using opioids three months after they were discharged, compared with those who did not receive opioids in the hospital.

    The time when people were given opioids also made a difference in their long-term use of the drugs. Only 3.9% of people who had no opioids for 24 hours before their discharge were still using opioids three months later. By comparison, 7.5% of patients who took opioids within 12 hours of discharge reported long-term use.

    The study also found that opioids were often the first line response to pain. Less dangerous options like over-the-counter painkillers were given first only 8% of the time, researchers found.

    “Inpatient opioid use has been something of a black box,” Donohue said. “And, while our study could not assess the appropriateness of opioid administration, we identified several practices—low use of non-opioid painkillers, continuous use of opioids while hospitalized, opioid use shortly before discharge—which may be opportunities to reduce risk of outpatient opioid use and warrant further study.”

    Another recent study found that about half of patients who underwent surgery were able to manage their pain without opioids, using just over-the-counter painkillers. Research like that indicates that opioids are likely unnecessary for some patients who receive them, even in a hospital setting.

    “There are alternatives to opioids for surgical pain that work well and we should be using them more,” said lead study author Michael Englesbe.

    View the original article at thefix.com

  • Self-Described "El Chapo Of Opioids" Doctor Accused Of Drug Crimes

    Self-Described "El Chapo Of Opioids" Doctor Accused Of Drug Crimes

    The former New Jersey doctor stands accused of a number of charges including prescribing oxycodone over a text message.

    Former North Jersey family medicine doctor Robert Delagente is being charged with distribution of controlled substances and obstruction of justice after years of allegedly calling himself the “Candy Man” and the “El Chapo of Opioids.”

    Federal prosecutors are charging Delagente with improperly prescribing drugs such as oxycodone, Percocet, and Tylenol with codeine, failing to monitor his patients for addiction, and agreeing to prescribe oxycodone, the generic form of OxyContin, to one patient over a text message.

    “I’m literally sticking my neck out and can lose my medical license or [be] arrested for what I just did,” Delagente allegedly texted.

    Furthermore, he’s been accused of altering patient medical records after law enforcement began seeking to gain access to them following other allegations of misconduct. According to federal court documents obtained by NorthJersey.com, he also once referred to an opioid prescription for one of his patients as “oral heroin.”

    These allegations come as part of a widespread crackdown on doctors who failed to follow the law when prescribing controlled substances such as opioids. In addition to going after the manufacturers of drugs like OxyContin, prosecutors are shutting down “pill mills” where doctors allegedly excessively prescribe addictive drugs to patients while enjoying perks provided to them by manufacturers like Purdue Pharma.

    Last month, 60 people were charged in a crackdown, including 31 doctors. These individuals are accused of prescribing millions of pills in the space of only a couple of years. Some allegedly wrote unnecessary prescriptions for Facebook friends, left blank prescription pads for staff to fill out, and even exchanged sex for prescriptions of oxycodone and fentanyl. One doctor operating in Dayton, Ohio stands accused of giving out 1.75 million pills in the space of just two years.

    These charges were part of a single operation by the Appalachian Regional Prescription Opioid Strike Force, which was launched by the Trump administration in 2018.

    Opioid addiction and overdose deaths have disproportionately affected the Appalachian Region of the U.S., leading the federal government to take targeted action in the area.

    “The opioid crisis is the deadliest drug crisis in American history, and Appalachia has suffered the consequences more than perhaps any other region,” said Attorney General William Barr of the charges.

    Back in New Jersey, Dr. Delagente faces up to 20 years in prison and a fine of $1 million for the distribution of controlled dangerous substances and another 20 years and $250,000 for obstruction of justice. His attorney has not responded to requests for comment.

    View the original article at thefix.com

  • Dentist Wrote 200 Opioid Prescriptions For Five Patients In One Year

    Dentist Wrote 200 Opioid Prescriptions For Five Patients In One Year

    The dentist who wrote the opioid prescriptions claims state investigator were “telling lies” but he did not provide or clarify any additional details.

    A dentist in Tennessee has had his professional license revoked for reportedly writing approximately 200 prescriptions for opioid medications to just five patients, some of whom were never physically present in his office.

    A discipline report from the Tennessee Department of Health revealed that Michael R. Tittle, 64, who maintained a dental practice in the small town of Erwin, Tennessee, allegedly lacked the proper records to justify writing the prescriptions, which in one case totaled 71 prescriptions for 10 hydrocodone pills over the course of just six months.

    In a statement to the Tennessean, Tittle claimed that state investigators were “telling lies,” but he did not provide or clarify any additional details.

    In addition to the revocation of his license, Tittle was also assessed a civil penalty of $13,000, plus court costs not to exceed $3,000. These details, as well as the allegations against Dr. Tittle, were made public on November 15 as part of a monthly discipline report by the state Department of Health, which maintains public records on doctors and other health care professionals throughout the state. 

    According to the report, Tittle’s office came under investigation after the Department of Health received a complaint about his prescribing practices while on a five-year probation for multiple infection control violations. After reviewing his Controlled Substance Monitoring Database report, the Department requested 13 dental records; these were found to lack “a concise description and justification for the amount and frequency of controlled substances,” according to the report. 

    Prescription records for five patients were also highlighted in the report; in addition to the aforementioned patient, one patient is reported to have received 49 prescriptions for hydrocodone and 14 prescriptions for oxycodone, totaling 630 tablets, between October 2016 and September 2017.

    Another patient reportedly received 24 prescriptions, totaling 210 tablets, for more than a year after undergoing a root canal, while a third received two prescriptions for oxycodone and two for hydrocodone, all totaling 110 tablets, between August and November 2015, despite the fact that no documentation could confirm that the patient had ever set foot in Tittle’s office.

    The report also noted that Tittle admitted to having a pre-signed, blank prescription slip in his office that had been “copied onto security paper to generate additional pre-signed prescription slips.”

    To settle the case, Tittle agreed to the revocation of his Tennessee dental license as well as $1,000 in civil penalties for each of the 13 records reviewed by the Department of Health and the “actual and reasonable costs” of prosecuting the case. The findings were also reported to the National Practitioner Data Bank.

    View the original article at thefix.com