When the U.S. Department of Justice slapped St. Vincent Indianapolis Hospital with a $1.2 million fine late last month, it
stunned local medical professionals.
But the issue behind St. Vincent's troubles is no surprise. The diversion of prescription drugs from the medical field into recreational use is a widespread problem in Indiana and the nation.
And while it's not clear if there are more medical professionals improperly diverting drugs, there is strong growth in the overall abuse of prescription drugs.
"A sizable amount of our time is spent on prescription drugs in this state. It is a rising trend," said Dennis Wichern, assistant special agent in charge at the Indianapolis office of the federal Drug Enforcement Administration.
In 2003, nearly twice as many people admitted to abusing controlled prescription drugs--such as painkillers, depressants and stimulants--compared with 1992. According to the National Center for Alcohol and Substance Abuse at Columbia University, 15.1 million people admitted to abusing controlled prescription drugs in 2003.
That increase was seven times higher than overall population growth. And it corresponded with a 154-percent rise in the number of prescriptions of such drugs, according to the center.
"When individuals have an opportunity to have access to addictive medications, there's always a risk they'll take advantage of it," said Dr. Michael Wiemann, St. Vincent's chief medical officer.
St. Vincent was faulted for not properly accounting for prescription drugs in the clinic pharmacy at its primary care center on west 86th Street.
A former employee there stole more than 600,000 pills of hydrocordone, a potent painkiller. The employee, Dianne Hauss, was convicted of giving the pills to her son, who was selling them on the street, according to DEA officials in Indianapolis.
Wiemann noted that St. Vincent has increased its inventory monitoring and taken other steps to catch such thefts in the future.
While the amount of medicine stolen in the St. Vincent clinic was unusually large, smaller-scale diversion pops up all over the state. Terry Richmond, chief of the medical licensing section at the Indiana Attorney General's Office, estimated that half the complaints it receives are drug-related.
Based on the first half of 2007, the attorney general is on pace to receive nearly 600 drug-related complaints against doctors, nurses, pharmacists and pharmacies. That represents a tiny minority of the more than 90,000 licensed doctors, nurses and pharmacy personnel, but it's still a widespread problem, Richmond said.
"It's throughout the state, even in small communities," he said. "These are folks that, number one, are in pretty high-pressure situations. In addition to that is the availability factor."
A small percentage of complaints turn into cases that the Attorney General's Office brings before the state licensing boards for pharmacists, nurses and physicians. Still, those boards spend the majority of their time handling cases that involve the diversion of drugs for improper use.
Neither the Medical Licensing Board nor the Pharmacy Board could provide statistics on the number of drug diversion cases they deal with per year, or whether the total is rising or falling.
"The vast, vast majority of cases are drug diversion," said Marty Allain, director of the Pharmacy Board of Indiana.
Drug diversion accounted for about half the 30 or so physicians who were disciplined last year, according to case records filed on the Medical Licensing Board's Web site. Fifteen physicians were found to have abused prescription drugs themselves or improperly prescribed them to others.
Two doctors from Gary were convicted last year of diverting OxyContin to a drug ring in Michigan. Charles and David Chube were sentenced to prison terms of five and 15 years, respectively.
Because of the Chube brothers' case, the Indiana State Medical Association, a professional organization for physicians, will hold a conference in October about drug diversion.
ISMA President Vidya Kora said he wants to make sure doctors know how to document all their prescriptions so they catch problems and don't get in trouble with drug enforcement agents.
"When this came up, I thought it would be a good idea for the state medical association to do a conference and have that information available to all physicians as to what the current legal climate issues are," said Kora, a general internist from LaPorte County.
Kora doesn't want the prevalence of prescription drug abuse to lead to limitations on physicians prescribing narcotic painkillers, such as OxyContin, hydrocordone and Vicodin.
"They need to be careful in their prosecution, that way they do not scare physicians who are prescribing narcotics," Kora said about law enforcement agencies. He added, "It is a very touchy situation. This is something that a physician should be given the discretion to use."