Opioid epidemic has the US in its grip

Unintended consequences

The Cato Institute, a think tank in Washington, argues that efforts by law enforcers to curb illegal street-level use of OxyContin have produced unexpected and undesired results.

Initially, opioid therapy was limited to terminally ill cancer patients, but use of powerful painkillers was extended to those with chronic or acute pain. Many doctors, medical boards and law enforcement officials were wary because the drugs can be habit-forming. Wider use increased the danger of misuse and addiction, they said.

The problem worsened when OxyContin began to be sold on the black market. The US Drug Enforcement Agency used tactics developed to combat the illegal sale of cocaine and other drugs to fight black-market sales of OxyContin-undercover investigations, informers, arrests and asset seizure.

The Cato Institute said in a research paper: "The DEA's painkiller campaign has cast a chill over the doctor-patient candor necessary for successful treatment. It has also scared many doctors out of pain management altogether, and likely persuaded others not to enter it, thus worsening the already widespread problem of underrated, untreated chronic pain."

Making OxyContin pills crushproof so the powder could not be inhaled to get high led to increased heroin use. The narcotic is frequently injected intravenously and users often share needles. This has led to an increase in hepatitis and HIV infection, Cato Institute researchers said.

The US attorney for the Southern District of New York said a 30-mg oxycodone tablet has a street value of $20 to $30. At the high end of the range, a prescription for 120 tablets would net $3,600 in illegal sales of the drug. Some doctors have seen this as an easy source of tax-free cash.

In July, Ernesto Lopez, 76, was sentenced to five years in prison after being convicted of writing thousands of medically unnecessary prescriptions for oxycodone and fentanyl over three years. When arrested, Lopez had $729,000 in cash at his home in Queens, New York. He was fined $50,000 and ordered to forfeit $1.4 million from his "pill mill" operation.

Martin Tesher, 83, was convicted of prescribing oxycodone pills and other opioids from his office on Manhattan's exclusive Upper East Side and sentenced to 20 years in prison. A 27-year-old man with no apparent need for the drug died after Tesher illegally prescribed oxycodone, authorities said.

"Patients came to him at their most vulnerable," federal prosecutor Jennifer Sasso said at the sentencing hearing in April. "He did what a common drug dealer would do-he filled them with pills, an astronomical number of pills."

In Florida, Barry Schultz was sentenced to 157 years in prison in August last year after he prescribed and sold large quantities of medically unnecessary opioids.