Mohave County awash in pain medications
Editor's note: This is the second installment in our series regarding prescription pain medicines, those who need them, those who treat patients and those who fill their prescriptions. The series will also focus on those who are trying to address the growing problem of prescription drug abuse by people who have no legitimate reason to take them other than to get high.
Today, local law enforcement officers explain the epidemic of prescription drug abuse in Mohave County.
KINGMAN - Mohave County is Arizona's ground zero when it comes to the illegal use of prescription drugs. The chant "We're No. 1" sounds less than celebratory when our first place status involves the highest rate of pills dispensed per person in Arizona - enough to provide every adult in the county with a pill every few hours, 24/7 for four straight weeks, according to the Arizona Criminal Justice Commission.
Mohave County is ranked first in the state for youth misuse of prescription drugs. The state is ranked sixth in the nation for abuse among people 12 years old and older. Mohave County is ranked second in the state for the rate of deaths involving prescription pain relievers.
At a meeting the justice commission hosted in September at Kingman Regional Medical Center, a plan called the Prescription Drug Reduction Initiative was unveiled. The plan is described as a "multi-systemic, multi-agency collaborative approach to reduce prescription drug misuse in Arizona."
Representatives from law enforcement, doctors, pharmacists and community leaders participated in the discussion and there was an urgent sense that immediate action was necessary, according to Kingman Police Chief Robert DeVries.
KPD Sgt. Lymon Watson and two detectives involved in undercover work in both Kingman and Mohave County also spoke with the Miner. They asked that their names not be used or their photographs taken for this story.
Pills, Pills Everywhere
The number of powerful painkiller prescriptions that have been filled by Mohave County pharmacies is staggering.
"In 2010, Mohave County was second in the state for the distribution of oxycodone," said DeVries. That year, DeVries said, 6.8 million doses were distributed.
"That's enough to give 34 pills to every person in Mohave County. That's 200,000 people," said DeVries.
How many patients were involved is unknown, said DeVries, but not all of them had valid prescriptions. DeVries said prescription forgery is rampant.
The problem could be reduced if more doctors took advantage of the state's electronic prescription program that was implemented to combat forged or altered prescriptions.
"Only 20 percent of the doctors in Mohave County use it," said one undercover officer. The reluctance, according to law enforcement, is that e-prescriptions create another step for doctors to take.
Patients also "doctor shop" in search of pills, and people who have painkillers sell or give them to friends and relatives.
Not surprisingly, according to undercover officers, the same people who deal dangerous drugs like methamphetamine also sell pain medicine to addicts.
Perhaps most alarming, Watson, the school resource officer, said one in four students from sixth grade through 12th grade in Kingman steal prescribed medication from their parents.
"They take it right out of the medicine cabinet," said DeVries.
Local law enforcement officers are also taking an increasing number of reports from people claiming their prescription meds were stolen.
Call them cynical, but deputies and police don't think the crime happens nearly as often as it's reported.
In order to get a replacement prescription, a police report detailing the theft by law must be provided to the prescribing physician.
"I can't tell you how many times somebody calls and says somebody stole my prescription," said DeVries. "Most claim the pills were in their car. I find it interesting they would keep narcotic pills in their car. They're not supposed to be driving."
That in turn has led to an increase in the number of residents arrested for driving while under the influence of pain medication, whether they have a valid prescription and a legitimate need for the pills or not.
Yeh Day in Kingman
One focus of the multi-agency Mohave Area General Narcotics Enforcement Team is on doctors who specialize in pain management.
Nobody is more aware of the pill epidemic than the physicians who prescribe painkillers.
They have former doctor Albert Yeh to thank, in large measure, for the scrutiny under which they now find themselves.
Yeh was a Las Vegas doctor with licenses in Nevada and Arizona. He spent his Tuesdays practicing medicine in Golden Valley. Yeh didn't actually treat patients as much as he wrote out prescriptions for painkillers. A lot of prescriptions.
So many, said DeVries, that many of them were prewritten the night before to save time.
Other timesaving measures made a mockery of the practice of medicine. Patients did not have their vital signs checked. Medical examinations were not performed.
According to the Drug Enforcement Administration, which investigated Yeh for two years, Yeh created a computer program that allowed him to automatically enter false information on patients' charts.
One DEA undercover officer was prescribed painkillers 58 seconds after his visit with Yeh began. Yeh prescribed another undercover officer 240 painkillers just two weeks apart.
So many of Yeh's patients headed to area pharmacies after their brief interlude with Yeh that pharmacists throughout Kingman referred to Tuesdays as "Yeh day," said DeVries.
To add insult to injury - and to guarantee the state would be aggressive in supporting Yeh's ultimate prosecution - the doctor not only wrote more than 6,000 prescriptions working one day a week in 2009, about 90 percent of his patients were insured through the Arizona Health Care Cost Containment System.
Patients paid an average of $200 for the initial visit and $75 every time Yeh wrote a refill. He then billed the state insurance program $8 million, of which he was paid about $3 million.
Medicare and private insurance providers were bilked out of almost $1 million, according to DeVries.
Yeh saw about 150 patients every Tuesday. He never monitored them to determine if their dose was correct, if they had adverse reactions or taken any other steps most doctors routinely do in treating pain patients. Indeed, his staff referred to follow-up appointments as "refill visits."
On a single day, Yeh billed the state insurance program 69 hours. In January 2011, he pleaded guilty to three serious felonies - illegal control of an enterprise, money laundering and fraudulent schemes and artifices.
He agreed to serve 2.5 years in prison (he has since been paroled and deported to China) surrendered his medical licenses in Nevada and Arizona, and was ordered to pay about $700,000 in restitution to the Arizona Health Care Cost Containment System.
Heroin Makes a Comeback
The most abused pill in Mohave County is the opiate OxyContin, according to undercover narcotics detectives who work for MAGNET, which includes members of both the KPD and Mohave County Sheriff's Office.
As more doctors worried about falling under DEA scrutiny shy away from treating pain, and pharmacists are limited on how many prescriptions they can dispense each calendar month, people are turning to heroin as the pills become more difficult to find.
The effects of heroin are similar to OxyContin. The pills are not taken orally as prescribed, but are crushed and smoked in pipes or injected into veins through a syringe.
Not everybody who uses such powerful drugs understands their limits and they die.
DeVries estimates at least a dozen overdose deaths were recorded in the city in the last two years, most of them from heroin or powerful prescribed opiates.
Not only does heroin give them a high similar to that provided by OxyContin, undercover officers said heroin is less expensive than pills.
"It's definitely cheaper to buy heroin than OxyContin," said one detective. "You can get a pill for $10 to $25 or $30 dollars." The detective said the general price structure is $1 for every milligram.
While the prescription drug problem is acute in Mohave County, no area of the nation is immune.
In 1998, roughly 2,000 deaths were attributed to opioid overdoses in the U.S. In 2008, more than 14,800 deaths were caused by opioid misuse, representing a 600 percent increase in a decade.
"I've seen more overdoses in Kingman in the last two years than I've seen in my entire career," said Watson, a 24-year veteran.
Drugs in Schools
Watson said marijuana continues to be the most popular drug in Kingman high schools, but prescription painkillers are giving pot a run.
Fortunately, no high school students have been found in possession of heroin, but that doesn't mean the drug isn't around.
"We know it's in the schools," said Watson. "Students have told me about it."
Watson said there was widespread prescription drug abuse occurring at the Kingman Academy of Learning High School a couple of years ago, but the problem has since diminished.
"They think because it's from a doctor it won't hurt you," said Watson, who also said students will tell him they would never smoke cigarettes, but those same students see no problem with smoking marijuana.
"We're sending them mixed signals," he said. "They think marijuana is medicine."
Twenty Mohave County high school students were arrested on drug charges at school in 2012 following 29 in 2011.
The law enforcement professionals who spoke with the Miner understand their attempts to get a handle on prescription drug abuse has affected legitimate pain patients who can't always get their prescriptions filled when they need them because pharmacists are limited on how many they can dispense in a given month.
"We sympathize with people in need of help with their pain," said DeVries, "but our focus is on abuse. The more we can do to get illegal prescription abuse down, the more people in need will get their medication."
Law enforcement also agrees that prescription drug abuse leads to a rippling of crime in the county. Not only are incidents of DUI and domestic violence on the increase, the number of property crimes such as theft also are rising.