DEA Aims to Stem Painkiller Black Market

DEA agents are targeting the top of the supply chain as part of a comprehensive strategy to stop the flow of prescription drugs to street dealers.

CVS #219. In 2010, Cardinal shipped 2.05 million pills to the 24-hour store in Sanford, a town of 53,000 people north of Orlando, the DEA said. The numbers dropped in 2011 after CVS cut off the 22 doctors whom it suspected were writing illegitimate prescriptions. Still, Cardinal sold the pharmacy more than 1.8 million pills -- an average of 137,994 pills a month. Cardinal's other customers in Florida averaged 5,364 oxycodone pills a month.

About 42% of the CVS store's customers paid cash, the DEA said in court papers.

CVS #219 pharmacist Paras Priyadarshi told DEA investigators that the pharmacy's fastest-moving controlled substance was 30-milligram oxycodone, DEA group supervisor Ruth Carter said in a sworn statement filed as part of the federal court proceedings. Doctors often used the same diagnosis code on multiple prescriptions and often prescribed to two people living at the same address, which Carter said are signs of diversion.

Carter, in the sworn statement, said Priyadarshi told her customers often requested certain brands of oxycodone using street slang.

In a sworn statement in CVS' challenge to the DEA, Priyadarshi said the DEA misinterpreted his statements.

Pharmacist Susan Masso, who has worked at CVS #219 since June, said she would not fill prescriptions she thought were illegitimate. "I will not fill any prescription for any highly addictive drug, such as oxycodone, for any person who appears intoxicated or otherwise impaired," she wrote in a sworn statement filed in the CVS case.

Masso learned of the DEA concerns after agents interviewed her twice in October. She said the store took steps to reduce the risk of abuse and diversion. Besides suspending the 22 practitioners "who represented the majority of the oxycodone prescriptions," the pharmacy reduced the geographic area for doctors it served. As a result, the pharmacy has "dramatically reduced its ordering and dispensing of oxycodone," she said.

DEA investigators serving a warrant Oct. 18 noted that "approximately every third car that came through the drive-thru lane had prescriptions for oxycodone or hydrocodone," Carter said. "Priyadarshi knew that his store filled more oxycodone prescriptions than any other CVS in his district, but he reported that no one from CVS corporate had said anything to him about the high volume at the store."

CVS #5195. A few miles away in Sanford, this CVS store dispensed more than 58,000 oxycodone pills a month, and 58% of the customers paid cash, the DEA said. From 2009 to 2010, the number of oxycodone pills the pharmacy purchased from Cardinal jumped to 885,900 from 104,500. In 2011, the CVS purchased more than 1.2 million pills. Although Cardinal's electronic system for monitoring suspicious orders flagged the CVS orders 22 times for further investigation, Cardinal never held a shipment, notified the DEA or sent an investigator to visit the store, the DEA said.

CVS pharmacist Jessica Merrill described the oxycodone customers as "shady," Carter said.

"Cardinal shipped enough oxycodone for every man, woman and child in Sanford to have 59" pills in 2011, the DEA said.

In a sworn statement filed in the CVS case, Merrill said the DEA's account of her interview with Carter is inaccurate. She said Carter used the term "shady," and when she asked what the agent meant, Carter said people filling oxycodone prescriptions except cancer patients are drug seekers.

Merrill said she instructs pharmacists and technicians to reject prescriptions from people who have pinpoint pupils, show aggression or don't have a consistent medical history. The store keeps a binder on suspected doctor shoppers, which it shares with local law enforcement, she said. "I have assisted in at least 15 arrests related to oxycodone" since the end of 2009, Merrill said.

"I have never filled a controlled substance prescription, nor directed anyone else to do so, based on a belief that filling such a prescription would affect any bonus I received from CVS," Merrill said.

She estimates the store rejected about 10% of the prescriptions it received each day.

Michael Mon, Cardinal's vice president for anti-diversion, said in court papers that Cardinal's shipments to the pharmacies in Sanford "did not appear unreasonable."

"It is reasonable and not uncommon" for doctors to prescribe a 30-day supply of four to six, 30-milligram oxycodone pills a day for a person in chronic pain, Mon said. The amount of oxycodone Cardinal delivered to six pharmacies in Sanford would fill 26,201 four-pill-a-day prescriptions, he said.

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