The owner of MacLeod's Drug Store and his staff have seen it all from patrons desperate for painkillers.
They have been robbed twice at gunpoint and burglarized several times.
"It's very tough, but being here so long I wouldn't even think of quitting," said longtime owner Robert W. Kendzia Sr., 75.
But the job for Kendzia and other pharmacists in the Buffalo Niagara region got harder last week with the arrest of Dr. Pravin V. Mehta on federal charges of illegally prescribing controlled substances.
Mehta dispensed painkilling medication to more than 2,000 patients. Some, federal agents say, didn't need the drugs and sold them illegally.
So now hundreds of people dependent on painkilling medication will be seeking a new supply, and that worries police officers, doctors and drugstore workers.
"I fear what is going to happen on the streets," Niagara County Sheriff James R. Voutour said. "These people are addicted, and they will have to find a source."
* Pharmacies, including MacLeod's, are aware that they may become victims of burglary and robbery by those seeking painkillers. They already have security plans.
* Police in Niagara Falls expect to investigate more thefts of legitimate prescriptions for painkillers.
* Police also expect the city's hospital and doctors will deal with more desperate patients.
* Already-stretched drug treatment centers across the region expect an uptick in people seeking their services.
Law enforcement officials had investigated Mehta since 2009, Voutour said, after city police noticed a rise in prescription drug abuse and deputies at the County Jail detected an alarming trend in new inmates dependent on painkillers.
In some cases, inmates had to be put on detoxification. Others would come in addicted to drugs readily available on the street and would be in withdrawal, needing treatment.
"We were spending about $45,000 a month on pharmaceuticals," Voutour said, "and in Niagara Falls, many medicines that were believed to be legitimate scripts were prescribed by Dr. Mehta."
Mehta, known by many as "Dr. Feel Good," was supplying not only the users, but also the suppliers, according to Niagara Falls Police Superintendent John R. Chella. He cited an arrest the day before Mehta's as a prime example.
Douglas A. Wright, 40, of the Town of Niagara, was charged with dozens of counts of criminal possession and intent to sell narcotics, after police obtained a search warrant and seized more than 300 pills of oxycodone and hydrocodone, plus more than 60 Klonopins and 200 Xanax. All the pills were from prescriptions written by Mehta, Chella said.
Following the doctor's arrest, patrol officers will be stationed near Niagara Falls Memorial Medical Center, where people will look for a "quick fix," Chella said.
His department also issued a bulletin to local pharmacies warning that the doctor's arrest could lead to individuals resorting to crime to obtain drugs.
The Falls hospital has alerted its emergency room and switchboard staffs that Mehta's patients should be referred to other specialists who work in endocrinology or primary care.
"We don't have an outpatient pharmacy, so we obviously can't dispense [medications]," said Patrick J. Bradley, hospital spokesman. He said callers have been referred to the physicians' listing on the hospital's website, nfmmc.org, or the Niagara County Medical Society at 285-5789.
The county medical society normally receives one or two requests a day for patient referral services, said Dr. Maria Crea, executive director of the Medical Society of Niagara, Orleans and Genesee counties.
Since Mehta's arrest Thursday morning, "the phone's been ringing off the hook," Crea said.
Mehta's arrest presents at least two problems for his patients, said Crea, who worked as a pediatrician in Niagara Falls for 32 years.
The demand for new doctors may outstrip the supply. Then there's the question of what percentage of Mehta's patients should be on painkillers.
"I want to make it clear that everybody's who's on pain medication is not an addict," Crea said. "Many people are on the drugs legitimately."
Others are not, which, she said, will be an issue. "Physicians are not going to prescribe medication unless they see a patient and evaluate them."
For patients who shouldn't be on painkillers -- and who are addicted -- withdrawal symptoms could kick in within days, and in some cases hours, of a prescription running out.
"There's nothing quite as debilitating as an opiate addiction," Dr. Paul Updike, director of chemical dependency at Sisters Hospital in Buffalo. "For the most part, it's much more cruel than other addictions, because opiates create this physical dependence unlike any other drug."
Flulike illness, restlessness, anxiety and other symptoms of withdrawal can last for days. Other withdrawal symptoms such as low spirits and lack of energy can go on for months.
Stopping cold-turkey, Updike said, "is not a realistic approach" for most people addicted to prescription opiates.
Updike and others worry that Mehta's patients -- if they seek help -- could strain a treatment network already near capacity. State and federal regulations limit the number of patients each program can admit. Many already have waiting lists.
"This kind of thing could precipitate a crisis for opiate-addicted patients," Updike said, "and I think the truth of the matter is, nobody really knows what's going to happen."
Prescriptions written by Mehta will likely start running out in four to eight weeks, said Dr. Richard Blondell, director of the Center for Addiction Research & Education at Sheehan Health Network.
Putting Mehta out of business, Blondell said, is just the beginning. Statewide, deaths from prescription drug overdoses outpaced those from car accidents in 2009, he said.
"It's a huge problem, particularly among our young people," said Blondell, a University at Buffalo professor of family medicine. "They are addicted to prescription drugs, pills. Drugs that are available out on the illicit market -- out on the streets -- at some point started with a doctor with a pen and a prescription pad."
News Niagara Editor Scott Scanlon contributed to this report.
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