A Niagara Falls doctor stands accused of recklessly prescribing powerful narcotic painkillers to just about any patient who walked in his office.
His staff is accused of dealing the drugs on the streets.
And a Cheektowaga doctor sucked into a separate illegal prescription drug ring, while not arrested, turned in his license to prescribe narcotics and then retired.
That's only the beginning.
A physician's assistant at a Wyoming County hospital. A receptionist at a plastic surgeon's office in West Seneca. A pharmacy cashier in Buffalo. A medical secretary in Amherst. All arrested on prescription drug charges.
"In the old days, you needed the French Connection These days all you need is a prescription pad," said Erie County District Attorney Frank A. Sedita III.
Forget Colombian drug cartels and Afghan poppy fields. The latest explosion of powerful and addictive drugs to hit the streets is manufactured by American pharmaceuticals and sometimes dispensed by those we trust the most -- our doctors and other health care workers.
And Western New York sits at the center of this explosion.
A months-long Buffalo News investigation found that, in total, three of the most abused narcotic painkillers -- oxycodone, hydrocodone and fentanyl -- are prescribed by doctors in Western New York at a significantly higher rate than in the rest of the state.
In Western New York, use of hydrocodone, the most-prescribed drug in the nation, increased by more than twice the state average between 2007 and 2009, The News found.
The wider availability of opioids coincides with greater misuse of the drugs.
Among 15 regions in the state, parts of the Southern Tier have the highest rate of illegal use of prescription painkillers, and the Erie-Niagara region has the third-highest rate, according to federal data.
Western New York also is home to two doctors who prescribe the largest number of prescriptions for controlled substances in New York State.
One was arrested in January and charged with running his Niagara Falls office as if he were a drug dealer, according to federal prosecutors, prescribing powerful opiates to just about any patient who asked for them.
"We think the large majority of doctors [in Western New York] are doing things properly," said U.S. Attorney William J. Hochul Jr. "But a few are not, and we will prosecute those cases."
The News investigation included reviews of New York State Health Department data on prescription opioids, federal and local arrest and court documents, and interviews with dozens of law enforcement and medical professionals. It found:
* Prescription opioids appear to have become more popular among drug abusers than cocaine, leading to an increasing number of crimes related to prescription medications.
Most of the crimes involve drug users and street dealers who break into homes and pharmacies to get drugs or illegally buy or sell the drugs on the streets. But, as has been the case in Western New York and elsewhere around the nation, the problem is exacerbated when even a small fraction of the medical community itself -- whether receptionists and secretaries or doctors and physician assistants -- gets involved in the illegal drug marketplace.
* All addicts don't start out as street drug users. A recent University at Buffalo study of 75 addicts in a treatment program found 41 percent reported their addiction began with medicine legitimately prescribed by their doctor, but that most evenutally ended up buying drugs on the streets.
* Over 400 doctors have been arrested nationally since 2004 for mishandling prescription painkillers.
It's a small percent of the almost 1 million doctors in the United States, but the number of arrests in recent years is significantly higher than a decade ago, prior to the explosion in opioid availability and abuse. The most recent case here included Pravinchandra V. Mehta, the Niagara Falls doctor arrested in January on felony drug distribution charges.
No national figures are available on the number of medical support personnel arrested on prescription drug charges, but in Western New York, at least eight have been arrested in the past year alone.
* Taxpayers are picking up much of the tab on this illegal trade in narcotic painkillers. Many of the prescriptions used to buy street drugs are obtained through the publicly funded Medicaid program, some costing as much as $1,000 for a 30-day supply. A recent GAO report pegged the cost to Medicaid of opioid abuse in four states, including New York, at $63 million over a recent two-year period.
* The abuse of these powerful painkillers is deadly.
Nationally, accidental drug deaths involving prescription opioids more than tripled from 4,000 in 1999 to 13,800 in 2006. There were 113 drug deaths in the Buffalo Niagara region in 2008, with 84 involving opioids. The previous year, there were 88 deaths, 70 involving opioids, according to the most recent data available from the National Drug Abuse Warning Network.
"There are a lot of deaths as a result of prescription drug overdoses," said William Burgin, executive director at Alcohol and Drug Dependency Services in Buffalo.
Among them in recent years: Matt Rybinski, 17, of Lancaster; Zachary Crotty, 19, of Colden; Eric Fischer, 19, of Amherst; and Brandon Kopacz, 23, of Elma.
Also, Jeffrey Schmidt, 19, and William B. Jakobi, 27, both of Niagara Falls; Victoria A. Eikenburg, 25, of City of Tonawanda; Adam J. Tafelski, 22, of North Tonawanda; and Alane Butler, 48, of Amherst.
>A case study
The arrest of Mehta in Niagara Falls and the accusations lodged against him and his office workers offer a case study in what can happen when someone in the medical profession and illegal prescription drug trade mix.
A patient -- who t-nurned out to be working with the U.S. Drug Enforcement Administration -- went to Mehta complaining of back pain and asked for pain pills. Mehta spent about a minute examining the man. Without taking a patient history, Mehta prescribed hydrocodone, also known by such brand names as Vicodin or Lortab, according to court records. In a follow-up visit, Mehta spent about 30 seconds in the examining room with the patient before prescribing more drugs, records state.
In another instance, Mehta gave a patient an extra 30 pain pills for a friend with a back problem, even though Mehta had not examined the friend, according to court papers.
Some of the drugs Mehta prescribed ended up going to drug addicted or patients who sold the drugs to drug dealers or addicts, federal officials said.
Mehta's office workers also sold the doctor's prescriptions directly to street users and addicts, the DEA charged.
In one case, former employee Shannon Figurelli obtained a blank prescription slip from Mehta's office, the DEA charges. Figurelli wrote the prescription out in a Medicaid recipients' name and went with the Medicaid recipient to the drugstore, where the Medicaid recipient got the prescription for 90 oxycodone painkillers filled, according to court records.
Figurelli paid the Medicaid recipient $600 for her help, authorities claimed. Figurelli then sold many of the pills for $30 each on the Tuscarora Indian Reservation, court records state.
Medicaid, the government health program, paid $1,037 for the pills that Figurelli could sell for as much as $2,700, according to court documents.
In another instance, authorities said, Chantel Stypick, another former Mehta employee, who also had a prescription slip from Mehta's office, made out a prescription for 60 pain killers in an addict's name. The prescription cost $800. The addict put in $600 and Stypick $200, the authorities said. The addict got 20 pills; Stypick took the other 40.
Mehta and his staff poured some 40,000 prescriptions for controlled substances -- representing about 3 million pills -- into Erie and Niagara counties over a 2 1/2 -year period, according to the DEA. That was the second-largest number dispensed by any of the 65,000 doctors in New York State, according to state Health Department data.
The physician who distributed the most controlled substances in New York State is Dr. Eugene J. Gosy, a board-certified neurologist who runs a pain management center off Youngs Road in Amherst. With some 2,700 doctors referring patients to him, Gosy & Associates is believed to be the largest pain management center in the state.
The depth of the illegal prescription opioids problem, including the role doctors play in it, first became evident in the Buffalo area last summer, when the DEA busted a 33-member prescription drug ring allegedly headed by Michael McCall, of Cheektowaga.
McCall, 50, coached gang members on how to get doctors to prescribe painkillers to them, according to federal investigators. The drugs, they said, were then purchased with Medicaid and sold on the streets of Buffalo and suburban Erie County for a profit.
Gosy's pain center was among those the gang visited. But the favorite was the office of Dr. Marita Gopalakrishnan, a Cheektowaga internist who was viewed by many in the gang as the easiest mark of the physicians they targeted, according to federal sources.
When the investigation into McCall and his gang was completed, and the DEA approached Gopalakrishnan, the doctor voluntarily turned in his government registration to prescribe narcotics and then retired.
Gopalakrishnan contends he provided good care but was conned by some patients into giving them drugs.
"It was a working class neighborhood. There were a lot of people out of work and complaining of pain. I took pity on them," he said. "But some of the patients were fooling me."
Another doctor, Richard C. Dobson, of Rochester, also recently gave up his registration to write narcotic prescriptions. Prescriptions taken from his office were being used to illegally obtain fentanyl in Amherst, federal investigators said.
These issues go beyond the doctors and involve others in medical offices.
In the past year, a West Seneca woman working as a receptionist in a plastic surgeon's office was charged with forging prescriptions to obtain 8,000 hydrocodone pills over the course of a year.
A Rite Aid pharmacy cashier in Buffalo was charged with stealing 4,800 Lortabs, worth about $5,000, from the store by changing vials and computer items.
A North Tonawanda woman working as a medical secretary at the All Care For Women medical practice in Amherst, was charged with forging a doctor's signature to obtain as many as 1,900 Lortabs over three months.
And Charles M. Livingston, a former physician's assistant at Wyoming County Community Hospital in Warsaw, faces charges of selling blank stolen prescription slips for $800 each. The Orleans County district attorney said Livingston also worked at a sports medicine office and was medical director for the Rochester Raiders indoor football team. Police said prescription slips allegedly stolen from doctors by Livingston were illegally sold in numerous locations in Western New York.
Also arrested was one current and three former workers in Mehta's Niagara Falls office.
>What went wrong?
None of this has been lost on the larger medical community, which is trying to figure out what went wrong.
Opioids for cancer patients and others in pain at the end of life have long been an accepted medical practice. In recent decades, the trend has been toward aggressive treatment of noncancer pain with narcotics as well. It's been a blessing to many people genuinely in pain.
But it has also led to increased access to the drugs on the streets, an epidemic of deaths and overdoses -- and doctors who are what some in the medical community characterize as the "Four Ds": dated in their medical knowledge, duped by patients, dishonest or disabled by the drugs themselves.
The problem, some medical experts say, is complex. Any solution, they say, must balance the need to maintain access to painkillers for the many patients that truly need them.
"It's unrealistic to say you won't prescribe the drugs," said Dr. Paul Updike, director of chemical dependency at Sisters Hospital. "About 80 percent of visits to primary care doctors involve pain as the primary or secondary reason for the visit. For many of these people, these medications are appropriate."
e-mail: email@example.com: firstname.lastname@example.org: email@example.com: firstname.lastname@example.org
>The drug: Hydrocodone
For moderate pain, often combined with acetominophin.
Tradename: Vicoden, Lortab
Street name: Hydro
Retail Price: $0.83
Street price: $10 a pill