Michael Jackson and the Doctors

It has been announced that the LAPD and DEA are investigating the circumstances of Michael Jackson's death with an eye to determining whether any of his doctors broke the law in prescribing and giving him various drugs. Well they should. As the Anna Nicole Smith case demonstrated, there are plenty of doctors out there who violate the law when furnishing drugs/prescriptions to their patients. It's a much bigger problem than the public suspects.

Every doctor who handles, dispenses or prescribes drugs must have a DEA registration number as well as a license to practice medicine in a particular state. DEA, for its part, is tasked, through its Diversion Section, in monitoring all entities that produce, import, store, sell, handle or prescribe controlled substances (requiring a doctor's prescription)in the US. That includes pharmacies. All controlled substances must be accounted for whenever DEA conducts an inspection as they are legally authorized to do.

When any doctor prescribes or furnishes a controlled substance to a patient, he/she must meet three requirements:

1 Conduct a medical history of the patient for purposes of diagnosis (This is commonly the form you fill out when you visit a doctor for the first time as well as questions they ask you.)

2 Conduct a physical exam for purposes of diagnosis.

3 There must be a logical nexus between the drug prescribed and the ailment. For example, if a doctor prescribes a stimulant drug, such as amphetamine, for pain, that is outside the boundaries of established medical procedure and outside the legitimate doctor-patient relationship.

In addition, the doctor cannot over-prescribe a controlled substance. For example, if one doctor prescribes a thousand Oxycontins to a patient for pain in a one-month period, that hardly makes sense.

Yet there are doctors in this country who consciously prescribe controlled substances to "patients" whom they know are addicts and whom they know will turn around and sell much of the medications on the street. When I was stationed in Pittsburgh with DEA, a large percentage of the drug trafficking involved legally-prescribed drugs that were being fraudulently prescribed by doctors who were making great profits. There were actually certain doctor's offices in Pittsburgh where the line of patients went out the door and down the street as addicts waited to spend 5 minutes with the doctor and walk out with a prescription for drugs such as Percocet or Dilauded (strong opioids). One doctor's office we investigated actually had an armed guard in the waiting room.

Nor was the problem limited to crooked doctors. The other side of the problem was crooked pharmacists who routinely filled any prescription no matter how outrageous-often working in concert with crooked doctors who steered their patients to a particular pharmacy. Many pharmacists actually sold their drugs out the back door, later filing false burglary reports to cover up the losses since they were also subject to keeping detailed records on drugs dispensed and inventories. Similarly, a pharmacist is not off the hook legally if he/she is merely filling a prescription with a doctor's signature. For example, if Jake Snake walks into the pharmacy on Monday with a prescription for Oxycontin and returns on Tuesday, Wednesday and Thursday with similar prescriptions, the pharmacy is not bound to fill those prescriptions. Besides, it's all in the computer. The red flags are right there.

Of course, we have to wait for the investigation to be conducted before we pronounce our verdicts, tempted as we may be to declare that Michael Jackson was a drug addict and somebody is liable for helping him procure his medications. Sad that nobody ever intervened and got him into serious treatment, rather than acting as his enablers. With our system of record-keeping safeguards, however, there should at least be a paper trail that will incriminate somebody in this sordid story. Somebody is going to have to answer for their complicity. I look for a few people to be charged.