On a mission for more pills

For at least 15 months and probably longer, police say, Richard Upchurch of Jackson was a man on a drug-addicted mission, going from doctor to doctor and spinning a web of desperate deceit to get his hands on 7,000 prescription pain pills.

It's a classic case of what's known in medical and law-enforcement circles as doctor shopping -- a phenomenon that has plagued the medical community for decades but only recently has garnered national and local attention.

"It's a problem, but it's a problem that up until the last year has been off the radar," said Cape Girardeau County Prosecuting Attorney Morley Swingle.

Swingle said Upchurch -- who is awaiting trial on felony charges for which he could go to prison for five years if convicted -- is one of the first doctor-shopping cases his office has filed.

But after focusing for years on street drugs like crack cocaine and methamphetamine, the SEMO Drug Task Force is taking a serious approach to these cases after instances like Upchurch's have come to light, Swingle said. He said there are investigations underway of other people suspected of doing what Upchurch allegedly did.

The state is also looking at implementing a statewide monitoring system that would allow it to more closely watch the dispensement of controlled medications.

Upchurch's court records paint a picture of what area doctors say they have been dealing with for years. According to probable-cause statements, Upchurch admitted to police that, from August 2003 to October 2004, he'd go to doctor after doctor and tell them he was out of pain medication.

After getting a prescription, in one case for 60 hydrocodone pills, he'd show up at another doctor's office with a different story. It was a cycle of doing whatever it took to feed an addiction. Over that time, he obtained 7,000 hydrocodone pills, the court papers say.

Upchurch could not be reached for comment. A woman who answered the phone at the address listed on his court papers said he no longer lived there and that she didn't know how to reach him.

But the story sounded familiar to those in the local medical field, from doctors to dentists to pharmacists, who say that addicts will do or say whatever it takes to get prescription pain pills, such as OxyContin, hydrocodone and morphine. Those who get their hands on the pills either then take them -- orally or by injection -- or sell them.

"It's a very common problem," said Dr. A. Basit Chaudhari, a Cape Girardeau neurologist who treats people for pain.

Chaudhari suspects that 5 percent of the people who visit him are seeking pain medications to feed an addiction. He said that OxyContin, an opiate, appears to be the drug of choice.

"People are very fond of using these medications," he said. "They stimulate some of the receptors in the body. It gives them a sensation of happiness and elation. But it is addictive to people who use it for the wrong reasons. And if they take too much, they can easily overdose."

Trying to get certain drug

Chaudhari said that doctors and nurses keep a watchful eye for red flags that suggest a patient may be doctor shopping. He said that he becomes suspicious when a patient is determined to get a certain drug, refusing other forms of treatment such as physical therapy or other medications that are not narcotics.

If they suspect someone of doctor shopping, they terminate the person as a patient, Chaudhari said.

But it's not a foolproof system.

"There is no way to catch them all," he said. "You're a doctor, not a policeman."

Dr. Patrick Roupp, a dentist in Cape Girardeau for 29 years, said addicts have been trying to get pills from his office since he and his wife took it over from his father-in-law.

"He warned us of these pitfalls back then," Roupp said. "It's been a problem for as long as dentists have been able to prescribe narcotics."

Addicts will go to great lengths to get pain pills, Roupp said, concocting elaborate stories or calling him at home, where they know he doesn't have access to medical records. He said that addicts are counting on the fact that doctors don't remember all of their patients.

Roupp said he doesn't call in prescriptions from home unless he clearly remembers a patient and his history. If he doesn't, he tells the caller that he has to go into his office and check their records.

"I ask for their phone number, but when I call them back, surprise, no one answers," Roupp said.

Roupp said that addicts will also recite a long list of pain medications that don't work for them so they can narrow it down to what they want.

"You just have to be a little bit smarter than the person trying to get the drugs," he said.

When they can't get a doctor or dentist to cooperate, they even try to trick the pharmacy.

"They'll say things like, 'Don't put it through my insurance,' and try to pay cash," said John McMullin of John's Pharmacy. "That's a red flag. Whey would they not want their insurance to pay? We constantly watch for this sort of thing every day."

Auditing pills

Those in the medical field aren't the only ones watching. The state Bureau of Narcotics and Dangerous Drugs also monitors the state's 14,000 physicians, 1,225 pharmacies, 155 hospitals and 1,350 veterinarians, said Mike Boeger, assistant administrator of the bureau.

The bureau makes sure, with audits, that a physician or dentist is keeping close tabs on controlled narcotics. Every instance where a pill changes hands has to be documented. The bureau also will check a doctor's office to see if he or she can account for every pill dispensed.

"We go around and monitor and make them account for the safety and security of the pills," Boeger said. "It's the same way a bank examiner makes a bank accountable."

Boeger said that there are currently 43 registrants -- those individuals with the ability to prescribe -- that are on probation for all types of violations, from abusing the medicines themselves to being negligent in their records.

The state loses control over the pills once they have been dispensed to a patient. When it goes into a patient's hands, it becomes a law enforcement matter, he said.

But the state is trying to implement a monitoring program in the form of a database of all Missouri patients who receive prescription medications, Boeger said. The system would require the medical community to log on and report who gets medicines and how much. That would allow doctors offices, pharmacies and law enforcement to share information. The state has applied for a grant to study the matter. The legislature would have to pass a law to implement it.

Boeger said that then if a patient walks into an office and asks for a prescription, the office can then punch in his name and see if he's already been prescribed that medicine by another doctor.

"That would really shut them down," Boeger said. "To stop doctor shopping, you have to control the pills. This would help us do that."

smoyers@semissourian.com

335-6611, extension 137