When a patient showed up at a CVS Pharmacy last year with a prescription written by Missouri doctor Steven Puderbaugh for 240 20-milligram pills of oxycodone, something seemed off to the staff.
So they called the U.S. Department of Veterans Affairs clinic in St. Joseph where Puderbaugh worked. A nurse at the clinic said Puderbaugh was on a leave of absence. And the patient in question didn’t appear anywhere in the VA’s records.
A few months later Puderbaugh pleaded guilty to fraudulently attempting to obtain a controlled substance, a Class D felony drug charge that can carry a sentence of up to seven years in prison. He was sentenced to three years probation.
As Kansas, Missouri and other states try to get a handle on the opioid epidemic killing an estimated 90 Americans every day, they’re confronting a longstanding problem: physicians diverting the drugs for their own use.
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Last month, the Kansas Board of Healing Arts revoked Puderbaugh’s license, saying the doctor had repeatedly used the unnamed patient who showed up at the CVS that day.
“Dr. Puderbaugh wrote no less than 12 prescriptions to Patient 1 for other than a medically or lawful purpose, in that Dr. Puderbaugh wrote the prescriptions... for Patient 1 to fill and then give the pills to Dr. Puderbaugh,” the board’s order said.
The prescriptions he was writing will soon be restricted at CVS stores, which recently announced that it will limit patients new to opioids to a seven-day supply, starting in February.
Puderbaugh was practicing in Missouri with a Kansas medical license under federal rules that allow doctors with a license in any state to practice at any VA, military or Indian Health Service facility throughout the United States. He did not return a message left at his St. Joseph home and Thomas Theis, the Topeka attorney who represented him before the board, did not return a phone message or an email.
A spokesman for the VA said only that Puderbaugh “retired in lieu of being fired from the VA on June 1, 2016.”
Based on national drug rehabilitation data, 10 to 15 percent of doctors abuse drugs or alcohol. That rate is the same or slightly higher than the general public. The percentages are similar for nurses, according to the American Nurses Association. Studies have shown higher rates among pharmacists (18 to 21 percent) and certain medical specialties like anesthesiology, though other studies have called those results into question.
Physician opioid abuse is something Randall Williams, the director of the Missouri Department of Health and Senior Services, has said his agency will be looking out for as Gov. Eric Greitens’ administration rolls out the state’s first prescription drug monitoring program.
Williams has said the Missouri Board of Registration for the Healing Arts’ 58 total disciplinary actions against doctors last year may be low. Williams, who came to the administration from North Carolina, said that 20 percent of the medical board’s 180 disciplinary actions in that state last year were related to doctors misusing, abusing or diverting prescription drugs.
Keith Berge, an anesthesiologist at the Mayo Clinic, said it’s something his health system has confronted head on.
Mayo recognized a pattern of anesthesia workers ending up in treatment for addiction to fentanyl, a highly concentrated opioid, more than a decade ago. Then in 2008, the health system was rocked by scandal when a catheterization lab nurse was caught stealing patients’ fentanyl and replacing it with saline.
Mayo started an internal Drug Diversion Intervention and Response Team to help spot doctors abusing drugs early and get them help.
Berge has served as chairman of Mayo’s Medication Diversion Prevention Committee and has also been on Minnesota’s medical licensing board. He said that in most states doctors can’t write prescriptions for themselves and writing prescriptions for controlled substances like opioids to family members would raise red flags. But writing a prescription to someone else and using them to get the pills, like Puderbaugh, is certainly not unheard of.
“There are any number of stories,” Berge said. “Sometimes it’s splitting the pills and somebody usually is getting something in return. It’s illegal behavior.”
But Berge said physician addiction is a small part of the overall national opioid epidemic and misuse by patients is a much bigger problem.
Simone Cummings, a professor at Webster University in St. Louis has studied physician misuse of prescription drugs. Her research showed that there’s generally four ways for doctors to get hooked on medications: stealing from office or hospital inventories, taking medication samples, misusing a valid prescription from their personal physician, or defrauding patients by using them or their identities to get pills.
While troubling, Cummings also said physician abuse is not the driving force behind the opioid epidemic.
Doctors generally practice in groups, she said, and it’s hard for them to get away with abusing painkillers for very long. Whether they’re stealing fentanyl from hospital stock or writing fraudulent prescriptions for oxycodone, someone is going to notice, like the CVS staff did in Puderbaugh’s case.
“Ultimately, they always get caught,” said Cummings, the dean of Webster’s business school. “Unlike patients, who can go on and on and on, without anyone having the opportunity to find out they’re misusing prescription drugs.”