The Register-Herald, Beckley, West Virginia

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May 28, 2013

Local physician the top hydrocodone prescriber for Medicare patients in W.Va

BECKLEY — A Beckley and Charleston-based neurologist has been listed as the state’s No. 1 prescriber of hydrocodone acetaminophen to Medicare Part D participants, according to data recently published by ProPublica, a web-based nonprofit news organization.

Dr. Iraj Derakhshan in 2010 had 609 — or 94 percent — Medicare Part D patients with at least one narcotics prescription. However, although he is the top prescriber in the state of hydrocodone, a drug that carries a criminal penalty if it’s possessed without a prescription or obtained from an unlicensed individual, Derakhshan says the pain medication is also the No. 1 prescribed pain medication in the United States.

The average percentage of hydrocodone-prescribed patients for most doctors is 25 percent, the ProPublica data says. Derakhshan argues, though, that other doctors have become “scared” to write pain medication because of strict regulation and stigmas. Most of his patients are referrals, he added.

“Just because I write pain medication does not make me a bad person,” Derakhshan said. “People come to me for help. I see nothing wrong with relieving pain.”

More recently, pain medication has become a political issue, putting fear in doctors to prescribe it to those who need the medication. Because it is becoming more difficult for those in pain to legally obtain the medication, people realize they can make a profit selling some of their pain medication to others — creating a high-priced black market, Derakhshan said. He likened the market for pain medication to that of the market for alcohol during prohibition. Because people could not get alcohol legally, “gangsters” were able to sell it and make large profits.

ProPublica, which obtained its information from Medicare Part D under the Freedom of Information Act, says that the hydrocodone prescribed by Derakhshan in 2010 has a retail cost of $1.3 million with the average prescription price being $118 each.

Derakhshan said that his patients sign contracts agreeing that they will not sell their pain medication and if he hears or is told of a patient doing so, he dismisses that patient.

Of Derakhshan’s Medi-care Part D patients prescribed narcotics, 13 percent are 65 or older. The average is 66 percent 65 and older. Derakhshan explained many of his patients have joint pain and migraines, and many have been injured working in the southern West Virginia coal mines. He said it is human nature to seek relief from pain and it is “inhumane” to prevent them from having access to medication that can ease that.

Hydrocodone brand names are Anexsia, Ceta Plus, Co-Gesic, Dolorex Forte, Hycet, Lorcet, Lorcet 10/650, Lorcet Plus, Lortab, Lortab 10/500, Lortab 5/500, Lortab 7.5/500, Maxidone, Norco, Stagesic, Theracodophen-650, Theracodophen-Low-90, Vicodin, Vicodin ES, Vicodin HP, Xodol 5/300, Xodol 7.5/300 and Zydone. It is a narcotic and a schedule III controlled substance.

ProPublica’s examination of Part D data from 2007 through 2010 showed that, in many cases, Medicare failed to act against providers who have been suspended or disciplined by other regulatory authorities.

Doctors barred by state Medicaid programs for questionable prescribing remain able to dole out the same drugs under Medicare. So can dozens of practitioners who have been criminally charged or convicted for problem prescribing, or who have been disciplined by state medical boards, ProPublica reports.

Although Derakhshan practices locally, he was ranked first in the state for prescriptions for hydrocodone acetaminophen only. Other doctors within the state’s borders have been ranked as top prescribers for oxycodone and other regulated narcotics.

Derakhshan says it is “extremely rare” for those under a doctor’s care, who are using the pain medication as prescribed, to develop an addiction. It is those who are taking the medication incorrectly who become addicted, he added. Furthermore, over-the-counter pain medication causes more fatalities because of gastrological bleeding than prescribed medication, Derakhshan said.

The data ProPublica analyzed was from 2007 through 2010 and it is the first time Medicare has released prescribing information with provider identities, ProPublica reports.

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