BECKLEY — A 16-seater van rumbles down an Interstate highway, bound for the sunny skies of Florida, but this is no recreational trip.

Behind the wheel is a drug dealer, and his riders are scouting the pain clinics and pharmacies in the Sunshine State to buy up massive supplies of narcotic painkillers.

Back in West Virginia, the dealer peddles the booty for $80,000, and enjoys a healthy profit, after sharing some of the proceeds with the “patients” who made the two-way trip.

“Just imagine,” says Dr. M.K. Hasan, a Beckley psychiatrist, certified in this country, Canada and England, “in 2009, there were 128 million prescriptions for hydrocodone written in the United States.”

Patients easily get multiple prescriptions for painkillers and other medications, and most of them are selling them in the drug subculture, he says. Others simply have become hooked on such medications and get all the prescriptions they want to feed a sudden drug habit.

A patient once came to Dr. Hasan after getting a narcotic pain medicine from another physician.

“And what was he doing with it?” the doctor said.

“I don’t use it for pain,” he quoted the man as saying. “I use it for the house payment and the car payment.”

In recent years, the practice has come to be known as “doctor shopping,” and Hasan says the situation clearly is out of hand.

“It’s becoming an epidemic,” he said.

“It’s nationwide. And southern West Virginia is one of the most notorious in that respect.”

So prevalent is the problem of misuse and abuse of drugs that the road to Florida has been labeled the “OxyContin Highway” by some who are alarmed.

One highway alone in Florida, Hasan says, boasts some 200 pain clinics, where dealers and drug abusers can shop for pills as easily as buying candy in a store.

Hasan sadly blames members of his own profession for about 50 percent of the problem.

“Doctors are greedy,” he said. “They charge $300 to $400 per person per visit. It happens here, of course.”

One of Hasan’s patients was a 15-year-old basketball player who went to an emergency room and right off the bat, a doctor prescribed Lortab.

“The doctor should have tried a non-narcotic first,” he said.

“The doctor gave him medicines too fast. In any county in the country, a small group of physicians are responsible for a lot of these things.”

Tobacco, alcohol and marijuana have been the normal avenues of abuse for adolescents, but older Americans have turned to pharmaceuticals for recreation, and profits.

Across the land, some 14 percent of adults have reported the use of pain killers for nonmedical purposes, Hasan said.

Hasan says Congress in the past understandably tried to loosen the rules on pain management, but such actions have had the unwanted effect of spawning a black market for prescription opiates bearing a higher street value than all other drugs, save cocaine.

In an interview, Hasan showed deep concern over the fact that some in his profession simply dispense pills at will, knowing they aren’t being used for their intended purpose. Nearly half of all emergency room visits result from prescription drug abuse involving opioid-related medicine, or for a combination of illicit substances, alcohol among them.

In only four years, ending in 2008, opioid-related ER visits climbed 126 percent. From 1996 to 2006, the numbers shot from 16,605 to 74,750.

“In West Virginia,” he said, “this trend especially has been severe.

“During the same 10-year period, nonheroin opioid treatments soared in the Mountain State from two treatments per every 100,000 to 78 in every 100,000. Currently, West Virginia has the third highest nonheroin opioid treatment rate in the nation.”

Hasan feels most doctors are acting responsibly, but some indiscriminately issue opioid prescriptions, fueling the problem.

As an outspoken member of the West Virginia Board of Medicine, he is pushing a number of reforms and seeking help from the board and the Legislature in the upcoming session in a determined effort to reverse the trend of addiction and illegal use of narcotics.

For starters, he wants doctors to use a pharmacy profile kept on patients to see how much medicine has been used by patients, and the sources of the prescriptions.

“They’re not required to put methadone on the pharmacy profile,” he said.

“They dispense the medicine and nobody knows how much they give, who they give it to. This is not in the profile. It should be mandated that methadone should be on the pharmacy profile.”

A second front on which to assault the problem is the old supply-and-demand issue.

“We can control to some extent the physician supply, which is the biggest problem,” Hasan said.

“Demand also can be controlled by education and increasing the co-pay.”

Which leads to a third issue Hasan raised: Requiring a co-pay in advance would help with any drug prescribed, but especially with narcotics. After three months of treatment, if the patient still wants a prescription, the medicine should be pre-authorized through Medicaid, or private insurance, he feels.

“Another thing that needs to be looked into, if a guy goes to a judge — and I’ve talked to judges — the judge will know if your drug screen is negative,” he said.

“It’s not there. The patient is not taking it. He’s selling it. He should not only confront the patient but also write that doctor a letter, and tell him, ‘I saw this patient in jail, and the screen was negative.’”

Hasan says the federal Drug Enforcement Agency needs to play a role, as well, with a requirement to monitor all pharmacies to see which doctors are prescribing too many drugs.

A new horizon has surfaced of late in the drug culture, thanks to a drug known as suboxone used to treat addicts, taking the place of methodone.

“What happens is, they replace street drugs with these,” Hasan said.

“It’s easy to get. They go to a doctor’s office and get the medication. It’s cheaper. “

An initial visit might cost the patient $400, but follow-ups would run around $100.

“You’re talking about a cash cow for the physicians,” he said.

Hasan routinely treats patients at Southern Regional Jail outside Beckley, and says three-fourths of the ones he sees are there for drug-related reasons.

A number of doctors often pass up alternatives to narcotics, such as psycho-social and behavioral techniques, as well as non-addictive adjunctive medicines to lower the reliance on opioids.

“The result has created a culture of iatrogenic drug addiction, and the offending providers are ascribed as being ‘legalized drug pushers,’” he said.

“It is our intention to propose pragmatic changes to physician practices to address this ever-growing problem. The public should demand that physicians be responsible for their behavior. And not only physicians. Society as a whole needs to come in.”

— E-mail: mannix@register-herald.com