Despite the very clear opioid epidemic that is happening in our country right now, there are still many people out there who are profiting off of the market, both legally and illegally.
For one Rhode Island doctor of pain management, the curtains came to a close this past week when he pled guilty to receiving kickbacks from a pharmaceutical company for prescribing the highly addictive Fentanyl spray.
The doctor pleaded guilty to one count each of healthcare fraud and kickback conspiracy and is facing a maximum of 15 years in prison.
What is Fentanyl Spray?
According to the website of the pharmaceutical company who creates Fentanyl spray or Subsys, is a single-use spray device that delivers 2-3 drops of fentanyl under the tongue. It is a fast-acting opioid that is intended for cancer patients aged 18 years or older, who are already opioid-tolerant.
The prescription is a high-powered opioid that is only intended to treat breakthrough (pain that isn’t relieved by their current opioid medications) cancer pain. It is extremely potent and extremely addictive.
The company describes on their website that in order to be “opioid tolerant” enough to qualify for the fentanyl spray, they must already be taking “at least 60 mg of oral morphine daily or an equianalgesic dose of another opioid daily for a week or longer.”
The very first warning listed on the website is,
“WARNING: LIFE-THREATENING RESPIRATORY DEPRESSION; ACCIDENTAL INGESTION; CYTOCHROME P450 3A4 INTERACTION; CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS; RISK OF MEDICATION ERRORS; ADDICTION, ABUSE, AND MISUSE; REMS and NEONATAL OPIOID WITHDRAWAL SYNDROME”
The Legal Implications
Just about everyone in the nation is aware of the current opioid epidemic, and the number of lives we are losing daily to addiction and accidental overdose. It has shown no age requirements, as there are a very high number of middle-aged and elderly overdoses due to prescription pain medications, especially in conjunction with any other benzodiazepines or sleep medications that are widely prescribed.
That being said, it has been pointed out very clearly to medical professionals, to limit or even to not prescribe opioids, unless it is absolutely necessary. Many states have even created a database that doctors use to input the information of patients who are asking for or receiving opioid medications, to ensure that those people are not receiving multiple prescriptions from multiple doctors.
So it is safe to say that this doctor knew exactly what he was doing, and the legal implications of it.
Dr. Jerrold Rosenberg
Dr. Rosenberg admitted in court last Wednesday that he prescribed Subsys (Fentanyl Spray) to people whom he knew did not have cancer, and then falsified their medical records so insurance companies would pay for it.
The company whom he received kickbacks from, Insys, has stated that they take responsibility for the actions of those who were involved, and it has been discovered that Rosenberg’s son worked for the company from 2012 to 2013.
In total, Rosenberg reported receiving over $180,000 in kickbacks from Insys for the prescription of Fentanyl Spray. His indictment reports him even refusing to change the prescription for his patients that reported having debilitating side effects or a desire to stop using the medication.
Dr. Rosenberg is reported being “far and away the biggest prescriber of the Fentanyl Spray in Rhode Island, and even one of the top prescribers in the nation.”
How This Happened
After a sales representative from Insys pleaded guilty about her involvement of offering kickbacks, she explained the process by which she recruited doctors, physicians, and even APRN’s to prescribing the highly addictive prescription.
These medical practitioners were paid to participate in “Speaker Programs” which were typically held in high-end restaurants, to gather licensed health professionals and educate them about the drug Subsys. “In truth, the events were usually just a gathering of friends and co-workers, most of whom did not have the ability to prescribe Subsys, and no educational component took place. “Speakers were paid a fee that ranged from $1,000 to several thousand dollars for attending these dinners. At times, the sign-in sheets for the speaker Programs were forged so as to make it appear that the programs had an appropriate audience of healthcare professionals.” – Natalie Levine, previous Insys sales representative.
Medicare Plan B authorized payment for the Fentanyl Spray from three major medical practitioners from the Speaker Programs, resulting in a loss of approximately $4.5 million.
Trump Administration’s Move to Counteract this Fraud
In his statement to the public last week, Trump acknowledged that this is a National Health Emergency, and that plans were being put into place to stop the opioid epidemic. The President, while not requesting any additional funding to combat the issue, did state that his plan would include a requirement for all FEDERALLY employed prescribers be trained in safe practices for opioid prescriptions, as well as a federal initiative to develop non-addictive painkillers.
Aside from that, his main goal is to increase, “really tough, really big, really great advertising” as an attempt to stop people from using drugs in the first place.
Long Story Short
The real issue here is the pharmaceutical companies and the amount of sway that they have in Congress and throughout medical centers around the country. Not to mention the health insurance industry and the lackadaisical attitude it has about okaying payouts for countless prescriptions that many of the users most likely don’t even need. It wouldn’t be a surprise if many more medical professionals came forward or were found guilty of engaging in kickbacks and illegal activity involving prescribing and insurance fraud. For those of us who are recovering from an addiction, or who have children or loved ones suffering from substance abuse, this could all mean a big change in the future towards available treatment.