This story, part of a joint project by Oklahoma Watch and The Oklahoman, is by Andrew Knittle and Phillip O’Connor of The Oklahoman and Warren Vieth of Oklahoma Watch.
In August, when former physician William Valuck pleaded guilty to murder for the prescription drug overdose deaths of eight patients, the owner of an Oklahoma City pain clinic where Valuck plied his illicit trade was never mentioned in the courtroom.
Patrick A. Reynolds, the owner of Vista Medical Center, is not a doctor. His primary business, he has said, is real estate.
Reynolds, 69, of south Oklahoma City, is one of at least several Oklahoma pain clinic owners who hold no medical license.
Public officials and experts in the field say allowing non-physician ownership of clinics makes them more difficult to regulate and helps explain why Oklahoma has among the highest prescription drug abuse and overdose death rates in the country.
“To me, one of the most important things is who gets to own these clinics,” said Sandra LaVenue, deputy general counsel of the Oklahoma Bureau of Narcotics and Dangerous Drugs Control. “The clinics that end up in trouble tend to have ownership that is separated from the primary physician … Essentially, what they’re trying to do is separate the money from the prescribing.”
Valuck wasn’t the first person who worked at Vista to run afoul of authorities. At least four other medical professionals who worked at Reynolds’ clinic have been disciplined for overprescribing in Oklahoma or other states.
Three of those five have been linked to the deaths of at least 20 patients from prescription drug overdoses.
Neither Reynolds nor his lawyer responded to interview requests.
Several states have adopted laws increasing oversight of pain clinic operations, including bans on non-doctor owners. They say the laws have helped reduce the number of people dying from overdoses.
Narcotics bureau officials helped draft such a measure for Oklahoma. But they backed off earlier this year under pressure from medical industry lobbyists and regulation-wary lawmakers, officials said. They plan to test the waters again in 2015.
Fueling an Epidemic
Pain clinics dispense highly addictive narcotic drugs such as morphine, oxycodone, hydrocodone, methadone, fentanyl, diazepam (Valium) and alprazolam (Xanax). Those seven drugs account for the majority of prescription drug overdose deaths that in recent years have driven state officials to pursue tougher monitoring, saying the state faces a crisis. Last year, more than 800 Oklahomans, or on average about two a day, died of overdoses from all drugs — more than in car wrecks.
Several authorities interviewed by The Oklahoman and Oklahoma Watch said they believe most doctors specializing in pain management are conscientious practitioners who try to ensure that their patients are not overusing narcotic medications.
The problem has accelerated in recent decades because of a movement within the medical community to dispense opiate drugs more aggressively to treat chronic pain patients instead of reserving the highly addictive medications for terminal patients experiencing extreme pain.
These authorities said they are convinced most pain management clinics are operating responsibly. But the actions of a few have contributed to the state’s prescription drug abuse crisis.
Drug authorities said their goal is to reduce overprescribing without deterring good doctors from providing compassionate care to tens of thousands of Oklahomans with back injuries and other chronic pain conditions.
Addressing the problem of non-doctor-owned pain clinics is near the top of their priority list.
A Powerful Tool
Prescription drug abuse and overdose deaths began to spiral upward following the introduction of new narcotic painkillers such as OxyContin in the 1990s. In recent years, nine states have enacted comprehensive laws designed to increase oversight of and punish abuses by “pill mills.”
Florida was among the trailblazers. In 2010, 2011 and 2012, the state took several steps to crack down on rampant overprescribing at clinics. One of the key measures was a 2010 law requiring pain clinics to register with the state and restricting ownership by anyone other than a licensed physician, group of licensed physicians or licensed health care clinic.
Before the changes, Florida was the national epicenter of prescription painkiller abuse. Overdose deaths increased 61 percent from 2003 to 2009. By 2010, the state was home to 98 of the 100 U.S. physicians who dispensed the highest quantities of oxycodone directly from their offices, according to the Centers for Disease Control and Prevention.
Following the enactment of its new pain-clinic restrictions and a series of enforcement raids across the state, more than 250 pain clinics were shut down, the CDC reported. Prescription drug overdose deaths fell by 23 percent. Deaths caused by oxycodone plunged by 52 percent.
“They’ve clearly cut down on the number of pill mills,” said Sarah Kelsey, CEO of the National Alliance for Model State Drug Laws in Charlottesville, Va. “There are fewer pills on the market, fewer doctors overprescribing.”
Other states that have enacted broad pain clinic regulation acts are Georgia, Kentucky, Louisiana, Mississippi, Ohio, Tennessee, Texas and West Virginia, according to the alliance.
“Certain components of pain clinic laws are an important part of a comprehensive approach,” Kelsey said. “Ownership is certainly a big one. It should be owned by a physician licensed to prescribe controlled substances.”